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Health Plan, State Try To Settle Medicaid Dispute

George Hodan (Public Domain Pictures)

An administrative law judge Tuesday agreed to give attorneys for the state and Lighthouse Health Plan another two weeks to try to settle a dispute about a patient-assignment policy for Medicaid beneficiaries in Northwest Florida.

Lighthouse Health Plan attorney Edward Philpot told Judge Robert Telfer III that the parties are working toward an agreement, and “indications appear good that we are on the right track.”

“There are a couple of items we are working through, trying to get the language right,” Philpot, an attorney with the firm Nelson Mullins Broad and Cassel, said on a conference call.

Philpot said Hurricane Michael, which caused state offices to close for nearly a week, led to a delay. Telfer agreed to hold the case in abeyance until Nov. 7.

Attorneys for Lighthouse, a type of managed-care plan known as a provider-sponsored network, filed a petition in administrative court arguing that the patient-assignment policy helps its competitor, Humana Medical Plan, and that the policy is an improper unadopted rule.

Lighthouse is affiliated with Pensacola-based Baptist Health Care and was awarded a contract this year to provide Medicaid “managed medical assistance” services in Medicaid regions 1 and 2. Combined, the regions stretch across 18 counties in Northwest Florida.

Medicaid managed-medical assistance plans cover acute care and other traditional health services.

Humana Medical Plan also was awarded a Medicaid contract in regions 1 and 2. It was awarded a “comprehensive” contract, which means it is responsible for managed medical-assistance services as well as long-term care.

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News Service of Florida
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