J.C.S. v. Agency for Health Care Administration

ALTENBERND, Judge.

J.C.S. and her husband, J.S.S., appeal a final administrative order that addresses J.C.S.’s health maintenance organization’s failure to provide plan benefits within the contractual time requirements for eligible Medicaid recipients. The relevant contract was entered into between the State of Florida, Agency for Health Care Administration (“AHCA”), and J.C.S.’s HMO, Wellcare of Florida, Inc., d/b/a Staywell Health Plan of Florida (“Staywell”). We affirm.

In pertinent part, the hearing officer found that Staywell had ultimately secured certain appointments for J.C.S. but that…