In 2013, about 22 percent of the state’s Medicaid recipients were enrolled in a managed care program where an insurance provider receives a set fee to provide medical services regardless of how costly those services are. Now, according to the Division of Medicaid, officials say approximately 70 percent of the around 709,000 enrolled in the Medicaid are in a managed care program.
Erin Barham, a spokeswoman for the Division of Medicaid, said, “The goals (of managed care) are to improve access to care, the quality of care, and health-care outcomes and therefore, reduce the overall cost of the program through cost avoidance.”
Almost from the beginning of the program when first authorized by the Legislature in 2011, there have been complaints from the state’s health care providers that the managed care companies have tried to hold down their cost by denying or curtailing needed health care services and have been slow to reimburse providers for the services they provide.
Rep. Tracy Arnold, R-Booneville, said he is trying to build a base of support to pass legislation to scrap the managed program and go back to the traditional Medicaid program where health care providers are paid a set fee for each service they provide.
He said research has not shown that managed care is meeting its goals – to provide preventive services and thus improve the health care of the recipients and to hold down the expenses in the program that is now costing about $1 billion annually in state funds and about $6 billion counting federal funds.
“It appears the managed care companies are more interested in managing money than people’s health care,” said Arnold, who said he hears constant complaints about the Medicaid managed care program from recipients and their providers.
Arnold said several years ago legislators had to quietly delay passage of the Medicaid appropriations bill to force one of the managed care companies to properly reimburse Magnolia Hospital in Corinth.
And once he received a phone call from the wife of a Booneville physician concerned that the managed care company was not approving a test for a child whom the doctor feared might have a brain tumor. The company eventually approved the test, which revealed the child did have a tumor.
“My fear is somebody will die because they do not know who to call to complain,” said Arnold, who said he made phone calls on behalf of the child and other Medicaid recipients in Prentiss County.
A 2016 report compiled for legislators and first reported by online news source Mississippi Today cites problems with both the oversight and efficiency of Medicaid’s managed care program.
But Medicaid officials say the managed care program is making strides with a difficult population. Medicaid provides health care for the disabled, poor pregnant women, poor children and certain groups of the elderly.
Legislators have placed pressure on Medicaid Executive Director David Dzielak to curb costs in the program, which is the fastest growing agency in state government. But Dzielak has told legislators that a tiny fraction of the Medicaid costs are administrative and that his agency is faced with having to pay for the health care that the recipients receive.
“We’re starting in a pretty big hole,” Dzielak said to legislators in a 2016 hearing. “We are 50th in every (health care) category,” meaning Mississippi has a lot of unhealthy people who are placing a drain on the state’s revenue.
The goal is that managed care will make the costs more predictable and will provide preventive care that will help people remain healthy and less of a cost to the state.
“We are looking for them (managed care companies) to be not just case managers, but care mangers,” Dzielak told legislators.
But many legislators like Arnold say they do not see any curtailment in Medicaid costs, but they do hear multiple complaints about the managed care programs.
Gov. Phil Bryant, who appoints the executive director, said he would like to see more research on the effectiveness of managed care.
But the governor said Dzielak has his confidence.
“Running Medicaid is one of the most difficult jobs in the state,” Bryant said.
Dzielak is currently embroiled in litigation where a coalition of Mississippi hospitals that formed its own managed care company was bypassed for a California company for a Medciaid contract. The coalition says Dzielak had a conflict in awarding the contract because he had discussed an employment position with the California company. Medicaid has maintained the contract was properly awarded.
Sen. B Hob Bryan, D-Amory, said the state missed an opportunity by not putting into law that the hospitals would be given special consideration in awarding the managed care contracts The hospitals have been critical of the managed care companies, saying they are refusing needed medical procedures for Medicaid recipients.
Bryan said the hospitals “went to great lengths” to form their own managed care company and should be given the opportunity to if they can do a better job at providing services than the other companies.
“But that was the legislators’ fault for not mandating that in law, not Dr. Dzielak’s,” Bryan said. He said the Legislature in January could mandate that Medicaid give a certain percentage of recipients to the hospitals’ managed care company.
But he said it would be difficult to return to the old system where providers were just paid for each medical procedure, saying it resulted in unneeded procedures and costs the state could not sustain.