Third Compromise Reached On Medicaid Bill

A third compromise was reached Wednesday on a bailout plan for the Mississippi Medicaid program, one that combines payment reductions with fees to generate enough cash to keep programs afloat and claims paid.

Medicaid executive director Rica Lewis Payton said Wednesday that she will not have money to pay claims on March 7 if no bailout program is in place. She earlier had said the program would run out of money at the end of February.

"We process bills on a weekly basis,'' Payton said. "The bills will be processed this weekend and on Monday we get information on what the claims payments are and those bills will be paid Thursday of next week."

"If there is not action taken, we would not have state funds to pay bills,'' she said.

Two previous bailout compromises fell victim to opposition from medical groups, primarily pharmacists and doctors.

The second compromise reached Tuesday failed when doctors protested that all medical providers, regardless of whether they see Medicaid patients, would have to pay $1 per office visit to support Medicaid.

A first proposal was scuttled after medical groups fussed over proposed reductions in Medicaid payments.

"Third time's a charm, I guess,'' said Senate President Pro Tempore Travis Little, D-Corinth, one of the six negotiators on the compromise.

House Speaker Tim Ford, D-Baldwyn, said didn't know if the reality of Medicaid's problems had sunk in for many legislators.

Most of those lobbying on the issue so far have been doctors, nursing home directors and pharmacists.

"If we don't get something passed, next week it's going to be the recipients down here,'' Ford said.

The third compromise combines a 5 percent reduction in payments to doctors and other medical groups in the Medicaid program with new fees on pharmacists, nursing homes beds and hospital beds. Overall, the package produces $84 million in cost savings and new money for Medicaid.

Senate Public Health and Welfare Committee Chairman Robert "Bunky" Huggins, R-Greenwood, said doctors, faced with cuts or fees, opted for cuts.

"The same people who came to me opposed to assessments came to me now in favor of cuts,'' Huggins said Wednesday.

He predicted a close vote, possibly on Thursday. Medicaid is a federal-state program that provides health coverage for the needy, aged, blind and disabled.

About 650,000 of Mississippi's 2.8 million residents rely on the program. Mississippi Medicaid is running a $158 million deficit in the budget year that ends June 30.

Huggins said strong lobbying by doctors shelved the second compromise.  Ford agreed.

"The doctors have acted ugly in using threatening letters and phone calls,'' Ford said.

Under Wednesday's compromise, the state still will use $108 million from this year's payment from the tobacco companies for the settlement of the lawsuit the state filed against them. Next year's annual payment from the tobacco companies of $144 million also will go into the Medicaid program.

House Public Health and Welfare Committee Chairman Bobby Moody, D-Louisville, said more cost containment issues will be addressed in Medicaid to slow the program's growth.

As conferees wrapped up work on the compromise, Rep. Steve Holland, D-Plantersville, urged them to start explaining the bill to legislative colleagues.

"I would admonish y'all to use every ounce of your political strength and your moral and ethical and social and spiritual strength to get this passed,'' Holland said.

Holland said the immediate benefit to Medicaid would be the money transfer out of the tobacco settlement fund. He said the assessments and cost savings would be implemented once the bill is signed by the governor.

Gov. Ronnie Musgrove has expressed misgivings about the bill but has not said he would veto it. Payton said the worst thing is that payments could be delayed for a short time.

"I just have to be optimistic that providers will continue to deliver services to Medicaid recipients,'' Payton said.

A glance at some proposed Medicaid changes in a third compromise proposal agreed to by negotiators Wednesday:

  • Five percent cut in the rate Mississippi pays doctors and other Medicaid providers, except nursing homes. The rate cut would not apply to the University of Mississippi Medical Center.
  • Recipients to receive one new pair of glasses every five years instead of every three years.
  • Seven prescriptions per Medicaid recipient per month instead of the 10 now allowed. After five prescriptions, a recipient would need approval to receive more.
  • Co-payments to increase on all Medicaid services where allowed, generally up to $3 each. For example, prescription drug co-payment goes from $1 to $3.
  • Recipients to receive a 34-day supply of each prescription refill instead of the 90-day supply now allowed. Officials say this is aimed at reducing waste of unused drugs.
  • Pharmacists' dispensing fee to increase from the current $4.91 per Medicaid prescription to $5.41 per Medicaid prescription.
  • Pharmacists to be assessed $1 dollar each on all prescriptions filled.
  • Increase assessment on nursing beds from $2 to $3 per bed.
  • Add assessment on hospital beds of $1.50.
  • If a patient is on both Medicare and Medicaid, prescriptions would be billed to Medicare, which is fully funded by the federal government. Medicaid is paid with a combination of state and federal money.