Medicaid, costs and quality of care, big issue of 2018 legislative session

Mississippi Clarion Ledger

Mississippi lawmakers are gearing up to address the sunset this legislative session of the state's heavily debated Medicaid program, which provides health insurance to more than 760,000 Mississippians.

This tasks the Legislature with reauthorizing the Division of Medicaid through what's called the "Medicaid technical amendments bill." It's an opportunity for lawmakers to reexamine the program and make significant changes.

Dr. Steve Demetropoulos, a Coast-based emergency care physician and chairman of the Medical Care Advisory Committee, presented his committee's recommendations to the Senate Medicaid Committee Wednesday.

Demetropoulos argued in favor of spending money on the front end, mostly on items aimed at improving Mississippians health, to save money on the back end in avoided medical costs.

One example is a drug Medicaid could deliver to pregnant mothers, who have delivered babies prematurely in the past, that reduces the chance of another premature birth by one-third.

Giving birth for moms on Medicaid costs an average of $5,300 when the pregnancy is full term, whereas births between 32 and 37 weeks cost $15,000, nearly three times as much. Plus, there are often additional long-term health problems, and therefore costs, for babies born prematurely, Demetropoulos argued.

Mississippi has both the highest rate of babies born with low birth weights as well as infant mortality. These are both factored into Mississippi's 50th ranking, making it the least healthy state in the country, in America's Health Ranking's recently -released 2017 report.

Demetropoulos also advocated to increase the limit of prescriptions for Medicaid recipients from five to eight. He described a scenario where a patient takes several regular medications for chronic issues and then gets sick, requiring him or her to take another, exceeding the limit.

"They should never get where they have to make a choice on a prescription," Demetropoulos said.

In this vein, the advisory committee also recommends Medicaid fee-for-service patients be given unlimited doctor's visits, versus the 12-a-year restriction they have now. Medicaid patients on the state's managed care program, MississippiCAN, are already allowed unlimited visits.

Senate Medicaid Committee Chairman Brice Wiggins, R-Pascagoula, brought up issues with prior authorization, the process managed care's insurance companies use on the front end to determine whether they will reimburse for services based on medical necessity. Physicians have complained the process takes too long, preventing timely care.

Wiggins also said the state is committed to the managed care program, which has been the subject of much consternation in past months. He argued that despite lawmaker concerns of the program's effectiveness, it's still relatively new.

"When you do something this big, there's going to be issues and we need to address that," Wiggins said.

Next, the advisory committee plans to study possible improvements to the transportation system for Medicaid patients.

Demetropoulos made a point during the meeting to request that the Division of Medicaid leadership better value his committee and its work. He said he's had a good working relationship with some middle-level Medicaid employees, but he'd like to see better engagement from the leadership, namely Medicaid Director David Dzielak.

"Leadership starts at the top, and the culture is directed by the person in charge," Demetropoulos said.

"The big missing link (in Medicaid) is providers not having input," he said at the beginning of his presentation.

Medicaid said in a statement: "Since the Medical Care Advisory Committee began meeting last December, the Mississippi Division of Medicaid has consistently worked in collaboration with the committee throughout the year. We have provided administrative support for each meeting and supplied a wide range of information, data and reports as requested. After hearing Dr. Demetropoulos’ comments this morning, we have reached out to him to ensure we are making every effort to support this important committee."

House Medicaid Committee Chairman Chris Brown, R-Nettleton, has called a similar hearing on Medicaid for Thursday.

"It's finally coming at the 11th hour and 59 seconds, which is better than no time," said Rep. Steve Holland, D-Plantersville, who chaired the Public Health and Human Services Committee in the House for 28 years.

Holland has criticized the leadership since September for failing to hold Medicaid hearings sooner, forcing legislators to enter the 2018 session virtually clueless about likely changes to the multibillion-dollar program. (Medicaid's state and federal budget is bigger than the entire budget of the state of Mississippi).

"I'm almost excited about the hearing. It's almost like birthing a baby when you don't know the sex. What's it going to be?" Holland said Monday, feigning enthusiasm.

Roy Mitchell, director of the nonprofit Mississippi Health Advocacy Program, is keeping a look out for changes to Medicaid — eligibility responsibilities moving under the Department of Human Services or enacting a Medicaid work requirement — that were not discussed in Wednesday's Senate committee meeting.

Mitchell said his organization has "been in Medicaid defense mode for so long."

"We're going to do everything we can to let providers and community-based organizations know that the governor's office is trying to transfer eligibility to an agency that is under federal investigation and to an agency whose practices have caught national attention for punitive policies," Mitchell said last week. "With the whole issue of a work requirement, similarly we think that it is an answer to a problem that doesn't exist in Mississippi. We will be pointing out the administration inefficiencies ... We see it as a state boondoggle."