SID SALTER: Medicaid program again lands squarely in political quagmire

Budget negotiations at the state Capitol are slowly grinding toward stalemate as House and Senate leaders are as yet unable to overcome old arguments about the Medicaid program.
Gov. Haley Barbour and the Division of Medicaid maintain the posture they’ve held consistently for the last several years – that the state’s hospitals should help fund Medicaid with $90 million in provider fees, commonly referred to as the “hospital tax.”
The House leadership several years ago refused to discuss the “hospital tax” at all, calling it “a tax on the sick.” But in the current economy, House leaders and the Mississippi Hospital Association leadership,. which has their ear, apparently have decided that while it’s not acceptable to “tax the sick” at a $90 million annual rate, taxing them at a $53 million annual rate wouldn’t be so bad.
Senate negotiators and Barbour say that’s because the House hospital tax proposal actually expands the Medicaid program – substantially negating the value of the House version of the “hospital tax” compared to the Senate version.
House leaders say their version provides needed funding for Medicaid while allowing the state’s hospitals to survive the stagnant economy.
But the real sticking point in the current Medicaid negotiations – which is the key to formulating an overall state budget for the fiscal year that begins July 1 – is Barbour’s desire to hold $60 million of the federal stimulus package back to be used in 2011. Barbour and Senate Appropriations Committee Chairman Sen. Alan Nunnelee, R-Tupelo, both predict should be the state’s toughest fiscal year.
The federal stimulus package will provide about $790 million for the state’s fiscal years 2008-2011. Much of that federal aid comes in the form of temporarily raising the state’s Medicaid “match” rate from the current rate of about $4 for every $1 the state contributes to about $5 for every $1 of state money.
But that increased match ends midway through FY 2011 and Mississippi will again be confronted with funding its Medicaid program without tapping one-time money.
House leaders say that Barbour and the Senate cannot “hold back” the $60 million in stimulus funds because the federal government won’t allow it.
But the stimulus bill language indicates that Barbour and his appointees at Medicaid can save this year’s Medicaid stimulus dollars, but if any new restrictions on are put on the state’s Medicaid program relative as it existed July 1, 2008, Mississippi would no longer be eligible for the enhanced federal Medicaid match under the stimulus.
That brings us back to another bedrock Medicaid disagreement between the House and Senate. Barbour and the Senate enacted so-called “face-to-face” annual Medicaid reauthorizations which required recipients to physically show up and prove their eligibility for Medicaid each year. Prior to that, recipients could reapply by mail. Currently, the House leadership appears to be set to make the face-to-face reauthorization issue part and parcel to crafting a Medicaid budget solution. Barbour and the Senate remain committed to retaining that requirement.
Mississippi has to have a new budget in place in less than six weeks. Today, the prospects of getting that done appear bleak at best.
Contact syndicated columnist Sid Salter at (601) 961-7084 or e-mail ssalter@clarionledger.com.

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