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Mississippi Today

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

Despite bribery charges, Mississippi prosecutor, other officials can remain in office

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mississippitoday.org – Caleb Bedillion, The Marshall Project – 2024-11-12 11:00:00

Sweeping corruption charges have rocked local government in Mississippi’s capital city, with potentially significant implications for the local legal system. 

During arraignments on Thursday, federal prosecutors charged Hinds County District Attorney Jody Owens, Jackson Mayor Chokwe Antar Lumumba and Jackson City Councilmember Aaron Banks with a string of bribery and corruption charges.

All three pleaded not guilty and were released pending trial.

The charges stem from an undercover sting operation in which FBI agents posed as real estate developers and allegedly provided bribes to win the support of local officials.

Former Jackson City Councilmember Angelique Lee and local businessman Sherik Marve’ Smith previously pleaded guilty to corruption charges as part of plea agreements. 

All three officials charged Thursday have influence over the local legal system in Mississippi’s largest city and county. Owens is the county’s prosecutor, with sweeping power over felony prosecutions in a county that has struggled with violent crime, a backlog of cases and a troubled jail. 

Lumumba appoints the Jackson police chief. Lumumba has fought against the creation of a state-controlled police force with jurisdiction within certain areas of the city, as well as a special state-controlled court for those areas. His beleaguered legal position may only strengthen the efforts of statewide leaders to exert more control over local policy within the state’s capital city.

Banks, as a councilmember, votes to confirm or reject Lumumba’s appointments, including police chief. The city council also sets the budget for city government departments, including the police department and the municipal court. The Jackson City Council can also impose other policies, including a controversial youth curfew policy that came earlier this year.

Can Owens, Lumumba and Banks remain in office while facing criminal charges?

Yes. While the Mississippi constitution forbids anyone who has been convicted of almost all felonies from holding elected office, nothing requires a person to resign or take a leave of absence from their job before a conviction. 

Owens on Thursday indicated no plans to resign. Instead, he said he would fight what he called a “flawed FBI investigation” and said, “I’m going to get back to protecting Hinds County and being the district attorney that you elected me to be.”

Owens’ predecessor, Robert Shuler Smith, faced multiple state criminal prosecutions during his tenure in elected office and never resigned. None of the charges brought against him by then-Attorney General Jim Hood ended in a conviction.

In 2016, then-state Rep. Nick Bain filed a bill that would have created a process to remove local officials from office following an indictment, but that bill never advanced. 

The state constitution allows people convicted of manslaughter and state or federal tax crimes to hold elected office. 

What happens if Owens resigns?

Owens was most recently elected in 2023 for a four-year term that began January 2024 and will run through the end of 2027. If he’s not convicted before then, he can complete the entire term and even qualify for reelection again. If he were to be convicted or plead guilty before the end of 2027, he would be removed from office.

On Thursday, U.S. District Court Judge Daniel P. Jordan set a trial date for Jan. 6, but delays in criminal cases are common.

If Owens resigns or is removed with more than six months remaining in his term, Gov. Tate Reeves will appoint someone to replace him until a special election can occur. Special elections to replace a district attorney generally occur as needed in November of each year. 

If Owens were to resign now, that means a gubernatorial appointee would serve as Hinds County’s district attorney for a year until a special election in 2025. Any qualifying candidate could run in the special election to fulfill the term, including the gubernatorial appointee. 

If Owens were to resign or be removed from office with less than six months remaining in his term, the governor would simply appoint someone to fulfill the term and the winner of the regularly scheduled general election would take office at the beginning of the next term. 

What would happen if Lumumba or Banks were to resign or be removed from office?

The current terms of both Lumumba and Bank conclude next year, with municipal general elections set for June and new terms beginning in July.

Lumumba said on Thursday that he will continue to run for reelection. Banks declined to answer questions about whether he intends to remain in office or to seek another term.

If either Lumumba or Banks were to resign with less than six months remaining in their term, state law requires that the Jackson City Council would replace either with interim appointments who would serve the remaining months of the terms.

If either man were to resign or be removed before the end of 2024, the City Council would have to order a special election to fill the vacant posts.

Can voters recall elected officials in Mississippi?

Mississippi does have an obscure and very roundabout recall process, but only for county officials, despite several unsuccessful efforts to expand the law. State Sen. Jeremy England, a Republican from the Gulf Coast, has filed some of those bills, and said he did not think a district attorney could be recalled under the current law, but they could have been recalled under a bill he has filed before. 

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

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On this day in 1914

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mississippitoday.org – Jerry Mitchell – 2024-11-12 07:00:00

Nov. 12, 1914

Civil rights leader William Monroe Trotter pictured in 1915. Credit: Wikipedia

Civil rights leader William Monroe Trotter led a delegation that confronted President Woodrow Wilson. 

Raised in Hyde Park, Massachusetts, Trotter had more education than the president. He had graduate and postgraduate degrees from Harvard University, where he became the first Black member of Phi Beta Kappa. 

“New Englanders liked to talk as if ‘the Negro problem’ afflicted only the South,” The New Yorker wrote of him, “but Trotter looked around his beloved Boston and saw segregation in the city’s churches, gyms, and hospitals. This ‘fixed caste of color’ meant that ‘every colored American would be a civic outcast, forever alien in public life,’ he wrote.” 

In 1901, he started The Guardian with the motto: “For every right, with all thy might.” The newspaper called itself “an organ which is to voice intelligently the needs and aspirations” of Black Americans.” 

Both he and his wife, Deenie, published The Guardian each Saturday, only missing two issues: “The Trotters had no children and did not want any; The Guardian was their child.” 

In their pages, Trotter leveled vicious attacks against Booker T. Washington and his accommodation policies, calling him “the Great Traitor.” When Trotter began to question Washington at a gathering of 2,000, a fight broke out, which became known as “the Boston riot,” and he was arrested, spending 30 days in jail. The wealth his family once enjoyed turned to poverty because of the money he sunk into his newspaper. 

“It has cost me considerable money, but I could not keep out of it,” he wrote. “I can now feel that I am doing my duty and trying to show the light to those in darkness and keep them from at least being duped into helping in their own enslavement.” 

He turned his attention to political candidates he felt would support African Americans and began backing Wilson, whom he met and shook hands with in 1912 “with great cordiality.” 

A year later, he and Ida B. Wells and other civil rights leaders expressed dismay over the reinstitution of Jim Crow and even shared a chart that showed which federal offices had begun separating workers by race. 

In 1914, Trotter and other Black leaders appeared at the White House with 20,000 signatures, demanding an end to Jim Crow in federal offices. The leaders told Wilson they felt betrayed because they had supported him in the election, and he had since reinstituted segregation in the federal government that included separate toilets and dismissed high-level Black appointees. 

“Only two years ago you were heralded as perhaps the second Lincoln,” Trotter said, “and now the Afro-American leaders who supported you are hounded as false leaders and traitors to their race.” 

He reminded the president — who had been busy championing his “New Freedom” program to restore fair-labor practices — that he had promised to aid Black Americans in “advancing the interest of their race in the United States. … Have you a ‘New Freedom’ for white Americans and a new slavery for your Afro-American fellow citizens? God forbid!” 

Wilson responded that “segregation is not humiliating but a benefit” and that he had put the practice back in place because of friction between Black and white clerks. Trotter challenged this claim, calling Jim Crow humiliating to Black workers. 

Wilson stuck to his guns, telling Trotter that if he and other Black Americans think “you are being humiliated, you will believe it.” The exchange lasted 45 minutes, and the president challenged Trotter’s “tone” as offensive: “You have spoiled the whole cause for which you came.” 

The civil rights leader responded, “I am pleading for simple justice. If my tone has seemed so contentious, why has my tone been misunderstood?” 

The argument landed on the front page of The New York Times. During World War I, the State Department refused to give Trotter a passport to Paris. To get around the restriction, he took a job as a cook on a freighter to France, and when he began reporting on the plight of Black soldiers, French newspapers shared his reporting, and he spoke there about discrimination against African Americans. 

When Trotter returned home, he was welcomed by 2,000 supporters. He unsuccessfully championed a section added to Wilson’s 14 Points for peace that would say, “The elimination of civil, political, and judicial distinctions based on race or color in all nations for the new era of freedom everywhere.” 

Trotter helped found the Niagara Movement, a forerunner of the NAACP. The civil rights organization adopted his proposal to address segregated transportation as a grievance, but the group rejected his proposal to make lynching a federal crime. 

He championed cases the NAACP was slower to pursue, including Jane Bosfield, a Black woman was told she could only work for a Massachusetts hospital if she ate separately from her white fellow workers. 

When the racist movie, ‘The Birth of a Nation’, appeared on a screen, the national NAACP tried to raise money for a rival film to counter those lies, but Trotter believed in direct action. His protests succeeded in shutting down a play that was the basis for the movie, which depicted Klansmen as heroes. After failing to halt the debut of the film in Boston, he teamed up with Roman Catholics to get a revival showing canceled. 

His tactics were later used by the modern civil rights movement “to integrate lunch counters, buses, schools, and other essential spaces,” The New Yorker wrote. And his mindset “incubated the politics of Malcolm X and of the Reverend Martin Luther King Jr.” 

A multicultural center at the University of Michigan bears Trotter’s name, and his first home in Dorchester is now a National Historic Landmark. He made the list of the 100 Greatest African Americans.

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

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DOJ lawsuit: Mississippi Senate paid Black attorney half what white colleagues made

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mississippitoday.org – Emily Wagster Pettus, Associated Press – 2024-11-11 09:25:00

JACKSON, Miss. (AP) — The Mississippi Senate discriminated against a Black attorney by paying her about half of what her white colleagues were paid for doing the same job, the U.S. Justice Department says in a lawsuit it filed Friday.

“Discriminatory employment practices, like paying a Black employee less than their white colleagues for the same work, are not only unfair, they are unlawful,” said Assistant Attorney General Kristen Clarke, head of the Justice Department’s Civil Rights Division.

Kristie Metcalfe worked as a staff attorney for the Mississippi Senate’s Legislative Services Office from December 2011 to November 2019. Attorneys for the nonpartisan office write bills and handle other legal questions for the 52 senators. Many of them stay on the job for decades.

The Senate office employed only white attorneys for at least 34 years before Metcalfe was hired, and she was the only Black attorney on staff during her time there, the lawsuit said.

Metcalfe’s starting salary was $55,000, while other Senate staff attorneys were paid $95,550 to $121,800, according to the lawsuit. The other attorneys received pay raises about a month after Metcalfe was hired, making their salary range $114,000 to $136,416. Metcalfe did not receive a raise then.

The current governor, Republican Tate Reeves, presided over the Senate as lieutenant governor from January 2012 until January 2020 — most of the time Metcalfe worked for the Senate.

The Associated Press sought comment about the lawsuit Friday from Reeves and current Lt. Gov. Delbert Hosemann, who is also a Republican.

“We do not comment on pending litigation,” said the current secretary of the Senate, Amanda Frusha White, who works for Hosemann.

Metcalfe’s salary remained $40,000 to $60,000 less than her lowest-paid white colleague during her years on the job, the lawsuit said. It also said the Senate hired another attorney, a white man, in December 2018 and set his salary at $101,500, which was $24,335 more than Metcalfe was being paid at the time.

Metcalfe and the new attorney both had eight years’ experience practicing law, although the new attorney had not yet worked for the Legislature. They were assigned the same types of work for the Senate, the lawsuit said.

The lawsuit said Metcalfe complained about the pay disparity to with then-Sen. Terry Burton, a Republican. As the Senate president pro tempore, Burton was chairman of the Rules Committee, which sets staff salaries. He denied Metcalfe’s request to equalize her salary with that of her new colleague, the lawsuit said. She resigned about 11 months later.

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

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