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Medicaid awards managed care contracts after two-year stalemate

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mississippitoday.org – Gwen Dilworth – 2024-08-28 15:35:10

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, incoming CEO of the Mississippi Hospital Association and CEO of TrueCare. Credit: Jerry Mitchell/MCIR

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. 

Drew Snyder, Mississippi Division of Medicaid executive director, speaks during the Medical Care Advisory Committee meeting at the Woolfolk State Office Building in Jackson, Miss., Friday, Sept. 22, 2023. Credit: Eric Shelton/Mississippi Today

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 could suffer the most if health insurance subsidies lapse

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mississippitoday.org – Gwen Dilworth – 2024-12-03 16:01:00

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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Citing lack of body, defense casts doubt on Jimmie ‘Jay ‘ Lee’s death

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mississippitoday.org – Molly Minta – 2024-12-03 13:49:00

OXFORD – Jimmie “Jay” Lee disappeared on his mother’s birthday. 

Every year, Lee would call his mother, Stephanie, to sing “Happy Birthday.” On July 8, 2022, he texted her around 2 a.m. But the 20-year-old never responded after that. Not to Stephanie’s texts. Or to her 92 missed calls. 

That’s because just a few hours later, Lee was allegedly killed by Sheldon Timothy Herrington Jr., a fellow student at the University of Mississippi with whom Lee had a secret relationship, the prosecution argued in their opening statement in Herrington’s capital murder trial on Tuesday at the Lafayette County Courthouse. 

Lee had gone back to Herrington’s apartment at Herrington’s behest after the two had fought about sex, the prosecution said. Lee was a well-known member of Oxford’s LGBTQ+ community, but Herrington, whose family leads a prominent church in his hometown of Grenada, was not. 

“He invited Jay back over with the promise that he was gonna do something he’d never done,” said Gwen Agho, a special prosecutor from Hinds County who joined the case to assist Lafayette County District Attorney Ben Creekmore. 

But after 22,000 pages of evidence, 71 search warrants and seven law enforcement agencies, there is no direct evidence to show that Lee is dead, argued state Rep. Kevin Horan in his opening statements defending Herrington. 

There is no body, no DNA, no blood and no urine, Horan said. Last week, he successfully moved to exclude evidence from K9 dogs from the DeSoto County Sheriff’s Department that “alerted” to the smell of a dead body in Herrington’s apartment and car after questioning its validity. 

Horan also sought to cast doubt on evidence on what may be the strongest piece of circumstantial evidence the prosecution has to offer: A Google search that Herrington allegedly made while Lee was on his way over that reads “how long does it take to strangle someone.” 

The search could have been about sexual activity with anyone, not just Lee, Horan said. 

“I submit to you, ladies and gentlemen, that at the conclusion of this case, you’re going to have just as many questions then as you have now about whether or not they’ve proven a death,” Horan told the jury. 

In fact, Horan said the evidence will show that it was actually Lee who threatened Herrington, because Lee sent a message before heading over telling Herrington “if this goes bad, it’s not gonna be good for you.” 

If convicted, Herrington faces the death penalty or life in prison without the possibility of parole. 

“You can’t go on objection, you can’t go on speculation, you can’t go on suspicion,” Horan told the jury. “Guesswork. Wonderment. All of those things you can’t do.”  

The opening of trial came after jurors arrived late Monday night from Hattiesburg. Two years after Lee went missing, it was sparsely attended. Few sat behind Herrington, who never turned to face the gallery. 

But Lee’s family and close friends seem just as committed to justice. Lee’s friends were the first members of the public to enter the courtroom shortly after 8 a.m. Some members of Lee’s family wore shirts with his picture on it. 

They were instructed by Judge Kelly Luther to avoid emotional outbursts during testimony. Tissues boxes were placed in front of where Lee’s family sat. The attorneys were also told to keep their cool. 

“I anticipate a hotly contested case,” Luther said before proceedings started. 

The jury was comprised of eight women and seven men chosen from Forrest County. Eleven were white and four were Black.

During the selection process in Hattiesburg, potential jurors were asked if they had any problem with proof of death because Lee’s body has not been found, and none raised a hand. They were also asked if they knew any members of the LGBTQ community, or if they didn’t want to be exposed to information about a relationship between two men.

In his opening statement, Horan noted the case was touchy, due to Lee and Herrington’s sexual relationship and the emotions of Lee’s mother, who was the state’s first witness on Tuesday. 

“The court is gonna instruct you at the conclusion of this case that you cannot allow your sympathy for a mother to come into play here,” Horan told the jury. “Y’all have got to decide this case on the facts.” 

Horan also said that the jury will see no evidence to support Herrington’s underlying offense of kidnapping. 

“If that didn’t happen, the rest of their case goes like a house of cards,” he said.

Aside from the Google search, Agho did not address the way Herrington allegedly killed Lee in her opening statement. 

Instead, she emphasized all the details that police have gathered to prove Lee is no longer living. When Lee’s friend stopped by his apartment at Stephanie’s request, the door was ajar. Lee’s dog was inside. So were his valuables and his clothes. 

That fall, Lee was slated to enroll in a master’s degree in social work at Ole Miss, but he never showed up for class. In the two years since he went missing, there have been no more credit card charges under his name, and no more social media posts. 

“No more anything,” Agho said. “The plans for grad school? Moot. … All proof that Jay’s no longer with us.” 

In November, a Lafayette County judge declared Lee dead, at the request by his parents for a legal declaration of death.

When Stephanie Lee testified, she said the last day she saw her son was on July 7 before he headed back to Oxford after spending the holiday at home in Jackson, according to her testimony. 

“What was the last thing you ever heard from your son?” Agho asked. 

“It’s your birthday,” she replied.

Justice Reporter Mina Corpuz contributed to this report.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Help Us Build Trustworthy, Community-First Journalism

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mississippitoday.org – Mississippi Today – 2024-12-03 09:00:00

In a survey of more than 5,000 American adults conducted by Gallup and the Knight Foundation, only 23% said they believe most national news organizations care about “the best interests of their readers, viewers, and listeners.”

That statistic is troubling. It reflects a growing gap between the media and the people they serve—a gap we’re committed to bridging at Mississippi Today.

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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