Anna Wolfe, Mississippi Clarion Ledger Published 11:01 a.m. CT July 6, 2018 | Updated
11:39 a.m. CT July 6, 2018
The complexities of Medicaid often contribute
to the confusion of the program. Here, we break down some of the numbers for
Mississippi Medicaid. Dustin Barnes/The Clarion-Ledger
After a hard-fought bid for billions of
dollars from Mississippi Division of Medicaid, California-based Molina
Healthcare is preparing to start managing the health care of thousands
of Mississippians.
Lawmakers and division officials celebrated a
ribbon cutting June 26 in Jackson for Molina Healthcare of Mississippi, which
is one of three insurance companies who last summer won $3 billion-a-year in
managed care contracts.
The three-year contract award is still the
subject of litigation.
Medicaid beneficiaries in the managed care
program will be given the opportunity to switch to the Molina policy, which is
set to start Oct. 1. New managed care enrollees will be automatically placed in
Molina's plan until it insures 20 percent of state
beneficiaries. Molina also recently began entering contracts
with health care providers.
Mississippi has contracted with the two other
insurers, UnitedHealthcare and Magnolia Health, since the state's managed care
program, MississippiCAN, began in 2011.
"Having a third managed care entity will
expand options for Medicaid beneficiaries and create a more competitive
environment that over time should lead to better care for beneficiaries and a
better value for taxpayers," Medicaid director Drew Snyder said in a
statement. "Molina Healthcare has been easy to work with during the
implementation phase, and remains on track for the October 1 operational
go-live date."
Medicaid pays the managed care companies a set
amount per month — around $550 for every adult, $290 for every child and $1,120
for every person with a disability who is on the program — to
manage their health care. This helps the state maintain a stable Medicaid
budget, since the amount paid out is not dependent on how sick the beneficiaries
are in a given year, like with traditional fee-for-service Medicaid.
In turn, the managed care companies are tasked
with helping nearly half a million Medicaid members stay healthy by providing
more preventive care, like screenings and unlimited doctor's visits. If Mississippians
stay healthy, they'll require less expensive services.
"We are thrilled to launch Molina's
Mississippi health plan and are looking forward to serving Medicaid
beneficiaries through the MississippiCAN program," Bridget Galatas,
president of Molina Healthcare of Mississippi, said in a release. "We have
been coordinating closely with the state's Division of Medicaid, along with
local providers and community-based organizations, and we will continue to work
with these excellent partners to provide access to high-quality care for our
members."
The set-up also means Molina, United
and Magnolia keep any dollars allocated for healthy patients that
are not paid out for preventive services or care for the sicker ones.
Two losing bidders, Mississippi True and
Amerigroup, protested the award and claimed the division's scoring criteria
was biased against them, that their scores were unfairly low and that the
former Medicaid director had a conflict of interest with one of the winners.
Emails used as evidence in court showed
conversations about job opportunities between Molina officials and former
Medicaid director David Dzielak. Molina officials asked Dzielak about potential
executives for its Mississippi branch several months before it was awarded the
contract and also encouraged Dzielak to apply for the Medicaid director
position in another state.
Mississippi True, a provider-sponsored
health plan backed by over 60 local hospitals, sued the agency in Hinds
County Chancery Court, but the case was voluntarily dismissed. In April, the
nonprofit filed another 192-page lawsuit against the division, Dzielak and
the governor's office.
"The MississippiCAN contracts were
awarded and are being performed in violation of unambiguous
Mississippi statutory and regulatory law," the lawsuit reads.
The lawsuit is ongoing.
During the 2018 session, several lawmakers
attempted to carve out a portion of the contract for Mississippi True, arguing
in part that any excess dollars paid out of the Medicaid program should go to
hospitals instead of insurance companies.
The measure failed to pass in the Medicaid
technical amendments bill that is revisited by the Legislature every three
years.
"I still think that we have enough room
for a provider-sponsored health plan and I would still like to see that
happen for Mississippi," said Rep. Becky Currie, R-Brookhaven, one of the
loudest opponents against the bid.
Molina touts its policy of providing the
following services with no required copay: prenatal care, emergency services,
hospital care, flu and pneumonia vaccines, lab testing and X-rays, prescription
drugs, regular doctor visits, vision coverage and expanded behavioral health
services.
Molina, like United and Magnolia, offers
unlimited doctor's visits to its members.
Traditional fee-for-service Medicaid patients
are restricted to 12 visits per year, though many lawmakers thought they had
required the division to change its policy to remove the restrictions during
the 2018 session.
Medicaid officials announced at the end of
June that restrictions on doctors visits and monthly prescriptions would remain intact July 1.
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