Senate panel passes bill forcing Medicaid managed care plans to offer more after-hour appointments

Health care isn’t something that always can be scheduled during regular business hours.

There’s an effort underway in the Legislature to make sure the managed care companies that receive billions of dollars to provide care to the poor, sick and elderly remain open between 5 p.m. and 8 a.m. Monday through Friday and on the weekends.

Specifically, the bill would amend Medicaid statutes to require that at least 50% of a managed care plan’s primary care provider network offer availability to Medicaid enrollees during off hours.

The Senate Health Policy Committee passed SB 40, offered by Sen. Barbara Sharief, a Miramar Democrat.

“The goal is simple: It’s just to ensure Medicaid enrollees can see providers outside of regular business hours when families may need the care,” Sharief said Tuesday in presenting her bill. “As you know, many Medicaid recipients, especially working parents and caregivers, struggle to get appointments after 5 p.m. weekdays or on weekends, and the lack of access pushes them into the emergency room, into our more expensive modes of treatment.”

The 50% requirement is higher than what plans contractually agreed to offer earlier this year when they signed new Medicaid managed care contracts worth hundreds of billions of dollars.

Those contracts require all managed care plans statewide to require at least 40% of their participating primary care providers to offer after-hour appointments by Sept. 30, 2026.

The percentage of providers accepting after-hour appointments increases to at least 50% effective Sept. 30, 2027, for a large swath of the state — from Northwest Florida east to Jacksonville, through the so-called Florida Heartland north and west of Lake Okeechobee, and south to the Florida Keys.

Managed care plans in Medicaid Regions C and D, which includes Pasco, Hillsborough, Manatee, Polk, Hardy and Highlands counties, would be required to have 45% of their primary care providers offer after-hours access to care by Sept. 30, 2027.

The requirement doesn’t change for Medicaid managed care plans operating in Region F, which includes Sarasota, DeSoto, Charlotte, Glades Lee, Hendry and Collier counties. After-hour access requirements for managed care plans now are negotiated through contractual agreements between the Agency for Health Care Administration and the managed care plans.

The bill is supported by the Florida Association of Nurse Practitioners as well as AARP Florida.

Before the vote, committee member Sen. Rosalind Osgood, a Fort Lauderdale Democrat, thanked Sharief for her efforts.

“In my other job, I work with a lot of individuals that fall into this category, and a lot of times they’re working so they can’t meet the regular doctor’s scheduled hours. So, having opportunities to access medical care and nontraditional hours would be very beneficial,” she said.

HB 163 is the companion measure sponsored by Miami Gardens Democratic Rep. Felicia Robinson. That bill has been referred to the House Health Care Facilities & Systems Subcommittee; the House Health Care Budget Subcommittee; and the House Health & Human Services Committee. It has yet to be placed on any agenda.