Healthcare providers recently attempted to incorporate a provider-sponsored health plan into Mississippi’s Medicaid marketplace, but their efforts failed to gain legislative traction.

Proponents say the plan would keep billions of dollars here in Mississippi instead of sending that money elsewhere. 

According to Rep. Becky Currie, R-Brookhaven, who represents Copiah, Lawrence and Lincoln counties, two healthcare corporations dominate Mississippi’s Medicaid market. They are Magnolia Health and United Healthcare, and each currently holds a 20 percent share of the state’s managed care health plan market — also known as MississippiCAN.

Molina, a business based out of California, is the newest addition to Mississippi’s Medicaid marketplace. Like Magnolia and United, it has been offered a 20 percent share of the managed care market, and it should begin operating by July 1.

While Mississippi intends to welcome Molina into its Medicaid fold, Currie — who is a registered nurse — said other states are eliminating the company from their insurance markets due to its record of non-payment to health providers.

“We have a lot of problems with these out of state companies paying our providers,” she said. “And, when those companies refuse to pay, our providers have no recourse.”

In response to complaints from hospitals across the state, Rep. Chris Brown proposed a bill as a solution, but the measure promptly died in committee.

A provider-sponsored health plan, as outlined in House Bill 1482, is a Mississippi not-for-profit corporation formed for the purposes of operating a not-for-profit health plan or managed care entity, with its principal place of business within the State of Mississippi, and which is owned and governed exclusively by a not-for-profit Mississippi hospital or physician industry.

The proposed provider-sponsored health plan, called Mississippi True, would have involved over 60 in-state hospitals, including King’s Daughters Medical Center in Brookhaven. The new plan would help guarantee payment to health providers and boost the level of care available to Medicaid recipients, proponents say.

“This would be a Mississippi company that would provide Mississippi jobs,” Currie said. “It would keep billions of dollars that are currently going to Missouri, Georgia and California in our state.”

Alvin Hoover, CEO of KDMC, believes Mississippi True is a good alternative to MississippiCAN.

“Managed care hasn’t worked out very well,” he said. “Medicaid costs have skyrocketed, and, from a hospital standpoint, we jump through a lot of hoops to give the appropriate care to our Medicaid patients. Even after jumping through those hoops, we still end up with a lot of denials.”

Hoover believes managed care plans drive down costs by denying service and payment to health providers.

“It’s a little disappointing that many of our legislators haven’t recognized the legitimate argument we’ve made,” he said. “We want them to understand that we’re already doing the work, but we could do the work more efficiently from a financial standpoint under a provider-sponsored health plan.”

Hoover estimates that Mississippi True would generate roughly 400 in-state jobs, while simultaneously bolstering the financial integrity of Mississippi’s health providers.

“Our hospitals are struggling,” Currie said. “If we don’t give them a break at some point, we might have to consider how Brookhaven would function without a hospital?”

Mississippi’s Medicaid program covers one-fourth of the state’s population, including people in nursing homes, disabled adults, pregnant women and young children. The program is projected to spend $945 million in state money and more than $5 billion in federal money this year.