Jackson Jambalaya

The House Committee on Medicaid held a hearing on the MississippiCan program last week on March 17. MississippiCan is an attempt by Medicaid to imitate Medicare Advantage. The program is administered by United Health Care and Magnolia Health Plan (Centene is the parent company.). Medicaid pays the two companies a capitated rate. Under a capitated rate plan, Medicaid pays the insurance companies a flat fee per patient. The insurance companies keep the difference between the health care costs for the patient and the capitated rate (See March 1, 2010 on MississippiCan below.) thus there is a financial incentive to contain health care costs.

Medicaid representatives at the hearing stated the program aimed to save the state five percent a year in Medicaid expenditures. Medicaid made several classes of enrollees eligible for MississippiCan: SSI, disabled child at home, working disabled, Department of Human Services Foster Care, and breast/cervical group patients. Medicaid claimed these groups had the highest costs.

The program has generated no small amount of controversy, as was evidenced at the hearing. Medicaid, UHC, and MHP representatives all predictably extolled the virtues of MississippiCan. It was going to lower costs. Personal stories of patients saved by MississippiCan were told. It broke new ground in actually being proactive in focusing on the patient's healthcare. Mom. America. Apple Pie. Who could be against MississippiCan?

Well, more than a few health care providers are. This correspondent has spoken to several who have experienced MississippiCan and the picture is not pretty. The testimony of several doctors at the hearing support what was privately reported to JJ. Medicaid states the program is voluntary. However, what Medicaid does is enroll the patient in MississippiCan and allows them to opt-out if a form is submitted. Many patients submitted such forms in December only to find out after January 1, 2011 the forms did not matter as Medicaid enrolled them in MississippiCan anyway. This is a big deal when the patients find out their doctors or therapy providers are not enrolled with either of the two plans.

In-network? What do you mean Kingfish. Frankly, MississippiCan is a cluster____ as it is creating many problems with healthcare providers. Medicaid actually had a very good system. If a provider submitted the proper paperwork before a deadline each week, Medicaid paid the claim a week later. Providers are now being told by UHC and MHP the payments can take over thirty days and up to ninety days to be made to the health care provider. Keep in mind these providers are not all hospitals enjoying millions of dollars in revenue streams. Many are special-needs therapists, pediatricians, solo practicioners, and others who aren't exactly able to enjoy a sudden cut-off in income for several weeks or months. In other words, small businesses we conservatives claim to love so much.

The insurance companies operate as do most in the industry: there are in-network and out-of-network health care providers. The in-network providers are paid a higher rate for services rendered to the patient than are those out-of-network. Unfortunately for the health-care providers, few were enrolled with either insurance company on January 1. Many of the providers lose money on the out-of-network rates and more than a few have quit accepting MississippiCan. Few, if any, will go on the record to complain about this because Medicaid has earned a reputation for auditing health care providers that make the wheel squeak too loudly. Then there is the paperwork. One doctor testified at the hearing it took her 45 minutes to an hour to complete the paperwork only she could complete for ONE MississippiCan patient.

Several providers reported to JJ the two insurance companies tell them it takes up to 90 days (or more in some cases) to process their application to become in-network providers. Not a big deal unless you are the mother of a special needs child forced to suddenly find a new pediatrician because the one who treated him his whole life is now suddenly out-of-network or is not enrolled with either company. Then she finds out there are only two or three such doctors in her area and oh, by the way, its going to take a while to get one to see a new patient. If the doctor will accept the patient.

The stories about the enrollment mess among healthcare providers sounds very similar to the one created when the government forced radical changes upon real estate appraisers two years ago. No one is prepared, there is a huge bottleneck of providers trying to get enrolled, and many face a sudden termination of revenue. Several have been forced to lay off employees as they were not able to afford such a drastic change in circumstances. These companies are small businesses. They don't get rich off of Medicaid patients but can't afford to see MississippiCan patients if they can't get paid. That is one tenant of capitalism you know: have to avoid losing money in order to stay in business.

The Mississippi Chapter of the American Academy of Pediatrics issued a statement (posted below) that argued "MississippiCan is not resulting in improved quality of care, improved efficiency, less paperwork,and more preventative care as Medicaid promised." Dr. Weissenberger gave her own stories that were in sharp contrast to the rosy picture portrayed by the suits (Her letter is posted below.). The CEO and CFO of Grenada Lake Medical Center damned the program as well. He made it quite clear no patient is turned away that needs help but the program is a huge mess they can no longer handle (My apologies. The camera only had two hours of memory and his testimony was not recorded.). Meanwhile, Mary Troupe of the Citizens with Disabilities downplayed the concerns of the doctors and those with complaints about the program as she shilled for MississippiCan. She testified it is a much-needed program, worked well in other states, and while the complaints didn't need to be ignored, not too much weight should be given to them as all of these companies were good folk that are going to work things out and have already made a positive difference for Medicaid patients.

Documents presented to Committee:
United Health Care Highlights
Mississippi Medicaid facts on MississippiCan
Magnolia Health Plan
Dr. Weissenberg's letter, Agenda, Letter from Academy of Pediatric Physicians



Agenda:
Opening remarks: Chairman Dirk Dedeaux
Medicaid: Phyllis Williams
United Healthcare: Jeff Drozda
Centene/Magnolia Health Plan: Pam Shipley
MHA: Mike Bailey
Grenada Lake Medical Center: Keith Hartsill, CEO
Citizens for Disabilities: Mary Troupe
American Academy of Pediatric Physicians: Dr. Weissenberg
Physician: Dr. Gerrihill Chance