From 2021 to 2024, Centene, the state’s largest Medicaid contractor, negotiated with the Florida Attorney General’s office and the Agency for Health Care Administration (AHCA) to settle claims that its pharmacy benefits manager did not pass on savings from prescription rebates. The deal wasn’t reached until September 2024, and the negotiations took some weird, possibly illegal turns, with $10 million never going to AHCA.
Twists & Turns
As early as July 2021, the state had a settlement agreement drafted for $67 million. See Florida 7.14.21 Working Draft.
- However, emails show that in June 2022, Gov. Ron DeSantis’s chief of staff, James Uthmeier, didn’t want to execute it. He wrote to attorney Crystal Stickle and Jason Weida, AHCA chief of staff, and several others, “As we discussed, we will not be signing the attached release at this time. We have yet to see any hard data and may prefer to go the route of litigation.”
The dollar amount of the deal didn’t change for the next two years. Then, in September 2024, emails show that AHCA was preparing for a Sept. 10 meeting with the Executive Office of the Governor (EOG). The settlement agreement brought to the Governor’s office wasn’t much different. There was no mention of the Hope Florida Foundation.
Here is the cover email regarding the draft:
From: Christopher A. Koster <Christopher.A.Koster@CENTENE.COM>
Sent: Thursday, September 5, 2024 5:56:55 PM
To: Sheeran, Andrew <Andrew.Sheeran@ahca.myflorida.com>
Subject: RE: Centene Corporation
For Settlement Purposes Only / FRE 408
Andrew,
Thanks for your time this morning. Attached, please find a version of the PBM settlement agreement that aligns with previous settlements in other jurisdictions and which has been modified for the State of Florida.
Happy to discuss at your convenience.
If possible, I’d be grateful if you could acknowledge receipt of the above document.
Best regards,
Chris Koster
Executive Vice President, Secretary and General Counsel
See FL Settlement Agreement – Centene Draft 9.5.24 230pm
But the day after meeting with the Governor’s office, on 9/11/24, a new redlined draft was circulated.
From: Sheeran, Andrew (AHCA General Counsel)
To: James Percival; John Guard. (Attorney General’s Office
Subject:RE: Centene Corporation
Date: Thursday, September 12, 2024 5:50:35 PM
FL Settlement Agreement – AHCA draft 09.12.24 545 PM.docx
Redline attached. Redline
The redline version dictates $5,000,000 going to the Hope Florida Foundation.
It adds:
- WHEREAS, Hope Florida, through The Hope Florida Foundation, Inc., serves a mission that is important to the policy goals of the State of Florida.
- The “Hope Florida Donation” has the meaning ascribed to it in Section B.2. of this Agreement.
- The settlement has $62,048,611 going to the Florida Attorney General. “In addition, the Centene Entities shall make a one-time donation to The Hope Florida Foundation, Inc., in the total aggregate amount of Five Million Dollars ($5,000,000) (“Hope Florida Donation”).”
- The Hope Florida Donation shall be paid by wire transfer to an account of The Hope Florida Foundation, Inc., in the manner to be directed in writing by the Attorney General pursuant to the Notice provisions of this Agreement.
On Sept. 13, 2024, Chief Deputy Attorney General John Guard expressed concerns.
From: John Guard
To: Sheeran, Andrew; James Percival
Subject:RE: Centene Corporation
Date: Friday, September 13, 2024 2:58:00 PM
Andrew:
I have approval to sign on behalf of the Attorney General. I think the payment section needs to be modified. Normally, the federal share is explicitly detailed in the settlement agreement, and I am not sure AHCA wants us to get the remainder of the money. If it is just going to the Legislature and GR, I can probably make it work, but I believe this is different from than I have seen in a settlement with Medicaid monies. Happy to discuss.
John
By Sept. 19, 2024, AHCA pulls out Florida’s Office of Inspector General as a party to the settlement, and the AG’s role is changed. Centene voices concerns about the removal, writing: “We would like FL OIG to continue to be explicitly listed.”
- Centene reiterated their objection later in the draft: “As stated above, we would like FL OIG to be explicitly listed – can you explain the reason for the removal? Even if this language is removed, we understand that the subsequent language including “all other states departments and divisions, agencies, bureaus, plans, and/or programs, of the State of Florida” includes FL OIG. We would expect an email exchange confirming that the parties are in agreement on this point if the explicit reference to OIG is removed.”
The payment to Hope Florida was increased to $10 million. The state’s share reduced to $57,048,611. See FL Settlement Agreement – Centene Draft 9.19.24
On Sept. 24, 2024, Guard admits the settlement differs from other states.
From: John Guard
To: Sheeran, Andrew
Date: Tuesday, September 24, 2024 9:39:00 AM
Attachments: FL Settlement Agreement – Centene Draft 9.19.24.docx
Here are the Attorney General’s comments. I get that they negotiated this in every other state
with the AG. But they are negotiating this agreement with AHCA, and it is going to have to look
slightly different.
The 9/24 draft has a new clause:
- “WHEREAS, AHCA’s pending contracts with managed care plans under the Statewide Medicaid Managed Care program contemplate an expanded role for Hope Florida in the Florida Medicaid program, pursuant to which managed care plans will be required to collaborate with Hope Florida’s Pathways to Prosperity program to enable eligible Medicaid recipients to gain education, job, and life skills to achieve independence.”
See FL Settlement Agreement – AHCA Draft 9.24.24 400 PM CLEAN.
WHAT HAPPENED NEXT
The $10 million didn’t make it to Hope Florida’s Pathways to Prosperity program.
SEPT. 27, 2024: Florida signed a $67 million settlement with Centene. The settlement was not reported to state lawmakers, as required by law. Medicaid was reimbursed for its percentage of the $67 million.
In a May 15 podcast interview, Andrade said, “We would’ve never even known about this settlement if we hadn’t gotten our hands on one set of minutes from the Hope Florida Foundation that vaguely referenced it.”
- He added, “We were the only state in the country not to put out a notice without putting out a press release about our settlement with Centene. Every other state was proud of their settlement with Centene. We were the only state that hid it from the public. It was just so blatantly glaringly inappropriate and illegal.”
OCT. 11, 2024: James Uthmeier, DeSantis’ then-chief of staff, set up a conversation with Amy Ronshausen, executive director of the nonprofit Save Our Society From Drugs, according to text messages obtained by The Associated Press. At the time, Uthmeier chaired a political committee campaigning (Keep Florida Clean) against Amendment 3 that would legalize recreational marijuana.
OCT. 13, 2024: Secure Florida’s Future, a nonprofit led by the president of the Florida Chamber of Commerce, applied to the Hope Florida Foundation for a $5 million grant. Secure Florida’s Future Chair Mark Wilson proposed a “long-term, targeted business partner recruitment strategy and public awareness campaign.”
OCT. 14, 2024: The Hope Florida Foundation board was formally notified of the $10 million donation, which amounted to more than 10 times what the charity raised the previous fiscal year, according to recently released tax documents. The board was also briefed on the $5 million grant application from Secure Florida’s Future. “This proposal has been developed in alignment with the Department and Executive Administration,” reads a copy of the meeting minutes. Meeting minutes_10.14.24
OCT. 16, 2024: The Hope Florida Foundation wired $5 million to Secure Florida’s Future, according to Joshua Hay, chair of the foundation’s board.
OCT. 17, 2024: Secure Florida’s Future donated $2 million to Keep Florida Clean, the PAC controlled by Uthmeier, according to the state’s campaign finance database. Days later, Secure Florida’s Future sent $1.75 million more.
OCT. 18, 2024: Ronshausen messaged Hope Florida Foundation attorney Jeff Aaron about a grant application, according to texts shared with AP. Aaron texted Ronshausen a copy of Secure Florida’s Future application.
- “I’d do it like that for the same amount, and let’s see what the board agrees to,” Aaron texted.
- “Just emailed it,” Ronshausen replied.
- Aaron responded: “Received! Can you send me wire instructions?”.
We posted the text messages on April 19.
OCT. 22, 2024: The Hope Florida Foundation wired $5 million to Save Our Society From Drugs, according to Hay.
OCT. 23, 2024: Save Our Society From Drugs donated $1.6 million to Keep Florida Clean, followed by $3.15 million more in the following days.
NOV. 5, 2024: The marijuana amendment was backed by a majority of voters but fell short of the 60% threshold needed to pass.
FEB. 17, 2025: DeSantis appointed Uthmeier as Florida Attorney General.
APRIL 9, 2025: In the House Health Care Budget Committee meeting, Rep. Alex Andrade engaged in a heated exchange with AHCA officials regarding the $10 million directed to the Hope Florida Foundation.
- “Instead of taking the settlement money that was paid by this large company and putting it back into the state coffers, they said, $10 million of what you owe us, just give it to the Hope Florida Foundation at DCF, which makes no sense,” Andrade said on an April 10 podcast. “It’s a completely separate agency, and no one has been able to explain why AHCA did it, why that money was necessary to go to the DSO (Direct Support Organization) for the Department of Children and Families, or what that money’s being used for.”
Andrade pointed out that the Hope Florida Foundation had never registered with the state or filed a tax return.
- “They’ve never filed a 990 with the IRS and are refusing to share with us who’s donated to them and when and what they’re spending their money on,” Andrade noted. “These are simple questions. This is not rocket science. This is just good governance, and they’re just refusing to participate in that conversation.”
APRIL 15, 2025: Hay testifies under oath in a Florida House subcommittee chaired by Republican Rep. Alex Andrade. He defends Hope Florida’s mission but acknowledges that “mistakes were made.”
- “I cannot confirm what the funds were used for,” Hay says. “We have no monitoring procedures.”
He testified, “In recent weeks, the public reporting has made evident that mistakes were made. There are lapses in reporting procedures. The foundation was not provided with the staffing support necessary to ensure all matters were being quickly and appropriately handled.”
In a stand-up after the hearing, Andrade said, “Given Mr. [Uthmeier’s] involvement in the settlement and then the transfer to Hope Florida and then soliciting these grant proposals and then immediately receiving that to his PAC… That’s very much what it looks like [criminal behavior].”
Jeremy Redfern, speaking on behalf of Attorney General Uthmeier, challenged Andrade’s motivations, accusing him of having connections to Trulieve, a medical-marijuana company that reportedly spent approximately $150 million supporting the ballot initiative.
- “This is Democrat-style lawfare by a representative who is in the pocket of Big Weed,” Redfern, who is Uthmeier’s communications director, posted on social media platform X. “He’s pushing this hoax because his Canadian-traded marijuana bosses are mad they spent $150 million to have unrestricted marijuana use in public and lost.”
Gov. DeSantis and First Lady Casey DeSantis came to Pensacola State College to defend Hope Florida. The Governor addressed what he described as “manufactured smears” against the Hope Florida program, suggesting that House leadership is “colluding with liberal media and the Democratic party in Florida” to undermine the Hope Florida initiative.
APRIL 16, 2025: The Hope Florida Foundation released its tax documents and bylaws. Board member Stephanie White of Pensacola took center stage at the Hope Florida Foundation board meeting, questioning discrepancies in the organization’s financial reporting. White challenged the foundation’s Form 990 reporting, noting that substantial distributions appeared missing.
- “They were only listed four (distributions) for $40,000. I know for a fact that more money was given,” White stated firmly. “My church was given $20,000 in 2024. None of that is listed.”
Florida Politics broke the news that Erik Dellenback, Executive Director of Hope Florida, resigned from his position effective May 1, just months after joining the charity in January.
- In a podcast, Andrade questioned the Hope Florida Foundation chair Joshua Hay’s ties to the DeSantis administration.”The chairman of the Hope Florida Foundation, he volunteers in that capacity, but he’s part of a company that has received over a hundred million dollars in state contracts,” Andrade said. “When you have that type of relationship, obviously, you want to go along to get along. You want to do everything in your power to make the Governor and the executive branch happy because they’re your meal ticket. Unfortunately, for Josh Hay, the chairman of the Hope Florida Foundation, he received terrible advice from Governor DeSantis’ personal attorney, Jeff Aaron, and he was put in a terrible position to be the one actually approving these two grants and then distributing them immediately.”
APRIL 22, 2025: Uthmeier told reporters that he “wasn’t part of securing the deal” for Centene’s donation but “everything looks legal.”
“I’m glad for what we did,” Uthmeier said. “I’m very thankful those groups stepped up and helped us secure a big win.”
- Florida’s Senate Committee on Ethics and Elections, which is chaired by Sen. Don Gaetz (R-Crestview), did not confirm AHCA Secretary Shevaun Harris and Department of Children and Families Secretary Taylor Hatch before the legislative session ended on May 2.
APRIL 23, 2025: Restore Our Nation PAC sent out texts from Gov. Ron DeSantis asking voters to contact Pensacola lawmaker Alex Andrade: “Tell them (sic) to stand with the people and me to keep Florida free.”
APRIL 24, 2025: Andrade wrapped up his committee’s probe after Aaron, Ronshausen, and Wilson declined to testify.
- “I am firmly convinced that James Uthmeier and Jeff Aaron engaged in a conspiracy to commit money laundering and wire fraud and that several parties played a role in the misuse of $10 million in Medicaid funds,” Andrade said. “I’ll leave the rest of the investigation up to the FBI and Department of Justice.”
In a podcast interview, Andrade said, “Well, one thing I think people need to kind of internalize is that the governor’s office runs far more akin to say’ Veep’ than it does’ House of Cards.”
- The lawmaker added: ”These people might be petty, they’re certainly incompetent, but it’s comical how incompetent they are. These people, we’re not sending our best to the Governor’s office right now. These people are not doing a good job of even covering their tracks, and they just simply refuse to produce information and hope people kind of forget about it and get swept under the rug.”
MAY 14, 2025: At a roundtable held at a church in Brandon, Gov. Ron DeSantis and First Lady Casey DeSantis defended Hope Florida, describing it as not merely a program but a “movement” that represents one of the “only meaningful reforms to the welfare state since the Great Society of the late 1960s.” DeSantis directly addressed these allegations when questioned by a reporter about the appropriateness of the AHCA settlement.
- “They did a good job negotiating it. They did a good job across the board,” DeSantis responded. “The reality is no one would say anything about this if it wasn’t for, some people have an agenda. Some people want to try to obliquely hit the First Lady, even though she wasn’t involved in the AHCA thing.”
While Gov. Ron DeSantis and First Lady Casey DeSantis were defending Hope Florida, Save Our Society from Drugs (SOS) chair James Holton submitted his resignation from the organization’s board.
- Holton’s resignation letter stated that the SOS board had been completely unaware that the organization’s executive director, Amy Ronshausen, had accepted $5 million from the Hope Florida Foundation.
Adding another layer to this complex situation, the Tampa Bay Times reported that Ronshausen was suspended as executive director at Save Our Society from Drugs on April 22, according to a whistleblower complaint she sent to Holton on May 7.
MAY 19, 2025 In Tallahassee, the State Attorney’s office confirmed it had opened an investigation into the Hope Florida Scandal.
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