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
Mississippi House set to vote this week on income tax elimination-gas tax increase plan
A House committee passed a major tax cut plan on Tuesday evening that would eventually abolish the state income tax, reduce taxes on groceries, increase local sales taxes and provide more money for road work.
The plan would over time cut about $1.1 billion from the state’s current revenue. Proponents say economic growth will cover this, and not result in major cuts to government services or spending.
“This is one of the most transformational pieces of legislation that this state has ever seen,” House Ways and Means Chairman Trey Lamar said in the committee meeting.
The legislation passed the GOP-majority House committee with no audible opposition, though Rep. Robert Johnson III, the House Democratic leader, raised concerns that the state’s budget may not collect enough revenues in the future to offset the tax cut.
The legislation would reduce the income tax rate from 4% to 3% next year. Then, it would reduce the rate by .3% each additional year until the tax is eliminated in 10 years.
The plan also trims the 7% sales tax on groceries to 2.5% over time. Under current law, Mississippi’s 7% sales tax is split between the state and municipalities where the tax is collected. To shore up the loss, the legislation would end the state’s 18.5% sales tax diversion to municipalities, meaning the full sales tax collected will go to the state budget.
To make municipalities whole, the bill adds a general 1.5% local sales tax for both municipalities and counties that the local governments can vote to opt out of. The tax collected by the counties would go toward local road maintenance.
Oxford Mayor Robyn Tannehill, an independent, attended Tuesday’s Ways and Means meeting and told Mississippi Today she supports the local 1.5% local sales tax because it means additional revenue for municipalities in the state.
“I’m supportive of any bill that increases revenues for Oxford, Mississippi,” Tannehill said.
The legislation also adds a new 5% tax on gasoline sales, which would go toward the Mississippi Department of Transportation’s budget for road and bridge infrastructure. The tax is expected to generate $400 million a year. Currently, Mississippi has an 18.4 cents-a-gallon flat tax on gasoline — a flat rate no matter the cost of a gallon. Transportation leaders have for years said they need an indexed tax that would rise with the cost of gasoline in order to generate enough money to keep up road maintenance.
Using the current average gasoline price in Mississippi of $2.62 a gallon, the proposed new tax would cost consumers 13 more cents a gallon.
Lamar, a Republican from Senatobia, said he intends to bring the bill up for a full House vote this week, and it’s expected to pass the 122 member chamber. But the legislation is several steps away from becoming law.
Once the legislation passes the House, it would likely head to the Senate Finance Committee, which is led by Republican Sen. Josh Harkins of Flowood, for consideration. Harkins has not yet responded to the House’s legislation, but he previously told Mississippi Today the Senate will unveil its own tax cut package in the coming weeks.
If the House and Senate agree on a tax cut measure, it would head to Republican Gov. Tate Reeves’ desk for consideration. Reeves has been a vocal champion of eliminating the income tax, but it’s unclear if he would support all of the House’s latest tax cut measure.
Lamar on Tuesday night told reporters that he had spoken with Reeves’ office, and he believes the governor will offer his support to the legislation. The governor’s office did not respond to questions about his stance on Lamar’s legislation.
Reeves in past years has opposed what he called “tax swaps,” tax cut proposals that sought to decrease the overall tax burden, yet raised another type of tax such as the latest House proposal. He’s also opposed past efforts to raise the gasoline tax.
“If a bill comes to my desk that doesn’t raise any other taxes that cuts the grocery tax and cuts the income tax, I’m fine with that,” Reeves said last week at a press conference.
Reeves, in 2021 notably opposed an effort led by Lamar and former House Speaker Philip Gunn that sought to eliminate the income tax and cut the sales tax on groceries in half while increasing the sales tax on other items by 2.5 cents on the dollar.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Stories Videos
Mississippi Stories: Chris Lockhart of Capital City Kayaks
In this episode of Mississippi Stories, Mississippi Today Editor-at-Large Marshall Ramsey took a tour of one of the best kept secrets in Jackson with Chris Lockhart of Capital City Kayaks. What started as a hobby to explore the green side of the capital city has turned into a family-fun spot for tourists and Jacksonians alike.
For more videos, subscribe to Mississippi Today’s YouTube channel.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
The post Mississippi Stories: Chris Lockhart of Capital City Kayaks appeared first on Mississippi Today.
Mississippi Today
Lawmakers must pass new legislation to improve access to prenatal care
Lawmakers will file another bill this session to help low-income pregnant women get into the doctor earlier – after the federal government rejected the program set up under last year’s law.
The implementation of the program has been delayed for months as a result of the discrepancy between what was written into state law and federal regulations for pregnancy presumptive eligibility.
Rep. Missy McGee, R-Hattiesburg, told Mississippi Today she will file a bill before next week’s deadline.
“It’s a priority to get pregnant women into the doctor as early as possible,” said McGee, who authored last year’s bill and chairs the House Medicaid committee. “The goal is the same, the priority for us is the same.”
The problem with the 2024 legislation is that it included a proof of income requirement – meaning patients would need to bring paystubs into the doctor’s office – which the Centers for Medicare and Medicaid Services, the federal agency responsible for approving the state plan, does not allow. Although the law is intended for low-income individuals, the federal government maintains that vocal testimony should suffice.
Federal guidelines state that while the agency may require proof of citizenship or residency, it should not “require verification of the conditions for presumptive eligibility” – which are pregnancy and income.
McGee said she will be taking out the proof of income requirement. The proof of pregnancy requirement is null, she said, since doctors would be able to see pregnancy during the first visit.
The law presumes certain low-income pregnant women as eligible for Medicaid, and allows them to receive treatment right away at no cost to them while their official Medicaid application is pending. This interim coverage only lasts 60 days, at which point the Division of Medicaid will typically have approved or denied their application, according to average application processing times.
The policy will cost roughly $567,000 and could cut down on the number of premature infants who end up in the intensive care unit, where the state might pay up to $1 million caring for a single baby. Mississippi has the nation’s highest rate of preterm birth, which adequate prenatal care has been proven to mitigate.
Advocates argue that the mandatory documentation is just another burden on pregnant women already facing socioeconomic barriers to health care.
Officials with the Mississippi Division of Medicaid said several times throughout the summer and fall that they were in negotiations with the federal government to work out the problem with state law.
Matt Westerfield, spokesperson for the Division of Medicaid, confirmed that the agency could not work out with the federal government the proof of income requirement state lawmakers wrote into the law.
McGee said the easiest solution is to draft new legislation. She is hopeful that the policy will garner the same overwhelming support this year that it had from lawmakers in both chambers last year.
“We do not believe that the changes do any harm to our objective, so we are willing to make these changes,” McGee said. “And really, I think it’s been helpful for the Division of Medicaid to have these in-depth conversations [with CMS] so we have a better idea of what CMS is looking for.”
The House passed the law 117-5 last year, and the Senate passed it 52-4.
The deadline to file bills is Jan. 20. McGee says she hopes to push the bill through the Legislature early on this year – as she did last year. In 2024, it was sent to the governor less than halfway through the session.
Thirteen providers were approved to participate in the policy in 2024, including the University of Mississippi Medical Center – the state’s largest Medicaid provider.
In addition to negotiating with CMS and accepting provider applications, the Division of Medicaid also conducted several provider training sessions throughout the fall.
Westerfield was not able to comment on whether the approved providers would be automatically enrolled in 2025 or whether they would need to reapply. He also declined to comment on whether the implementation process would be streamlined the second time around.
Other than minor changes to income verification, everything in this year’s bill will stay the same as last year.
An expectant mother would need to fall under the following income levels to qualify for presumptive eligibility in 2025:
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
-
News from the South - Arkansas News Feed6 days ago
Arkansas commission clears deputy in controversial arrest case
-
News from the South - Kentucky News Feed5 days ago
Metal armored fighting takes over the cage this weekend in New Albany
-
The Conversation16 hours ago
Vaccine hesitancy among pet owners is growing – a public health expert explains why that matters
-
Mississippi News Video6 days ago
Wintry mix expected in Mississippi this week. Here’s how to prepare
-
Local News5 days ago
Trump sentenced to penalty-free ‘unconditional discharge’ in hush money case
-
News from the South - South Carolina News Feed2 days ago
24 dead as fire crews try to corral Los Angeles blazes before winds return this week
-
News from the South - Texas News Feed5 days ago
2024: Another record-breaking year for Texas oil and natural gas industry | Texas
-
News from the South - Georgia News Feed4 days ago
MAP: Emergency room visits for respiratory illnesses are soaring in these states