State picks Molina Healthcare to manage care for Florida’s most medically complex children

The administration of Gov. Ron DeSantis has announced its intent to award a multibillion-dollar Medicaid managed-care contract for medically complex children to Doral-based Molina Healthcare of Florida.

The decision, announced earlier this month, is not final and can be challenged. Vendors had 72 hours following the Nov. 3 announcement to notify the state of their intent to challenge the decision.

Thereafter, statutes provide vendors an additional 10 days to file formal written protests with the state.

The Agency for Health Care Administration did not immediately say whether it had received any protest notices.

But Sunshine Health, the wholly owned subsidiary of Centene Health, won't be challenging "at this time" and attributed the decision to "concerns related to terms contained in the final version of the state's [invitation to negotiate] that we were not able to agree to."

The company did not elaborate on what those concerns were.

"Having served this program statewide, we have a deep understanding of the level of service and care the children who rely on this program need," the statement read. "In evaluating the state's proposed terms, our understanding of this population informed our consideration of multiple key factors, including whether the terms align with our mission of transforming the communities we serve, are sustainable for us as an organization, and will ultimately enable Sunshine to provide our members the quality care they deserve."

Centene is the health care company that negotiated a Medicaid settlement with the state that resulted in $10 million being sent to the nonprofit foundation associated with Hope Florida, an initiative pushed by First Lady Casey DeSantis designed to help people move off of government assistance programs.

The Hope Florida Foundation wound up sending millions to two groups that then steered money to an effort to defeat a ballot proposal on marijuana. The arrangement triggered a probe by the Florida House and has led to a grand jury investigation, according to several published reports. Centene has said previously that the Agency for Health Care Administration directed the terms of the settlement.

The state issued the invitation to negotiate the managed care program for medically complex children in December 2024. The ITN contains a section on Hope Florida and a requirement that the winning health plan coordinate with the program to help "graduate" people from Medicaid and Florida KidCare.

Rising enrollment, payments

The CMS managed-care plan is for medically complex children living in lower income households, whether they qualify for Medicaid or Florida KidCare, the state's version of the children's health insurance program.

Children enrolled in KidCare pay monthly premiums for the coverage whereas Medicaid-eligible children don't.

The new contract will expire Dec. 31, 2030, and cannot be renewed but can be extended if necessary to cover any delays during the transition to a new contract. There is no guaranteed payment; the contract notes payment is "contingent upon availability of funds."

But a review of Medicaid data shows state economists anticipate increases in the number of medically complex children enrolling in the managed-care network and hikes in the payments to the health plan for treating the children.

Florida's top economists predict enrollment in the plan will climb from an anticipated 113,171 children this year to 120,277 by June 2030. The state's monthly managed-care payments are expected to increase from about $4,555 per member per month to more than $5,400 per member per month by June 30, 2030.

Molina Healthcare of Florida is under contract for another Medicaid managed-care program to provide health care services in Miami-Dade and Monroe counties. While the CMS managed-care program caters to medically complex children, the Statewide Medicaid Managed Care Program provides services to a more traditional Medicaid population.

This report first appeared on the website of the Florida Phoenix, a nonprofit news organization dedicated to coverage of state government and politics from Tallahassee.