Medicaid, the state agency with the largest budget, will be removed from the control of the governor and placed under an independent commission under legislation that has cleared committee and is now before the Mississippi House.
“What we are doing with this bill right here is allowing some transparency, allowing some open meetings,” said Rep. Joey Hood, R-Ackerman, who explained the bill to members of the Appropriations Committee. The committee approved the legislation Tuesday.
Tuesday was the deadline for the bill to be passed out of committee in the chamber where the proposal originated. The full House will have until Feb. 11 to consider the proposal.
When asked about potential problems with the legislation that would make dramatic changes to the governance of the agency, Hood said, “There are problems, but we are going to work through those during the process.”
The bill was introduced by House Ways and Means Chair Trey Lamar, R-Senatobia, one of the more influential members of the House.
Gov. Tate Reeves said Tuesday he is not familiar with the legislation that could strip away a sizable amount of his authority in the area of health care, but said he would be updated on the proposal by his legislative team in the coming days.
“Entangling the Medicaid program in an ongoing political tug-of-war will not improve health outcomes for Medicaid recipients, elevate quality, lower spending trends, or reduce unnecessary burdens on patients and providers. We are concerned that Rep. Lamar’s legislation could threaten to hinder, if not completely undo, the significant progress that the Medicaid program has made in recent years,” said Drew Snyder, the current Medicaid executive director in a statement to Mississippi Today.
At times in recent years, Lamar and Reeves have been at odds over multiple issues, ranging from the source of funding for transportation needs to Reeves vetoing legislation to provide funds to help re-open a hospital in Lamar’s district. Reeves maintained it was improper to spend federal COVID-19 relief funds for the re-opening of the Tate County Hospital. Lamar and others argued spending the federal funds on the re-opening of the hospital during the pandemic was a proper expenditure of those dollars.
As far as the establishment of the Medicaid Commission, Lamar said it is his goal to bring more transparency to the $6 billion agency. The Medicaid Commission would be subject to open meetings requirements of state government. The agency under the direction of the governor does not have to conduct public meetings.
Some state agencies, such as the Department of Corrections, Human Services and Medicaid, are under the control of the governor. The executive directors of those agencies are appointed and terminated by the governor, though they must go through Senate confirmation.
Other agencies, such as the Board of Health and education from the kindergarten through university level, are governed by boards whose members are appointed by governors for staggered terms. In some instances the lieutenant governor and the speaker make appointments to those boards. The executive directors or heads of those agencies are answerable to the board or commission.
In terms of total funding, in both state funds and federal funds, Medicaid is the largest state agency with a budget of $6.61 billion for the current year. Both K-12 education and universities receive more than $3 billion in total funding from state and federal sources.
In essence, Lamar’s legislation is a back to the future proposal. The Legislature created the current Division of Medicaid, under the auspices of the governor, in the 1980s.
As part of a landmark 1983 state Supreme Court case, the old Medicaid Commission and multiple other boards and commissions were ruled to be in violation of the separation of powers clause of the Constitution because legislators were serving on executive agencies.
But the commission that was proposed in Lamar’s bill would consist of seven non-legislative members – four appointed by the lieutenant governor and three appointed by the governor. All seven members would face Senate confirmation.
Two of the lieutenant governor’s recommendations with be made upon advice from the speaker. The speaker constitutionally cannot make an appointment to the board in the executive agency since the speaker is in the legislative branch. The lieutenant governor is considered as part of the executive agency, though the position also has legislative responsibilities.
It is not clear how the process of the lieutenant governor making an appointment for the speaker would work.
Under the legislation, appointments to the commission would be made after July 1. But the legislation calls for Snyder to remain in place until January of 2024 when a new gubernatorial term begins. At that point, the Commission could choose to re-appoint Snyder, if he wanted to continue in the post, or select a new executive director.