Medicaid chief: Overhead to climb

By Bobby Harrison/NEMS Daily Journal

JACKSON – One portion of the controversial federal health care law will affect Mississippi more than most states.
Starting in January 2014, states can no longer require so-called “face-to-face” visits where people travel to a Medicaid office to apply to be covered by the state-federal health insurance program.
According to Ed Sivak, executive director of the Mississippi Economic Policy Center, Mississippi is the only state requiring the face-to-face visits to sign up or to recertify children. Five other states, he said, based on a Kaiser Family Foundation study, require some form of face-to-face for adults.
Despite the Affordable Care Act’s prohibition on the face-to-face requirement, David Dzielak, executive director of the Mississippi Division of Medicaid, said the mandated expansions in the federal law will result in his agency having to spend more on administrative costs.
Plus, he said, if the state opts to participate in the expansion of Medicaid to cover everyone earning up to 138 percent of the federal poverty level, the agency will have to hire at least 200 new employees to cover the additional administrative tasks.
Dzielak said the elimination of the face-to-face requirement will not offset the new administrative costs that will be incurred by his agency as the result of the Affordable Care Act.
Dzielak said the existing staff will still have to man the current 30 regional Medicaid offices and the 95 satellite offices that might be open for one day or a few hours at established times during the week.
A state Medicaid-requested study by Milliman, a private provider of actuarial services, places the administrative costs for the mandated new Medicaid services required by the act at between $15 million and $20 million during the 2014-20 time period.
The new mandated services include expanding Medicaid to cover foster children until age 26, and increasing the income level from 100 percent to 138 percent of the federal poverty level for children eligible to be covered by the Medicaid program.
In total, the Milliman report says those mandates will add between $272 million to $436 million to state Medicaid costs during the 2014-20 time period and add between 48,000 and 72,000 people to the Medicaid rolls.
If the state opts to expand the program to cover all people earning up to 138 percent of the federal poverty level, the increased administrative costs to the state will be between $97 million and $166 million during the seven-year time period, according to the Milliman study. The same study places the total costs to the state during the 2014-20 time period for both the mandated and optional expansions at between $609 million and $1 billion.
The Milliman study has been challenged by some who favor the expansion, saying its methodology was partially incorrect and pointing out it did not factor in the economic benefits to the state of the expansion.
Sen. Hob Bryan, D-Amory, has specifically challenged the Milliman claim on how much additional administrative costs the state will incur.
He said it appears that the study was not factoring in “for economies of scale” when calculating the administrative costs.
Rep. Steve Holland, D-Plantersville, who was more blunt, said, “I think it is an utterly flawed argument they are making to try to prevent the expansion from happening.”
Republican Gov. Phil Bryant has said he opposes the expansion because the state cannot afford it. Much of his argument against the expansion is based on the Milliman study.
Dzielak said Medicaid currently has the authority for 1,014 employees and currently has 867 of those spots filled. At least 200 more employees will be needed if the expansion occurs to cover the 220,000 to 370,000 new enrollees, he said.
Holland pointed out that nearly 400 employees were added at Medicaid in 2006 when the state started the face-to-face requirement.
He said he does not know why those employees can’t handle the Medicaid expansion since they will not be doing the face-to-face.
But Dzielak said they will be at their work capacity dealing with the existing Medicaid population and also will have to be available if an existing Medicaid beneficiary wants a face-to-face visit.
“If they want to do face-to-face, we still must provide them,” Dzielak said.

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