Medicaid

State to move forward with controversial $1 billion Medicaid contract

 

Herald/Times Tallahassee bureau

Despite a judge’s recommendation, the state will not revoke a $1 billion contract awarded to the Miami-based healthcare company Prestige Health Choice.

The contract, which will enable Prestige to provide Medicaid coverage in Miami-Dade and Monroe counties, came under fire last year, when a competing firm raised questions about Prestige’s ownership.

In a non-binding opinion last month, Administrative Law Judge John Van Laningham said Prestige should not have not qualified for the contract because healthcare providers control less than 50 percent of the company.

He urged the state Agency for Health Care Administration to rescind the award.

But in a final response submitted late Friday, AHCA attorneys called Van Laningham’s calculation and his legal interpretation “erroneous.”As a result, the contract will stand.

Florida is in the middle of a statewide push to transfer about 3 million Medicaid participants to private managed-care companies.The companies had to compete for contracts last year.

Prestige was selected to provide services in Miami-Dade and Monroe, as well as seven other regions across the state. The company that filed the challenge, Hallandale Beach-based Care Access PSN, said it was disappointed see Van Laningham‘s order overturned.

“The rejection by the agency of this independent review of the clear legal and factual matters presented sets a bad precedent for the independent, non-political review of such an important project for the Medicaid population in the state of Florida,” company officials said in a statement.

In the challenge, Care Access alleged that Prestige is controlled by the insurance company Florida Blue.

Van Laningham acknowledged that a Florida-Blue affiliated company owns 40 percent of Prestige’s shares and has an option to buy the remaining 60 percent. But he stopped short of supporting Care Access’s claim that the company had taken over Prestige.

Care Access plans to appeal to the the First District Court of Appeal in Tallahassee.

Contact Kathleen McGrory at kmcgrory@miamiherald.com.

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