Discord between the Mississippi Hospital Association and the Division of Medicaid is dwindling.
Six years ago the discord was palatable. MHA and 65 of its hospitals formed a non-profit corporation, Mississippi True, that developed the state’s only provider sponsored health plan. Mississippi True then competed for one of the state’s lucrative Medicaid managed care contracts. Under the leadership of Gov. Phil Bryant’s appointed director David Dzielak, Medicaid ranked the hospitals’ proposal next to last.
Lack of experience appeared to be a key issue. Mississippi True “argues it will never have the experience necessary to win an award if it can’t get the contract because of a lack of experience,” reported the Clarion-Ledger. “They structure the RFP to give the contract to whoever they want,” complained Sen. Angela Hill.
The hospitals and MHA protested and took Medicaid to court but to no avail. United Healthcare, Magnolia Health, and Molina Healthcare got the precious contracts.
After a while, the discord began to ease. Notably, when new proposals came up for review last year, Medicaid, under the leadership of Gov. Tate Reeves’ chosen director Drew Snyder, ranked the hospitals’ TrueCare proposal first.
“The top two ranked Offerors are TrueCare and Magnolia, each of which delivered especially strong Technical Qualifications, including innovative and ambitious approaches to delivery of services,” said Medicaid’s notice of intent to award. Molina was third-ranked and got the final award. United Healthcare, ranked fourth, lost out.
Three significant changes affected the hospitals’ proposal. First, the hospitals learned a lot from their earlier application and worked diligently to develop an exemplary proposal. Second, Snyder replaced Dzielak as Medicaid director. And third, hospitals changed their administrative services partner to CareSource.
The change to CareSource was significant. CareSource’s considerable experience clearly aided the rankings. And both TrueCare and CareSource are nonprofit organizations which allows them to emphasize service while the for-profit companies tend to emphasize profit.
The hoped for result is that all healthcare providers will see locally controlled TrueCare as a trustworthy partner dedicated to improving patient health outcomes. In particular, hospitals expect TrueCare will pay providers’ Medicaid claims more expeditiously and with fewer disputes. Any net differences between service costs and Medicaid’s capitated payments will not go to hospitals but into TrueCare capital reserves.
Final award of the new Medicaid contracts has been pushed back for at least a year. United Healthcare and Amerigroup protested to the Public Procurement Review Board. The board is expected to set a hearing date on the protests at its December meeting. Note: the protest left the current providers, including United, in place for an extra year.
If the protests get resolved as expected, come next July discord between MHA and Medicaid will have transformed into accord.
Bill Crawford is a syndicated columnist from Jackson.