TALLAHASSEE, Fla. – Two managed-care plans are battling in Leon County circuit court over the future treatment of 1,500 people in South Florida with HIV and AIDS and tens of millions of dollars a year in Medicaid payments.
The AIDS Healthcare Foundation’s current five-year Medicaid contracts in Broward, Miami-Dade and Monroe counties expire Feb. 28. It has asked a Leon County circuit judge to halt the movement of Medicaid patients from its plan to competitor Simply Healthcare.
Holly Prince, a regional vice president for Simply Healthcare, testified during a court hearing Tuesday that her plan could lose more than $32 million a year in Medicaid revenue if an injunction request by the AIDS Healthcare Foundation is granted.
After more than three hours of arguments, Circuit Judge Charles Dodson did not rule. Instead, he directed attorneys to submit recommended orders by 5 p.m. Wednesday.
AIDS Healthcare Foundation attorney Brian Newman told Dodson that an injunction halting the transfer was necessary because Medicaid patients in Southeast Florida, ground zero in the state for HIV infection, would be irreparably harmed if they were forced to switch primary health-care providers.
The suit includes as plaintiffs Medicaid patients K.H. and D.T., who had been treated by foundation doctors and were being forced to switch plans. But attorneys for the state Agency for Health Care Administration and Simply Healthcare noted that K.H. was no longer a member of the AIDS Healthcare Foundation and that some of D.T.’s physicians were included in Simply Healthcare’s network.
Simply Healthcare attorney Kevin Reck told Dodson that the state and Simply have taken steps to ensure a smooth transfer of 1,500-plus patients and that granting an injunction would be even more disruptive.
Additionally, Reck argued that the foundation failed to meet legal prerequisites for a temporary injunction, which include, among other things, showing irreparable harm. Reck argued that financial impact does not constitute irreparable harm.
Also, Reck argued that the AIDS Healthcare Foundation made a similar argument before the 1st District Court of Appeal and that it was rejected.
This is a “transparent attempt at a second bite of the apple,” Reck told Dodson.
The lawsuit in circuit court is part of a series of legal battles involving the AIDS Healthcare Foundation, Simply Healthcare and the Agency for Health Care Administration over the new Medicaid contracts.
The AIDS Healthcare Foundation has filed a lawsuit in Miami-Dade County asking that a judge ban Simply Healthcare from contacting AIDS Healthcare Foundation members who are enrolled in both Medicaid and Medicare.
The foundation also challenged the Agency for Health Care Administration in administrative court and received backing from a judge. But the agency rejected the judge’s ruling. The case is now on appeal.
Attorneys for the AIDS Healthcare Foundation argued that Simply Healthcare should be banned from serving the patients because the administrative case is on appeal --- and Simply Healthcare was involved in the litigation.
But the state argued that Simply Healthcare was an intervenor, not a named party, in the suit and that therefore a ban shouldn’t apply.
Florida lawmakers in 2011 required that almost all Medicaid beneficiaries enroll in managed-care plans, with contracts divvied up in 11 regions of the state. The state went through a lengthy process during the past two years to evaluate proposals from managed-care plans and issue new contracts. That resulted in the Agency for Health Care Administration entering a multi-year contract with Simply Healthcare to provide care to people with HIV and AIDS.