Mississippi Today
Medicaid’s managed care contracts at a standstill after two companies cry foul
More than a year after Mississippi Medicaid announced it was contracting with three companies to manage the care of their beneficiaries, those contracts have not been awarded.
That’s because two companies that weren’t chosen say the selection process was unfair.
UnitedHealthcare and Amerigroup, two for-profit managed care companies, were not chosen by Mississippi Medicaid as one of its contracted companies entrusted with managing beneficiaries’ health care. The two organizations have subsequently filed protests with the state, alleging the selection process was flawed, leading to a months-long stalemate over who will manage Mississippi Medicaid beneficiaries’ care after next summer.
The stakes are high: the contracts, funded by state and federal dollars, are worth billions.
The majority of Medicaid recipients in most states are enrolled in managed care organizations. Through a lucrative contract agreement, divisions pay these companies to deliver services to beneficiaries.
In exchange for a monthly payments — regardless of whether services were or were not used by a beneficiary during that period — the managed care organization must maintain a network of providers for its enrollees and ensure enrollees are not billed for covered services.
Managed care for Mississippi Medicaid beneficiaries began in 2011 with the inception of the division’s “coordinated care program,” or its managed care system called MississippiCAN.
According to its website, MississippiCAN currently provides health insurance benefits for more than 480,000 of the state’s most vulnerable citizens, including poor adults and children, people who are disabled and pregnant people. Medicaid insures about 837,000 Mississippians total as of September.
Though they’re theoretically well-intentioned — to increase services for beneficiaries and reduce costs for Medicaid — managed care organizations have been criticized by politicians, patients and health care leaders for prioritizing profit and hindering patient care.
Managed care organizations’ performances can vary greatly, and which ones the Medicaid agencies contract with is up to them. That’s decided through a process called procurement.
In December 2021, the Division of Medicaid began seeking new contracts and solicited “requests for qualifications” from managed care companies. Five prospective contractors submitted proposals in March 2022.
Mississippi Medicaid announced in August 2022 that it intended to award contracts to three of those: TrueCare, Magnolia Health and Molina Healthcare.
TrueCare, a not-for-profit company, was created by hospitals along with the state hospital association to provide what they believe is better care to patients, compared to traditional managed care organizations.
Molina Healthcare and Magnolia Health are both privately-owned companies that already administer services to Medicaid beneficiaries, along with UnitedHealthcare.
Magnolia has gotten the biggest contracts of all three — almost $9.3 billion for its contracts with Medicaid since 2017, which includes $1.2 billion in the emergency contract.
Magnolia is a subsidiary of health giant Centene. The St. Louis-based company is the nation’s largest Medicaid managed care company and one of Gov. Tate Reeves largest campaign donors.
Centene was previously investigated over suspicions it was over-inflating bills to Mississippi’s Medicaid division. The company never admitted wrongdoing, though Centene settled with the state in June of 2021 for $55.5 million.
Medicaid spokesperson Matt Westerfield said there were no “rules that would exclude Magnolia from the process due to the Centene settlement” when asked why, if the company was previously investigated, it was awarded one of the contracts.
Since 2017, Molina has been paid $2.8 billion to provide services for MississippiCAN and Medicaid’s Mississippi Children’s Health Insurance Program, according to the state’s contract database. In the most recent contract, the emergency contract that runs from 2023 until 2024, the company is getting paid more than half a billion dollars.
For the same services in the same time period, United received nearly $8.4 billion. The current emergency contract pays out more than a billion dollars for their services over the course of a year.
Companies involved in the process have seven days to file protests before the agency can officially award the contracts. Then, the contracts go to the state’s procurement review board for final approval.
Following Medicaid’s announcement about the new contracts in August, UnitedHealthcare, which had a contract with the agency the prior year, and Amerigroup, the two companies that were not chosen, submitted protests.
It’s unclear what United’s claims are. Mississippi Today did not have a copy of their protest at the time of publication.
Amerigroup’s protest alleges that Mississippi Medicaid failed to conduct a “blind” evaluation process, didn’t follow the state’s rules for contract procurement, the process was structurally flawed and “outside influences” affected its fairness.
Amerigroup cites several instances where it says companies shared identifying information. According to the protest, TrueCare revealed its connection to the Mississippi Hospital Association by mentioning the health information exchange program, which allows hospitals to share important information about patients with each other. It’s the only company with access to the exchange because of its association with hospitals.
Amerigroup also takes issue with Molina including a company-specific vaccine incentive program, “curved” graphics similar to their logo and “well-known” Molina food insecurity initiatives in its proposal. Magnolia’s proposal included mentions of its partnership with Adelade and AT&T, which would have been enough to identify them, the protest claims.
Magnolia and Molina did not respond to Mississippi Today’s requests for comment regarding these allegations. TrueCare’s CEO Richard Roberson declined to answer questions because “under the Division of Medicaid’s rules, all offerors are prohibited from making public disclosures to the media regarding the procurement.”
The “outside influences” cited by Amerigroup’s protest refers to a letter Sen. Kevin Blackwell, R-Southaven and chairman of the Senate Medicaid Committee, sent to Mississippi Medicaid Executive Director Drew Snyder on Dec. 3, 2021, a few weeks before the procurement process began. Blackwell in the letter vouches for TrueCare and criticizes the performances of the current managed care organizations.
Westerfield said the letter was “never seen by any evaluator, nor was any evaluator made aware that it had even been written.”
“It had no effect on the RFQ process or outcome,” he said.
The protest also includes a screenshot of texts between Drew Weiskopf, a consultant assisting with the evaluation, and Margaret Middleton, a lawyer for Mississippi Medicaid. In the texts, Weiskopf appears to insinuate that the evaluators were able to identify the companies — he refers to their “urge to standup (sic) and shout ‘I know who this is!’” and uses a GIF from the movie Elf in which a character identifies Santa Claus. The texts were allegedly sent during the evaluation meetings scoring the blind proposals.
“The texts do not reflect that any evaluator expressed knowledge of any Offeror, nor could the texts have done so, as no expression was ever made,” Westerfield said.
The Division of Medicaid’s response to the protests, which was to affirm its decision to award the contracts to the three managed care organizations, were issued this past summer. Both organizations appealed the agency’s decision to the procurement review board, and both of those protests are still pending.
As a result of the ongoing complaints, Medicaid extended the contracts of the current managed care organizations — United, Molina and Magnolia — and then issued one-year emergency contracts to them. Those contracts, which began in 2017, will be in place until June 2024.
Violations during the “blind” portion of the process have previously derailed Mississippi Medicaid’s procurement process.
Medicaid Executive Director Drew Snyder told lawmakers at a Senate Medicaid Committee hearing last February that “following the instructions for blind evaluations is one of the perilous spots where procurements can go off the rails.”
“I’m sure more than one agency can share a story of a lengthy procurement that had to be terminated because every vendor revealed some kind of identifying information about itself,” he said.
During a Medicaid procurement for different services two years ago, the agency confirmed that a company’s name appeared in a footnote, which delayed the process.
During the current procurement for managed care contracts, Medicaid said it took several steps to ensure the process was fair, including extensively reviewing submissions, including an independent review by a government office that plays a major role in state procurement processes, which found no problems. The agency also required mandatory training for procurement evaluators, who were “told repeatedly to inform [the Division] if they found any identifying information,” according to the agency.
“No evaluator ever notified DOM that he or she knew the identity of any Offeror, nor did any evaluator make any statement in the evaluation process inferring that he or she knew the identity of any Offeror,” Westerfield said via email.
The fate of the contracts now rests with the procurement review board, which has not yet set a date to hear the protests.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Senate passes its income tax cut plan
The Senate voted Monday evening to pass a tax cut that reduces the state income tax and the sales tax on groceries while raising the gasoline tax, setting up negotiations with the House.
The measure passed the GOP-majority Senate 34-15, with four Democrats supporting it and four Republicans opposing it. It now heads to the House, whose leadership is advocating for its own plan, which would eventually eliminate the state individual income tax.
The Senate plan amounts to a net tax cut of $326 million, a more modest sum than the $1.1 billion net cut passed by the House. The Senate would reduce the state’s flat 4% income tax to 2.99% over four years, while the House would eliminate the income tax over more than a decade.
Senate Finance Chairman Josh Harkins, a Republican from Flowood, told reporters that the legislation was a responsible way to cut taxes while slightly increasing the gasoline tax to provide more revenue for infrastructure funding.
“I think we’ve put forward a really good plan that helps families at the grocery store by lowering the sales tax on groceries,” Harkins said. “And it provides incentives and rewards work.”
The Senate plan would reduce the state’s 7% sales tax on grocery items, the highest in the nation, to 5% starting July 2025. Municipalities receive a portion of grocery tax revenue, and the Senate plan would make cities whole.
The Senate bill would raise the state’s 18.4-cents-a-gallon gasoline excise by three cents yearly over the next three years, eventually resulting in a 27.4 cents-per-gallon gas tax at completion. This is an effort to help the Mississippi Department of Transportation with a long-running shortfall of highway maintenance money.
Most of the chamber’s Democratic members opposed the plan over fears that the state could not afford to wipe out around half a billion dollars each year from its budget and still address some of the state’s critical issues such as public education and health care.
“That’s a lot of money, and we need that money for basic infrastructure,” Democratic Sen. Hob Bryan of Amory said. “Everyone benefits from infrastructure.”
Some Democratic members attempted to amend the bill to eliminate the grocery tax or change the tax structure to avoid increasing the gas tax. But the GOP-majority chamber on party-line votes defeated the amendments.
Four Republican senators voted against the final measure because it raised the gasoline tax, something they viewed as going against the GOP’s core ideology.
Sen. Angela Burks Hill, a Republican from Picayune, told reporters the gas tax increase would hurt rural people the most because they have to drive further for work and to purchase groceries.
“I’m just trying to follow my party’s platform of low taxes,” Hill said.
Now that both chambers at the Capitol have passed separate tax proposals, the key question will be how much legislative leaders can compromise on a final package. House Speaker Jason White, a Republican from West, and Republican Gov. Tate Reeves have said abolishing the income tax is their primary goal this session.
White previously told Mississippi Today that he’s willing to compromise with the Senate, but he wants a final tax cut that’s substantive and meaningful.
“We’re not interested in a small piece of a tax cut while not addressing other issues,” White said.
Reeves has thrown cold water on the Senate’s proposal because it doesn’t entirely eliminate the income tax. If lawmakers can’t agree on a proposal, he could call them into a special session to address taxes.
Harkins, though, said he hopes lawmakers can “build consensus” on a final package during the regular session. House and Senate leaders will likely debate the measure for the next month. The deadline for lawmakers to approve tax and appropriations bills is March 31.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
City goes to the suburbs, and Germantown is the winner
Can’t tell you how many times I’ve been asked this question in recent years: What has happened to Jackson Public Schools basketball?
Good question.
And I do know the answer, at least a large part of it. But first some background.
Used to be, you could count on several JPS powerhouses to bring huge crowds to the State Tournament at Mississippi Coliseum every February to watch Murrah, Lanier, Provine, Callaway and Jim Hill teams that annually produced some of the greatest basketball talent in Mississippi history. Often, fire marshalls stepped in and locked the Coliseum doors with still hundreds of fans outside hoping to get in.
That’s no longer the case. Not a single JPS boys team made it to the State semifinals this year. (The Lanier girls will play Choctaw County in a 4A semifinal game Wednesday afternoon.) Even just a decade ago, no JPS boys teams in the State Championships would have been heresy. This is not to say that the Jackson metro area is not represented at the Big House. Northwest Rankin, Brandon, Germantown and Madison Central teams all played in the semifinals on Monday. The Canton girls and boys will play Tuesday.
The suburbs are killing it. Inner city Jackson is not.
OK, so here’s a major reason why: In many cases, the city has moved to the suburbs. This is best illustrated by how the Germantown team from out Gluckstadt way hammered Biloxi 55-30 in the Monday noon Class 7A semifinals.
There were Germantown guards Michael and Mason Williams controlling the flow of the game with their ball-handling, passing and defensive skills. There was 7-footer Sam Funches IV dominating the paint at both ends with his length, nifty footwork and soft touch around the basket. There was guard/forward Michael Johnson contributing in so many ways with hustle and grit. And there was Devin Moore, a sturdy, 6-5 guard/forward scoring nine points on just five shots and also contributing five rebounds, three assists and two steals.
Here’s the deal: Michael Williams (a senior) and Mason Williams (a junior) are the sons of Mo Williams the former Murrah, Alabama and NBA great who now coaches at Jackson State. Funches is the son of Sam Funches III, who also played at Murrah, was recruited by Jim Calhoun at Connecticut and finished his career at North Texas. Johnson’s dad, Trey, played at Murrah and then was the SWAC Player of the Year at Jackson State before a long professional career in the NBA and overseas. Moore’s dad and an uncle both played at Jim Hill. Now, all live in Madison County and have turned the Germantown Mavericks, 23-5, into a powerhouse. The Mavs will play neighboring Madison Central in the 7A championship game, which will be played Thursday night at 8 p.m.
Said Mo Williams, who watched Monday’s proceedings from a seat in the Germantown cheering section, “It’s pretty obvious, isn’t it? It’s like the city has moved to the ‘burbs.”
We weren’t three minutes into the Germantown-Biloxi game when brothers Michael and Mason Williams combined to make a play that reminded we longtime Jackson-area fans of the kind of plays their daddy made at Murrah. Mason lofted a high, looping alley-top pass high above the basket. Michael , who will play for his dad at Jackson State, soared high above the rim and slammed the ball through to give the Mavs a lead they never relinquished.
Michael dunked again moments later, swished a three-pointer after that, and then scored on a spin move and a mid-range jumper seconds later. Before you knew it, a 7-6 deficit turned into at 21-11 lead,
Meahwhle, Funches IV, a 16-year-old junior, showed why virtually every college basketball coach in the country is recruiting him. Yes, he needs to get stronger. He could be – and probably will be – more aggressive. But you can’t teach a kid how to be 7 feet tall, and you can’t teach the deft shooting touch he already possesses. That’s inherited. These Germantown players inherited well.
This time last year, Mo Williams’ sons were helping Jackson Academy win the overall private schools state championship at Jackson Academy. Now they are trying to win a public schools championship.
Michael asked me: “Has anybody ever done that?”
I don’t know. I thought Andy Kennedy, the former Ole Miss and current UAB coach, might have done it back when he still had hair and transferred from Winston Academy to Louisville High School. But Kennedy text-messaged back: ”We won it at Winston but only won the north half at Louisville, got beat in the semifinals at the Coliseum.”
Somebody else might have done it. I don’t know. I do know precious few have had the opportunity.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Feb. 24, 1956
U.S. Sen. Harry F. Byrd Sr. coined the term “Massive Resistance” to unite white leaders in Virginia in their campaign to preserve segregation. The policy appealed to white Virginians’ racial views, their fears and their disdain for federal “intrusion” into the “Southern way of life.”
Virginia passed laws to deny state funds to any integrated school and created tuition grants for students who refused to attend these schools. Other states copied its approach.
When courts ordered desegregation in several schools in Charlottesville and Norfolk, Virginia Gov. James Lindsay Almond Jr. ordered those schools closed. When Almond continued that defiance, 29 of the state’s leading businessmen told him in December 1958 that the crisis was adversely affecting Virginia’s economy. Two months later, the governor proposed a measure to repeal the closure laws and permit desegregation.
On Feb. 2, 1959, 17 Black students in Norfolk and four in Arlington County peacefully enrolled in what had been all-white schools.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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