AGENDA REPORT
DATE: September 9, 2024
TO: City Commission
FROM: Bill McDaniel, City Manager
SUBJECT: Intergovernmental Transfer Program with the State of Florida
for Medicaid Managed Care Patients
EXECUTIVE SUMMARY:
Plant City Fire Rescue (PCFR) transports approximately 4,000 patients annually to local hospital emergency rooms, generating approximately $1,100,000 per year from Medicare, Medicaid, private commercial insurance companies and individual payers. The transport services are billed and collected by a private contractor, Digitech. Of the total patients transported to the hospital each year, 11% are covered by Medicaid. The average reimbursement for the services per Medicaid patient is lower than payments from Medicare and patients with private health insurance.
In 2016, the State of Florida authorized creation of a Certified Public Expenditure (CPE) program to provide supplemental payments to publicly owned and operated emergency medical transportation providers for Medicaid fee-for-service patients transported to local hospitals. This program leverages approximately 60% of Federal Medicaid reimbursements by allowing the State to certify the public expenditure incurred by the City as the State share. Since the inception of the CPE program in 2017, the City has received supplemental payments totaling $465,706.85 to close the gap between cost incurred and revenue received for each Medicaid patient transport.
In 2019, the State Legislature authorized expansion of the program to include the Medicaid Managed Care population. In order to leverage the 60% federal share, the City will provide an appropriation of $174,984.09 through an intergovernmental transfer (IGT) to the Agency for Health Care Adminstration (AHCA). In return, six Medicaid Managed Care providers within the Tampa Bay region will reimburse the City $233,570.88 for a net gross return of $58,586.79.
The City has executed agreements with six Medicaid Managed Care providers: Aetna Better Health of Florida, Inc., Florida Community Care, LLC, Humana Medical Plan, Inc., Simply Healthcare Plans, Inc., Sunshine State Health Plan, Inc., and United Health Care of Florida, Inc., that are in effect through September 30, 2024 dependant on an active agreement with AHCA.
The City participated in fiscal year 2024 State of Florida Medicaid Managed Care program via an agreement with the Agency for Health Care Administration (AHCA).
RECOMMENDATION:
That the City Commission authorize an inter-governmental transfer (IGT) program between the City and the State of Florida to provide a supplemental payment program for Medicaid Managed Care patients and authorize the City Manager to execute all required documents, including Medicaid Managed Care provider and the Agency for Health Care Administration (AHCA) agreements.
FISCAL IMPACT:
Funds from the Medicaid Managed Care providers will be deposited in the General Fund, Org # 00132705, Obj # 331262 - IGT Medicaid Managed Care Grant.
Prepared by: Jeremy Sidlauskas, Fire Chief