Centene Medicaid Settlements: Why Are Georgia and Florida Delayed?

Understanding the Prolonged Centene Negotiations with States

The saga of Centene Corp., a leading health insurer, and its settlement negotiations with various states continues to unfold over three years after it settled allegations of overcharging Medicaid programs. With over $1 billion in settlements agreed upon across 20 states, many observers are left wondering why two states—Georgia and Florida—remain at an impasse. As a leading company in the healthcare sector with $163 billion in revenue reported in 2024, Centene has faced criticism, yet it has admitted no wrongdoing in its settlements.

Unpacking the Holdouts: Georgia and Florida

Georgia’s delayed resolution in settling with Centene is noteworthy. Since 2019, when Gov. Brian Kemp’s administration hired law firm Liston & Deas to probe into state pharmacy benefit operations, there has been a conspicuous silence concerning negotiations, raising questions about their efficiency. Meanwhile, Florida mirrors this lack of transparency as state officials have withheld updates on their case against Centene, instead directing queries to the Florida Agency for Health Care Administration, which has also remained tight-lipped.

Impact on Medicaid Recipients and Local Economies

The delay in settlements potentially affects crucial funding for Medicaid programs in these states, impacting not just the patients who rely on these services but also the local economies. Experts suggest that a settlement with Georgia could yield significant funding, reminiscent of California's historic $215 million agreement or Ohio's $88 million settlement. Lawmakers, advocates, and local officials urge for these negotiations to be expedited to benefit those underserved in the Medicaid landscape.

Calls for Greater Accountability in Pharmacy Benefit Management

Across the country, the practices of Pharmacy Benefit Managers (PBMs) like Centene have come under scrutiny amid rising healthcare costs. Legislators are pushing for robust policy measures to reign in the excessive power of these entities in managing drug pricing, which can translate into higher out-of-pocket costs for patients. Calls from state officials to prosecute Centene rigorously echo a larger demand from constituents for more accountability among providers.

Future Outlook: A Shift in Healthcare Governance

As time passes, the stakes heighten. Georgia’s Attorney General Chris Carr has close ties to Centene through campaign contributions, leading some to speculate about the influences at play in these negotiation stalemates. With elections approaching, there is a pressing need for political leaders in both Georgia and Florida to claw back public trust and prioritize resolutions that will ultimately serve the interests of the public, not just the bottom lines of health insurers. The upcoming months will likely determine whether these delays will conclude with settlements or if further complexities will hinder progress further.