April 19, 2023 – Florida’s healthcare system is about to see a big change. On April 11, 2023, the state’s Agency for Health Care Administration (AHCA) shared its Medicaid Managed Care Invitation to Negotiate (ITN). This important step will help improve how healthcare services are provided under the Statewide Medicaid Managed Care (SMMC) program.

The ITN is looking for well-managed care plans that can give good healthcare services to people in Florida who use Medicaid. The state wants to work with organizations that focus on helping patients, use new ideas, and make the quality of care better for everyone using Medicaid in Florida.

By releasing the ITN, Florida wants to make its Medicaid managed care system better by making it more competitive. AHCA will choose health plans that show they can offer good services, take good care of patients, and work efficiently. The groups that are chosen will have to provide long-term care, managed medical help, and special plans for Medicaid users across the state.

The ITN talks about several important things, including:

1. Supporting New Ideas: The ITN wants managed care organizations to suggest new ways of giving care. This might include using telehealth, coordinating care, and looking at data. These new ideas should help improve patient health and save money for the Medicaid program.
2. Focusing on Quality: AHCA wants to work with health plans that care about making things better. The ITN lists specific ways to measure quality, like reducing the number of people who have to go back to the hospital, helping people see primary care doctors, and making sure people can get mental health services quickly.
3. Looking at Social Factors: The ITN understands that things like housing, transportation, and food can affect a person’s health. It asks managed care organizations to think about these factors and find ways to improve health outcomes for Medicaid users.
4. Building Stronger Networks: The ITN says health plans need to create and keep strong networks of providers. This will make sure that Medicaid users have access to all the services they need, like primary care doctors, specialists, and mental health services.
5. Being Accountable: To be open and responsible, the ITN says that health plans must report on how well they are doing. This will let AHCA keep an eye on how managed care organizations are doing and make sure they are meeting their goals and providing good quality care.

With the ITN, Florida is taking big steps to make the SMMC program better and help improve the health of people using Medicaid. By supporting new ideas, focusing on quality, and looking at social factors, Florida will change how healthcare is provided for people who need help the most.

Managed care organizations that want to be part of the SMMC program have until June 9, 2023, to send in their proposals. After looking at all the proposals, AHCA plans to announce the chosen health plans in October 2023. The new SMMC contracts will start on July 1, 2024, and will bring better healthcare services to Florida’s Medicaid users.

To read the ITN in its entirety, click here.