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Medicaid director wants expansion into managed-care program

Healthcare_logo_rgbJACKSON — Mississippi’s Medicaid director wants to expand a managed-care program that he says has helped save the state about $40 million.

David Dzielak said 22 percent of Medicaid recipients are in managed care, in which a company is paid a set fee to provide medical services, regardless of the services’ actual cost.

Dzielak said during a recent meeting at the Capitol that he’ll ask lawmakers’ permission in 2014 to expand managed care, according to the Northeast Mississippi Daily Journal.

“The people Medicaid serves are some of the most vulnerable in the state,” Dzielak said. “They make for some of the most difficult patients to manage.”

During the 2012 session, lawmakers gave Medicaid permission to put up to 45 percent of its recipients in managed care, but they said certain services would be exempt. For instance, hospitals are reimbursed under a fee-for-service model in which they are paid for the care provided.

Critics say managed care companies make money by limiting recipients’ access to health services.

Dzielak said managed care “places some predictability in costs” and also results in better health care outcomes. The managed care companies have an incentive to practice preventive medicine to hold their costs down. He said health care outcomes have improved in several areas for managed care patients.

Rep. Steve Holland, D-Plantersville, a former chairman of the House Public Health Committee, said he believes managed care has served a purpose in Medicaid. He said the educational component of managed care that helps recipients to learn how to deal with high blood pressure, for instance, has worked both to curb costs and produce better health outcomes.

But he said he is concerned about managed care companies “cherry-picking” recipients to sign up the most healthy, and thus, least costly.

“I am not saying we need to expand the program,” Holland said. “I think we are just about at the threshold. I like it right at about 45 percent.”


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One comment

  1. You know, I realize this is a Catch 22 situation, and that were we to deplete our resources, EVERY eligible person could receive NO healthcare at all. However, “Critics say managed care companies make money by limiting recipients’ access to health services.” is a scary, scary statement. I’m fairly certain that I don’t want ANYone else to be limiting my disabled daughter’s access to health services.

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