Borrowing a page from its Medicaid program, Florida is offering its $3.12 billion group health insurance program to tender in nine regions of the state.
The Department of Management Services issued three invitations to trade last week announcing the need for third-party administrators to manage for its HMOs, PPOsand benefits of pharmacy.
All three ITNs have the same deadlines. Interested parties have until July 21 to submit any questions. DMS will post responses to submitted questions in a timely manner on August 9th.
Responses to the ITNs must be submitted to the DMS by September 27, in accordance with the deadlines set out in the ITNs. DMS will evaluate responses for seven weeks between early October and late November. It will trade with the highest rated answers between December 5 and May 5, 2023.
DMS wants to announce the winning vendor on May 16, 2023 and have contracts signed and in place for calendar year 2024.
Florida has a self-insured state employee health program, which means the state of Florida pays for the costs of claims. But the state hires companies to manage the network of service providers and the payments.
Legislative and Governor’s Office economists agreed earlier this year that about 170,000 current and former state employees, along with their spouses and children, are enrolled in state group health plans. in November 2021.
Economists also estimated that the state employee health insurance trust fund, which is a combination of monthly employee premiums and state taxes, to cover the employer’s share of the premium, would have a deficit of $61.8 million as at June 30, 2024.
State economists will update registration and program fees when they meet in Tallahassee on August 10.
The state is moving forward with the offer after the This session’s legislature agreed to ratify the DMS rules that divided the state into nine regions. as part of the budget process, DMS drafted the rules after the 2019 Legislative Assembly decided to allow the program to be regionally tendered and to limit the number of HMO contracts awarded in each region.
In 2011, the Legislature passed a sweeping rewrite of its Medicaid statutes that included a requirement that most beneficiaries enroll in Medicaid Managed Care Plans. The law also authorized the state to tender the Medicaid program in 11 regions and to contract with a limited number of plans in each region.
In 2013, the Medicaid managed long-term care program was launched. The Medicaid-run medical assistance program followed in 2014.
State Medicaid officials are working on a new third purchase with ITNs expected to be released before the end of the year.