ImagineCare drops Medicaid managed care challenge

ImagineCare has filed a notice with the Agency for Health Care Administration (AHCA) of its intent to voluntarily withdraw its administrative challenge to state-level Medicaid managed care procurement.

ImagineCare was one of three rejected plans seeking to challenge the latest round of Medicaid managed care contract awards in state administrative court. ImagineCare also filed a challenge in Leon County circuit court, though the plan is expected to drop that challenge as well.

AmeriHealth Caritas and Sentara, the other two Medicaid managed care plans that notified the state of their intent to challenge the takeover, appear to be moving forward with their challenges.

Florida requires that most of its Medicaid enrollees, from the young to the elderly, receive their health care through managed care plans. In 2023, AHCA published its Medicaid Managed Care ITN to renegotiate new multi-year contracts worth tens of billions of dollars with the winning bidders.

The state announced in April its intention to award new contracts with Florida Community Care; Humana Medical Plan; Simply Healthcare Plans; South Florida Community Care Network, doing business as Community Care Plan; and Sunshine State Health Plan.

Seven companies notified the state of their plans to challenge the decision. Some objected because they were not awarded contracts in the regions they were competing for, while others protested because they had been excluded entirely.

After months of negotiations with some of the plans, AHCA announced in July additional contract awards, which resolved four of the seven disputes, leaving three others pending.

ImagineCare is a type of health plan known as a provider service network (PSN). ImagineCare, a joint venture of Spark Pediatrics and CareSource, does not currently have a Medicaid managed care contract in Florida. Sentara, also a PSN, also does not currently have any statewide Medicaid managed care contracts. AmeriHealth Caritas has Medicaid managed care contracts for two regions in the state.

Existing contracts are scheduled to expire at the end of the year.

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