OUR OPINION: Medicaid requires reform, assessment

The Mississippi Division of Medicaid’s first commitment to managed care for a sizable portion of its clients has led to savings of $40 million in the administration of the health care insurance program for about 645,000 Mississippians – elderly, disabled, poor pregnant women and poor children.

The savings, cited by Medicaid state executive director David Dzielak, are equivalent to about 5 percent of the total state-funded $800 million cost for Medicaid, which receives additional billions from federal funding in a generous matching formula.

Managed care is new as a major percentage to Medicaid in Mississippi, but managed care is not new in the private sector in Mississippi and most other states.

Managed care operates under a contracted fee payment to health care providers for various levels of care and medical procedures.

Under the Mississippi Medicaid plan managed care is limited, in part because some Medicaid proponents do not think managed care can provide all the health coverage its clients need because of the fiscal limits imposed by the program.

State Rep. Steve Holland, D-Plantersville, a former Public Health Committee chairman, believes in caution, but he said he has no major reservations at the current maximum level, which is 45 percent managed care.

He said while “cherry picking” could be a problem with providers treating the healthiest clients first, it is not insurmountable.

At this point in the program it seems reasonable to believe there’s a way to prevent cherry picking, if needed.

If Dzielak, as reported, will seek to expand managed care within Medicaid in the 2014 legislative session, isn’t there time to address concerns about cherry picking and coverage adequacy beforehand? Dzielak himself has expressed concerns about adequacy of coverage for children within Medicaid, an issue that could be resolved with pre-session, factual discussions and plans drawn before the Legislature convenes.

Mississippi cannot afford to decide it won’t seek to improve efficiency within Medicaid and at the same time provide adequate care for the most vulnerable clients, as Dzielak described them.

  • barney fife

    Reform does not mean denial of service.