Mississippi Today
Medicaid awards managed care contracts after two-year stalemate
Three companies will begin new contracts to manage the care of Mississippi Medicaid beneficiaries in July of 2025, barring further legal holdups.
For-profit, incumbent companies Magnolia Health and Molina Healthcare and new, nonprofit TrueCare were each awarded four-year, $3.8 billion contracts beginning Aug. 12.
The contracts were stalled for two years – since August 2022 – after two companies that weren’t chosen filed protests with the state alleging that the blind bidding process was unfair and reviewers were not properly blinded to the identities of applicants. The issue is still being litigated in court.
Enrollment in new plans should begin in May 2025, said Mississippi Medicaid spokesperson Matt Westerfield.
The contracts were awarded after Mississippi Medicaid issued one-year emergency contracts last month to Magnolia Health, Molina Healthcare and UnitedHealthcare – the companies currently contracting with the state for managed care services – for the second year in a row, giving new contractors time to implement services.
The state’s managed care program, MississippiCAN, seeks to lower health care costs and improve access to medical services for the state’s most vulnerable citizens, including children, people with disabilities and pregnant women. Beneficiaries of the Children’s Health Insurance Program, which provides low-cost health coverage to children in families that exceed Medicaid’s income ceiling, also receive coordinated care services.
Managed care companies receive per-member payments to maintain a provider network and implement programs intended to improve health outcomes for enrollees.
Nearly three-fourths of the state’s 653,916 Medicaid recipients were enrolled in MississippiCAN services in July 2024.
The effectiveness of managed care programs has been widely debated. Some people argue that managed care companies are incentivized to offer effective preventative care services to members in order to avoid high-cost medical services, while critics argue that their profits are made by denying or limiting services to patients.
Mississippi is one of 40 states that has adopted the managed care organization model for coordinating benefits, according to the National Conference of State Legislatures. The state began its program in 2011.
Mississippi Medicaid has awarded $37.8 billion in state and federally-funded contracts to four managed care companies since 2017.
They represent the largest contracts awarded in the state in at least the last 10 years, according to the state’s contract database.
Magnolia Health, owned by St. Louis-based Centene, has provided managed care services to the state since 2011. In 2021, Centene operated managed care programs in 29 states, according to data from KFF.
Magnolia Health has netted $14.9 billion in contracts from the state since 2017, more than any other managed care company.
California-based Molina Healthcare has provided managed care services to the state since 2017, receiving $8.6 billion in contracts. In 2021, it operated managed care programs in 16 states.
They are some of the most profitable companies in the nation. In 2023, Centene and Molina Healthcare reported nationwide profits of $2.7 billion and $1.1 billion, respectively.
TrueCare is a not-for-profit company established by Mississippi hospitals and the state hospital association to provide an alternative to traditional managed care companies. The company vied for a managed care contract in 2017, but was not selected during the review process.
Richard Roberson, CEO of TrueCare and incoming president and CEO of the Mississippi Hospital Association, said the goal of the nonprofit is to improve health outcomes for patients and lower care costs.
Because the company is governed by providers, it will be less likely to deny claims and more motivated to use preventative care to avoid costly care, Roberson said.
“I think there is a place for managed care if we’re truly managing care, and not just managing claims,” he said.
Contract controversy
Centene, the company that owns Magnolia Health, settled with the state for $55 million in 2021 amidst an investigation by Attorney General Lynn Fitch and State Auditor Shad White into whether the company inflated prescription drug bills to the Division of Medicaid.
“I do not care how large or powerful the company is, Mississippi taxpayers deserve to get what they paid for when the state spends money on prescription drugs,” said White in a statement at the time.
The company did not admit fault or wrongdoing under the agreement.
The Legislature in 2022 rejected a proposal by Rep. Becky Currie, R-Brookhaven, to prohibit the Division of Medicaid from hiring managed care companies that have settled with the state over allegations of fraud.
“I am for doing away with doing business with a company who took $55 million dollars of our money that was supposed to be spent on the poor, the sick, the elderly, the mentally ill, the disabled,” she said during discussion on the House of Representatives floor.
Magnolia officials at the time said the settlement amount of $55 million did not represent the alleged amount of fees the state was overcharged.
State Medicaid Director Drew Snyder argued the bill could cause a lapse in care for Medicaid beneficiaries and lead to a legal quagmire.
Centene was one of the largest contributors to Gov. Tate Reeves’ gubernatorial campaign in 2023. The company and its political action committee (PAC) have donated $370,000 to Reeves since 2010. It has also donated to many state legislators’ campaigns, according to public documents on the Secretary of State’s website.
A standoff
The contract selection process itself also attracted scrutiny.
Mississippi Medicaid began seeking new contracts for managed care in December 2021, with plans to begin the contracts in July 2023. The division’s “request for qualifications” yielded five responses.
The agency announced its selection of Magnolia Health, Molina Healthcare and TrueCare in August 2022.
A protracted legal battle began one week later when the two companies that weren’t chosen – Amerigroup and UnitedHealthcare – cried foul, arguing that the selection process was unfair.
The review process used a blind bidding process to evaluate applications while keeping the identities of the companies hidden.
The companies argued the state failed to properly “blind” contract evaluators to the identities of applicants by allowing companies to include identifying information in their application.
“Protests in state Medicaid managed care procurements are a near certainty,” Medicaid spokesperson Matt Westerfield told Mississippi Today in an email. “… It’s just become part of doing business for the companies that don’t win.”
The Division of Medicaid denied the protests in June 2023. The Public Procurement Review Board, the body responsible for reviewing contract acquisition processes, denied a subsequent appeal in April 2024.
The Public Procurement Review Board ruled that the Division of Medicaid properly carried out blind scoring procedures.
Amerigroup and UnitedHealthcare turned to the courts in April and May, respectively, when they sued the Division of Medicaid and the Public Procurement Review Board, aiming to halt the contracts from being awarded.
Westerfield acknowledged that the court’s adjudication process could alter the state’s plan to begin the new contracts in July 2025, but said the division did not expect any delays.
Minnesota-based UnitedHealth Group, which owns UnitedHealthcare, currently provides managed care services to Mississippi Medicaid beneficiaries. It generates more money than any other U.S. health care company, according to Becker’s Hospital Review. In 2023, the company reported $23.1 billion in net earnings. It provided managed care services to 26 states in 2021.
In the state’s 2023 external audit of managed care organizations, UnitedHealthcare met 98% of standards for MississippiCAN. Magnolia met 97% and Molina met 92%.
Amerigroup has not held a contract for managed care service in Mississippi. It is owned by Minneapolis-based Elevance Health.
Magnolia Health, Molina Healthcare and UnitedHealthcare did not respond to requests for comment for this story.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
A century later, Hattiesburg High plays for a second state title
Anyone who has read this column regularly through the years knows my love of history, Mississippi sports history in particular. That passion only increases when it involves my hometown, Hattiesburg.
This Saturday night, the undefeated Hattiesburg High Tigers will play Grenada for the State Class 6A Championship. Should Hattiesburg win, it would mark the school’s first state football championship in precisely 100 years. That’s right: On Dec. 5, 1924, undefeated Hattiesburg defeated Louisville 20-14 at Laurel for the state championship.
Hattiesburg High has won several state championships in other sports, but the 1924 championship remains the school’s only state football crown. And boy oh boy, is there some history there.
Let’s start with this: Hattiesburg businessmen chartered a 12-car train from Southern Railway for the 30-mile trip to Laurel. What’s more, they had the cars decorated in school colors, purple and gold. According to reports in the next day’s Hattiesburg American, more than 3,000 Hattiesburgers — nearly 1,000 on the train — made the trip, especially impressive since the entire town’s population was then just over 13,000 in the 1920 census.
More than 5,000 fans in all attended the championship game, at the time the second largest crowd to attend a sporting event in Mississippi history, second only to an Ole Miss-Mississippi State football game at the State Fairgrounds in Jackson.
Since there were no stadium lights back then, the state championship game was played in the afternoon. When the victorious Tigers and their huge following arrived back in the Hub City at 6:47 p.m. they were greeted by all the town’s industrial whistles and police and ambulance sirens. Hattiesburg telephone operators reported nearly 2,000 calls from alarmed residents wondering what in the world had happened to cause such a ruckus. A parade led by the mayor through downtown Hattiesburg drew a larger crowd than the parade that celebrated the end of World War I, the Hattiesburg American reported.
“The Tigers of Hattiesburg were in possession of the city,” the American reported the next day. “The sweet taste of victory sent the crowd of more than 3,000 into a riot of cheering … This kept up until late in the evening.”
So much history: Two of the Tigers heroes that night were brothers Gerald “Gee” and Harvey “Hubby” Walker, who would go on to become football and baseball stars at Ole Miss and then on to play Major League Baseball. Gee Walker was an American League All-Star who batted .353 in 1936 and remains the only player in Major League history to hit for the cycle (home run, triple, double and single) on Opening Day, which he did, in that order, in 1937 with the Detroit Tigers.
For the Hattiesburg state champs of 2024, Gee Walker caught the passes that his brother Hubby threw. Hansel Batten, a sturdy, handsome youngster, was the Hattiesburg running star who scored two touchdowns, including the game-winner. Batten would go on to star at Ole Miss, where he was teammates again with the Walker brothers. Batten played both running back and linebacker and captained the Ole Miss football team. After that, his story takes huge turn.
Batten would become the sports editor and sometimes news reporter of the Hattiesburg American, often writing about the sport he once played so well. Tragically, in 1932, Batten was the victim of an apparent murder. Tom and Venie Jones, a husband and wife, were charged with the crime. The husband was convicted and sentenced to life in prison, but later granted a new trial and acquitted. The wife was acquitted after a series of trials. The story of Batten’s mysterious death and the trials that followed is covered in a fascinating podcast series “Reckless on the Rails” by Ellisville journalist/historian William T. Browning that can be accessed here. I highly recommend.
A much happier story is that the modern day Hattiesburg High Tigers, coached by Tony Vance and quarterbacked by his son Deuce Vance, will play for a second state championship 100 years after the historic first. Former Mississippi State standout Michael Fair coaches Grenada, which enters the championship game with a 14-1 record. Kickoff is set for 7 p.m. Saturday night.
It should be a terrific game. One thing is certain, should Hattiesburg (13-0) win, the Hub City will have a hard time topping the historic celebration that occurred 100 years ago this week.
Columnist Rick Cleveland is a 1970 graduate of Hattiesburg High and a former sports editor of the Hattiesburg American. His father, Robert “Ace” Cleveland, was sports editor of the Hattiesburg American when Rick was born. Ace Cleveland, a four-sport letterman at Hattiesburg High, earned his nickname when the Hattiesburg American referred to him as Hattiesburg High’s “ace placekicker.” It stuck.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1967
Dec. 4, 1967
Martin Luther King, Jr. announced creation of the Southern Christian Leadership Conference’s Poor People’s Campaign, a movement to broadly address economic inequalities with nonviolent direct action.
“It must not be just Black people,” argued King, “it must be all poor people. We must include American Indians, Puerto Ricans, Mexicans and even poor whites.”
The idea for the push came from Marian Wright Edelman, who had recently taken U.S. Senator Robert F. Kennedy to witness poverty firsthand in the Mississippi Delta.
When she shared the idea that Washington officials should meet the nation’s most impoverished citizens, King embraced the vision, telling reporters, “We will go there, we will demand to be heard, and we will stay until America responds. If this means forcible repression of our movement, we will confront it, for we have done this before. If this means scorn or ridicule, we embrace it, for that is what America’s poor now receive. If it means jail, we accept it willingly, for the millions of poor already are imprisoned by exploitation and discrimination. … In short, we will be petitioning our government for specific reforms and we intend to build militant, nonviolent actions until that government moves against poverty.”
King talked of a debt that the nation owed Black Americans, who were set free in 1863, “yet they were not given any land to make that freedom meaningful.”
He compared it to an imprisoned man whom authorities learn is innocent, “then going up to the man saying, now you are free. And you don’t give him any bus fare to get to town. You don’t give him any clothes to put on his back. You don’t give him any money to get on his feet in life again. The whole code of jurisprudence would rise up against this and yet, this is what America did to the Black man.”
King didn’t live to see this dream through, assassinated five months later.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Mississippi could suffer the most if health insurance subsidies lapse
A new report warns Mississippi could see the steepest drop off in health insurance coverage if Congress doesn’t vote to extend temporary health coverage subsidies at the end of next year.
Over 100,000 Mississippians would lose health insurance – a 43% increase in the state’s already-high uninsured rate – the policy think tank The Urban Institute predicted last month.
“If the enhanced premium tax credits expire, there will be dramatic declines in Marketplace coverage and increases in uninsurance, but the effects will not be felt equally across states or by race, income, and age,” said Jessica Banthin, senior fellow at the Urban Institute in a statement. “Our analysis shows that their expiration could mean some communities may experience greater coverage losses, making healthcare unaffordable and inaccessible.”
The increased subsidies allow Americans to buy health insurance plans on the Affordable Care Act Marketplace at lower costs with enhanced premium tax credits. The benefits were first authorized by Congress in 2021 to help more Americans attain health care coverage during the COVID-19 pandemic.
They also allowed more Americans than before to access the premium tax credits by raising the income ceiling for eligibility and allowed low-income households to access insurance without paying premiums.
The benefits, which have led to a record high of 21.3 million people insured through the Marketplace nationwide, will expire in December 2025 without a renewal from Congress.
“If (the premium tax credits) go away next year, I’m afraid it will reset us to where we were five years ago, with the Marketplace policies basically becoming catastrophic plans again,” State Health Office Dr. Daniel Edney told Mississippi Today.
Catastrophic plans are designed to cover major medical emergencies but not routine medical care.
Premium payments are expected to increase by over 75% on average if the tax credits expire.
For a 40-year-old living alone in Jackson and making $30,000 annually, the cost of monthly premiums for a silver health insurance plan would rise $93 a month, from $49 to $143, according to KFF.
The Marketplace is a federally or state-operated health insurance exchange where people can shop for and enroll in coverage and access financial assistance based on their income.
The enhanced tax credits have contributed to a significant increase in health care coverage in Mississippi since 2021.
In 2020, 12.9% of Mississippians were uninsured, compared to 10.5% in 2023.
“It’s been a gamechanger,” said Edney.
Health care coverage through the Marketplace in Mississippi has nearly doubled since the benefits were passed, representing the second highest percent increase in the nation behind Texas.
Mississippi remains one of 10 states in the nation not to expand Medicaid coverage, making it more reliant on the Marketplace for affordable health care coverage. Marketplace enrollment rates since 2020 have grown fastest in states with high uninsured rates that have also not expanded Medicaid.
The Urban Institute’s data tool predicts that if the enhanced tax credits are not renewed, 143,000 Mississippians would lose coverage under subsidized Marketplace plans.
Some would have the option to enroll in employer-sponsored coverage or be able to afford health insurance without the additional benefits. But most are forecasted to lose coverage entirely.
Mississippi currently uses the federal exchange, but the Legislature passed a law authorizing the creation of a state-based Marketplace earlier this year, which could incentivize health insurance companies to offer policies at lower costs. But federal officials will not approve Mississippi implementing its own exchange because Gov. Tate Reeves has not yet provided a letter of approval.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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