After months of political stalemate between the Mississippi House and Senate, both legislative chambers passed a Medicaid technical bill on Tuesday.
And while both sides ultimately agreed on the legislation, which outlines how the agency will spend its $6 billion annual budget, the members of the Senate still declared themselves the winner of the two month political battle after they eliminated plans for a hospital-run insurance program pushed by the House.
House members had insisted on letting the insurance program, Mississippi True, have a chance at a lucrative contract with the Division of Medicaid. But the insurers who were already contracted with Medicaid pushed back, pointing out that Mississippi True had unsuccessfully bid on a contract last June. The Senate largely joined their fight, arguing that it would “set a bad precedent” for the Legislature to dictate which companies should receive agency contracts.
“Is it a win because we have a tech bill that doesn’t mandate a sole-source contract through the Division of Medicaid? Then yes, it’s a win,” said Senate Medicaid Chairman Brice Wiggins, R-Pascagoula, shortly after lawmakers filed the changes Monday night.
The issue of the provider-run plan, an offshoot of the powerful Mississippi Hospital Association, has long been a sticking point for House leadership. In June, Mississippi True lost out on one of Medicaid’s three billion-dollar managed care contracts. But the results of the bid were controversial enough that they contributed to the resignation of the agency’s executive director in December.
In an attempt to rectify this, the House had proposed two options designed to benefit Mississippi True. One would have given the new company a small portion of managed care beneficiaries. Another would have mandated the Division of Medicaid re-bid its contracts.
Outside the speaker’s office on Monday afternoon, several lawmakers said they were prepared to go to a special legislative session over the issue. Had the House and Senate not agreed on a bill by 8 p.m. Monday night, the bill would have died, effectively killing the Division of Medicaid along with it. The governor then would have had the authority to either run the agency by executive order or call a special session to try and resolve the issue.
“When you’re from a rural area like I am, our hospitals are the life blood of our communities, so they’re our priority,” said Rep. Tom Miles, D-Forest. “We don’t have to rush to make a decision.”
But anyone who expected House members to put up a dramatic fight when the bill hit the chamber floor Tuesday afternoon was sorely disappointed. In the end, the House debate clocked in at just over 40 minutes, nearly 15 minutes shorter than the Senate’s floor debate that morning. The House also passed the bill by a larger margin than the Senate, with just six votes against versus eight in the Senate.
While the provider-run plan may have been the main sticking point in negotiations, ultimately the Senate’s hard line on the issue wasn’t the deal-breaker House members said it was. And, they acknowledged, giving the Senate a win on that made room for several other programs the House had advocated, such as letting Medicaid pay for drug addiction treatment and increasing Medicaid’s payments to hospitals.
“That’s where I was on it,” said Rep. Jason White, R-West, who led the tech bill negotiations for the House. “I thought it was vitally important that we have a tech bill and while I understood the argument for a provider-sponsored plan — and I do get it, I want our hospitals to thrive — this bill allows for legislative input. If you don’t have a tech bill, you can call your legislator all day long and it’s not going to make a difference.”
The Medicaid tech bill that passed was what Wiggins and White each referred to as a “budget-neutral” bill. The sum of the proposals in it weren’t going to cost the agency extra money, but they weren’t going to save the agency money either.
Whether it’s also “chamber neutral,” meaning a bill that incorporates equal parts of the Senate and House plans seems to depend on who is answering the question. Off the bat, the Senate claimed big wins, not just from eliminating the provider-run health plan language, but also by including recommendations from the Medical Care Advisory Committee, which Wiggins had worked with closely over the last year. These included lifting caps on prescription drugs and primary care visits and allowing Medicaid to pay for 17-P, an expensive but highly effective medicine that delays preterm births.
“It is a very good piece of policy that advances Medicaid in the state, that improves outcomes and addresses accountability,” Wiggins said.
But not all of the Senate wins were House losses. The House had also supported lifting caps on prescriptions and primary care visits and the use of 17-P. And while hospitals remain shut out of the managed care game, the final version of the Medicaid tech bill did include several plans geared towards helping hospitals’ bottom line. The bill mandates a redo of the agency’s long criticized hospital reimbursement formula. And it includes a provision that lets certain rural hospitals get paid through Medicaid at the higher Medicare rate.
“I think it’s actually one of the best things we can do for our small, rural hospitals,” said House Public Health Chairman Sam Mims, R-McComb, who has sponsored similar rural hospital bills for several sessions, none of which had made it off the House floor.
The Medicaid technical bill also includes an amendment that allows Medicaid to pay for drug addiction treatments, another provision pushed in the House. And it includes House language mandating that Medicaid independently audit its managed care companies to ensure they are actually saving the state money.
“The Hospital Association made it about that one issue when it was not a single-issue bill,” Wiggins said.
Hanging onto the provider-run plan into the eleventh hour may have given House leadership extra leverage on other amendments. But even after the negotiation was reached, several House members still said they had given up too much.
“It’s not necessarily acceptable, but it’s the only thing on the table. It’s all we’re getting,” said Rep. Bryant Clark, D-Pickens.
The House held the proposal on a procedural that will have to be lifted Wednesday before it goes to the governor’s desk.