The Medicaid technical bill is at issue. It outlines how the agency will spend its $6 billion annual budget. Nearly half, or $3 billion, goes to companies that provide Medicaid coverage. The powerful Mississippi Hospital Association, who for many years has fought with these insurance companies, is now a candidate to join. The Mississippi House of Representatives has been aligned with hospitals for the past two months, passing versions of tech bills that would allow Mississippi True to be included in the managed-care program. Mississippi True is a new provider-run insurer that has the support of the Hospital Association. Last summer, Mississippi True was in a race for one of three lucrative managed care contracts that were given by the Division of Medicaid. Several lawmakers feel it is worth another chance. Magnolia Health, United Healthcare, and Molina Healthcare, the Medicaid insurers that received the contracts in June, argued against it, saying that it sets a poor precedent for legislators to get involved in agency business because they don’t like an outcome. The Senate has mostly backed the insurers and passed versions of a tech bill which do not mention a provider-run plan for health insurance. The Senate had earlier this month killed the House bill. The Senate killed the House’s bill earlier this month. However, the House kept the Senate bill alive and replaced its text with the House bill that the Senate had just killed. The final negotiations between the Senate and the House will take place this weekend. The bill will be killed if neither side can come to a compromise this weekend, which leaders of both houses acknowledge is possible. The state law allows the governor to take control of the Division of Medicaid, instead of the Legislature. Brice Wiggins (R-Pascagoula), Senate Medicaid Chairman, stated that “that is not something they want to see, but I know the House does too.” But this conference weekend. “Anything can happen.” Legislative leaders meet during conference weekend to work out the budget and resolve differences between the Senate and House versions of bills. This is before the Legislature adjourns for 2018. Both senators and members of the House say that letting the bill die would be a last resort. The fact that this possibility exists and is being discussed publicly shows how strong the push from managed care lobbies and hospitals is. It’s not the type of program that you would play political games with. It doesn’t matter what party you are in. Rep. Steve Holland (D-Plantersville) said that Medicaid isn’t a toy. “Medicaid is an insurance provider that provides health care to a quarter the citizens of Mississippi.” Over the years, lawmakers struggled with figuring out how much Medicaid’s budget would cost, which is currently at $6 billion in federal and state funds. The agency introduced managed care in 2011 to try and reduce costs. Managed care is a system where Medicaid pays insurance companies a flat fee for each beneficiary. This gives these companies incentives to keep their patients healthy and reduce the amount of services they use. The hospitals are often at odds with Medicaid insurers. They claim that they delay reimbursements and sometimes refuse payment. Hospitals could get a share of the lucrative managed care pie by implementing a provider-sponsored plan in which they would take care of their patients. It didn’t turn out that way. The Hospital Association and several legislators protested immediately after Mississippi True’s bid was rejected for a Medicaid contract. They claimed that Medicaid’s bidding process favors the three for-profit firms that were awarded contracts. This question has haunted the agency ever since, and led to the resignation in December of its executive director. Rep. Jason White (R-West), who wrote the House legislation, said that while we generally don’t pick winners or losers, we wouldn’t be in denial if it wasn’t for the fact that there were many questions about the last bid and the managed care contracts granted. “And there is an desire to do something about that.” This something has changed in different House legislation versions. The House Medicaid committee approved in January a version that would cut out between 5 and 10 percent of managed care beneficiaries. It would also give them to Mississippi True so the insurer could launch a pilot program. This was not liked by either side. Mississippi True claimed that the population was too small to allow the program to be successful, while lawmakers stated that it was the Legislature’s way to give a contract without a bid to a company it liked. The House bill was passed without the carve-out. Instead, the mandate that the agency discard the results from last summer’s bidding and rebid all three managed healthcare contracts was put in place. This too was met with resistance by lawmakers, who still have questions about the procurement last summer. Wiggins stated that Mississippi True has the right to do so and it is not unusual for them to request that the Legislature examine this matter. “I support the Hospital Association. This issue (of a Rebid) has been a difficult battle in the Senate. It was a long process. Mississippi True won six of seven bidders. They didn’t win. Few interest groups in the state have the broad legislative support that the Hospital Association enjoys. This is due to the fact that the organization has a large reach. Mississippi True, unlike the other managed care companies that won contracts and all of which have parent companies out of state, is a partnership of 60 hospitals throughout the state. This means that most legislators in their districts have a member hospital. These hospitals are vital to the state’s survival. Holland stated in January that they are the economic engines driving our state and need our support. House leaders are open to the fact that community ties are part and parcel of why the House has been so supportive of a rebid or a carve out. White stated that he was trying to help them and gave a defense of the carve out at the January House committee meeting. Although the managed care lobby may not have the same reach as the hospital association, it does have something that is just as important for legislators: deep pockets. Centene, the owner of Magnolia Health, donated nearly $360,000 in campaign contributions to Mississippi legislators in 2015. Centene donated more than $125,000 to legislators in 2017. The Hospital Association has its political action committee. In 2017, it donated $30,000 to Mississippi elected officials. This is not likely to be the complete picture. Centene is easier to track than the Hospital Association, which has a wide reach and falls under the umbrellas of its PAC, LLC, or Magnolia. However, this analysis is not possible for Centene. These 60 hospitals make up Mississippi True. Each hospital has a CEO, administrator, and doctor whose individual donations could influence state and local officials. The Division of Medicaid has maintained a neutral position regarding the two bills. It stated that it believes the Legislature will take the necessary steps to reduce agency costs. Drew Snyder, interim executive director, stated that his team had been working with legislators to assess the potential effects of the various amendments in the Medicaid technical amends bill. “I hope for a resolution which will allow the Division of Medicaid to provide quality care for the most vulnerable while operating within our appropriation limits,” said Drew Snyder, interim executive director. White, the sponsor of the bill, was visibly uneasy during January’s House Medicaid Committee meeting. He shifted in his chair and shook his head as lawmakers debated expanding Mississippi True’s population pilot program. White told the committee that any attempt to expand the pilot program’s size would be a “poison pills” to the bill, since this carve-out has already bypassed the legal bidding process. It’s not a pilot programme if it exceeds 20%. White stated that we are mandating, picking a winner, and then saying, “You didn’t win the bid, but you’re going in with the three other bidders.” Wiggins indicated that he is open to compromise in a Wednesday conversation with Mississippi Today. He didn’t give any details about the compromise, but said that the Senate position was what the Senate bill was, although it didn’t contain that (Mississippi True). It is what it is. It’s controversial. White stated that both the Senate and House have had “several positive conversations” so far. “But no one has drawn any lines in the sand. Both chambers support a Medicaid tech bill in this session. “I have been to many bill signings, where each side began by saying that they weren’t going to do this or this. White stated that they all ended up at the governor’s office to sign the bill._x000D