Patient Referrals by Medicaid Managed Care Organizations and Managed Care Plans:
HB 815 requires the Agency for Health Care Administration (AHCA) to contract for an analysis of how Medicaid managed care plans refer patients to affiliated organizations. The study must examine whether managed care plans, other than provider service networks, or their subcontractors own, control, or have profit-sharing arrangements with service providers or provider organizations that participate in the Statewide Medicaid Managed Care program.
The bill also directs the contractor to analyze the extent to which managed care plans steer patients to those affiliated providers and to compare the cost of services obtained through such referrals with the cost of services from other contracted providers. AHCA must submit the resulting report to the Governor, the Senate President, and the House Speaker by July 1, 2026, and the act would take effect July 1, 2025.
HB 815 does not directly change Medicaid eligibility, benefits, or provider payment rules; instead, it creates a new state-level reporting and oversight requirement for AHCA regarding managed care referral practices and financial relationships with affiliated providers. The bill would affect Medicaid managed care organizations, their subcontractors, affiliated provider entities, and the Statewide Medicaid Managed Care program by requiring data collection and cost comparisons that could inform future policy or enforcement actions.
Based on the available context, the bill appears to have been treated as an oversight and transparency measure rather than a controversial programmatic change. There are no recorded committee transcripts or votes showing debate, and the bill ultimately died in the Health & Human Services Committee. That suggests limited legislative momentum, but the text itself reflects a neutral-to-supportive policy approach focused on studying potential steering and cost impacts.
The main policy issue underlying the bill is whether Medicaid managed care plans may be directing patients toward affiliated providers in ways that could affect competition or increase costs. Potential points of concern include the administrative burden of data collection on managed care plans and the possibility that the analysis could be used to justify future restrictions on referral relationships. No specific opponents or supporters are identified in the available record, and no formal debate is provided.