Centene has been filling the campaign coffers of Mississippi officials for years and is one of Gov. Tate Reeves' largest donors.

Mississippi’s contract with Centene, an insurance company state officials are currently investigating over suspicions it overcharges taxpayers to boost its profits, is set to expire at the end of June, providing an opportunity for the state to end business with the company.

But the Mississippi Division of Medicaid, an agency under the governor’s office, expects to extend the contract for another year without issuing a new bid, agency spokesperson Matt Westerfield told Mississippi Today last Wednesday.

Centene, parent company to Magnolia Health, is one of three insurance companies the state pays to provide health coverage to the state’s most vulnerable residents, mostly children of poor families. Meanwhile, the insurer has been filling the campaign coffers of Mississippi officials for years and is one of Gov. Tate Reeves’ largest donors, contributing as large as $50,000 at a time to his campaign for a total of more than $200,000.

In the managed care program, called MississippiCAN, the state pays the insurers an up-front, per-member rate every month to cover about 485,000 recipients, as opposed to the state paying health care providers and pharmacies their fees and prices directly. About 64% of Medicaid recipients are in managed care and the rest — typically the more medically fragile patients — have fee-for-service Medicaid.

Centene pulls millions in taxpayer dollars for its role as middleman, and the state auditor and state attorney general are now investigating whether it used deceptive practices within its pharmacy benefits, the Northeast Mississippi Daily Journal first reported in March. Officials say the investigation resembles a lawsuit in Ohio, in which state officials allege Centene inflated drug dispensing fees, hid the true cost of pharmacy services and double-dipped its reimbursement.

A Magnolia Health spokesperson told Mississippi Today that the claims are unfounded and that the company has actually saved taxpayers millions of dollars. A written statement said Magnolia expects to return about $75 million to Mississippi “as a result of lower utilization brought on by COVID-19.”

“Recent criticisms and inaccuracies have been largely driven by parties with a longstanding agenda against Medicaid Managed Care,” the Magnolia statement reads.

Often when a state contract ends, the corresponding agency issues a Request for Proposals, or RFP. Vendors respond and the state awards a new contract based on how they score the proposals.

The Division of Medicaid typically takes its direction from the governor, but Westerfield said the agency believes it can extend its contract with Magnolia for another year “on its own” as long as it has approval from the Public Procurement Review Board.

Reeves’ office did not respond to Mississippi Today’s questions regarding the governor’s support for a contract extension.

The original three-year contract, which began in 2017 and was extended last year, is set to expire at the end of June, but contains an optional renewal through 2022. The Medicaid tech bill lawmakers passed this year also allows for an one-year emergency extension on the contract. Either would allow Magnolia to continue receiving millions from the state, even as the investigation continues.

“We as taxpayers deserve better than we’re getting,” said state Rep. Becky Currie, R-Brookhaven. “We need to let the RFP run its course in September (sic) just like it always does. I just believe that putting it off a year is just going to give Centene time to sweep things under the rug.”

Officials expect the investigation to conclude as early as this summer.

Investigators are focusing on the actions of Centene’s pharmacy benefit managers, third-party companies that manage pharmacy benefits for insurers. Magnolia paid its PBMs, extra middlemen that pharmacists have long bemoaned, more than $1.1 billion from 2016 to 2020, according to data the Medicaid division provided Mississippi Today.

The Mississippi Legislature addressed PBMs in 2018 when it prohibited the companies from including “gag clauses” in their contracts with pharmacies. These provisions had prevented pharmacists from telling patients cheaper ways to pay for their medication, such as if their copay is higher than the cash price of the drug.

When State Auditor Shad White took office later that year, his first announcement was that his office had found $600,000 worth of improper Medicaid payments to managed care companies. The office’s ongoing investigation into Centene began not long after; it sought help from a local firm in April of 2019, Daily Journal reported.

The lawsuit in Ohio is ongoing; Centene argues it adhered to its contract and followed state law. The Ohio attorney general Dave Yost alleged Centene’s “corporate greed” led its Ohio subsidiary to inflate costs through its pharmacy benefit managers.

“So why would we extend their contract?” Currie said. “Do we want to have a company with such corporate greed taking care of the most vulnerable people in our state? The sickest, fragile people in our state. I mean, it’s a no-brainer for me. We don’t want that.”

Correction: A previous version of this story misstated which month the Medicaid contract is set to expire.

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Anna Wolfe is a Pulitzer Prize-winning investigative reporter who covers inequity and corruption in government safety net programs, nonprofit service providers and institutions affecting the marginalized. She began reporting for Mississippi Today in 2018, after she approached the editor with the idea of starting a poverty beat, the first of its kind in the state. Wolfe has received national recognition for her years-long coverage of Mississippi’s welfare program, in which she exposed new details about how officials funneled tens of millions of federal public assistance funds away from needy families and instead to their friends, families and the pet projects of famous athletes. Since joining Mississippi Today, she has received several national honors including the Pulitzer Prize for Local Reporting, the Livingston Award, two Goldsmith Prizes for Investigative Reporting, the Collier Prize for State Government Accountability, the Sacred Cat Award, the Nellie Bly Award, the John Jay/Harry Frank Guggenheim Excellence in Criminal Justice Reporting Award, the Al Neuharth Innovation in Investigative Journalism Award, the Sidney Award, the National Press Foundation’s Poverty and Inequality Award and others. Previously, Wolfe worked for three years at Clarion Ledger, Mississippi’s statewide newspaper, where she covered city hall, health care, and wrote stories about hunger and medical billing, earning the Bill Minor Prize for Investigative Journalism two years in a row. Born and raised on the Puget Sound in Washington State, Wolfe moved to Mississippi in 2012 to attend Mississippi State University, where she currently serves on the Digital Journalism Advisory Board. She has lived in Jackson, Mississippi since graduating in 2014.