TALLAHASSEE, Florida — Hope Florida will face further scrutiny this week over its relationship with the state Agency for Health Care Administration, with state lawmakers probing newly enacted requirements for Medicaid operators that include sharing patient data, incentivized participation and the transfer of $10 million last year.
The program, led by first lady Casey DeSantis, aims to connect eligible residents in need with resources in the community. Gov. Ron DeSantis asked the Legislature this year to etch Hope Florida into state law, spurring questions about the organization and how it receives and spends its funding.
Hope Florida had already partnered with the Florida Department of Children and Families, providing agency staffers to help take calls from eligible residents. The flagship initiative for Casey DeSantis, who is widely thought to be considering a run for governor next year, also received a tremendous lift from AHCA. The agency, which oversees most of the Medicaid program, has made participation in Hope Florida a contractual requirement for insurance companies that provide managed care coverage for the majority of the state’s more than 4.3 million Medicaid enrollees.
A copy of minutes from an Oct. 14 Hope Florida Foundation Board meeting obtained by POLITICO includes an item about a resolution in a longstanding dispute with AHCA that resulted in a $10 million allocation to the Hope Florida Foundation.
When asked about the managed care contracts, AHCA spokesperson Mallory McManus on Monday said the agency has the right to choose the expanded benefits for Medicaid managed care. Of the $10 million allocation, McManus said the money was part of a pre-lawsuit settlement that ended in favor of the agency.
“There was no civil action and this settlement did not require the expenditure of state funds, so no notice was required,” McManus wrote in an email. “This was a pre-suit settlement in AHCA’s favor that was directed, in part, to the direct support organization which serves a population of individuals traditionally served by AHCA.”
The AHCA contract also requires managed care contractors to share data with Hope Florida. State Senate Democratic Leader Jason Pizzo (D-Miami) on Monday asked why an organization led by the first lady would need health care data from a program with millions of enrollees.
“The grift never ends and it gets creepier,” Pizzo said during a Monday phone interview. “Why does the first lady’s organization need access to medical records?”
Bookkeeping questions were raised last week in a state House bill analysis — prompting DeSantis to fight back and accuse the chamber of operating a smear campaign against the first lady’s program, which he said has already helped more than 30,000 people. Under the contract used by AHCA to govern much of its Medicaid managed care program, Hope Florida is guaranteed to receive referrals.
The model contract found on AHCA’s website incentivizes the participation from 10 insurance companies operating the Statewide Medicaid Managed Care program, which provides HMO-style coverage to almost 3.5 million enrollees. The companies that refer the most “successful” enrollees to Hope Florida will receive more enrollees assigned by AHCA, according to the contract.
“The Agency shall leverage the SMMC program to improve certain non-medical conditions through a closed-loop referral system that ensures the Managed Care Plan is accountable and incentivized to create Hope Florida,” the contract said.
The state Medicaid program has already faced scrutiny during this year’s legislative session by the House Health Care Budget Subcommittee. The panel last month grilled AHCA after staffers lost $160 million the Legislature had set aside to fix a previous agency bookkeeping error. And AHCA will go before the same committee Wednesday to continue ongoing discussion about the managed care program. Chair Alex Andrade (R-Pensacola) said on Monday he did not want to comment on AHCA’s managed care contracts until after Wednesday’s meeting.
“I don’t want to jump to any conclusions,” Andrade said. “But there are questions that haven’t been answered yet.”
Andrade also would not answer questions about the $10 million allocation from AHCA brought up by the Hope Florida Foundation board in October.
Questions about Hope Florida have surfaced as the Legislature considers FL HB1327 (25R), which would codify the program into law. A House staff analysis about the bill prepared before a House Human Services Subcommittee meeting last week highlighted difficulties in obtaining Hope Florida audits and other records from the state Department of Children and Families. The analysis prompted Gov. DeSantis to accuse House Speaker Daniel Perez (R-Miami) of helping Democrats and feeding false information to the media.
“They’re not trying to step on the left’s throat,” DeSantis said during an event at the Governor’s Mansion last week. “They’re giving a lifeline to the Democratic Party.”
Perez defended the staff analysis as being a routine part of the legislative process, but said the House will still continue to inquire about Hope Florida’s finances.