Jackson Free Press

On Monday, March 7, Gov. Haley Barbour delivered a hardcore ultimatum at the Capitol. "We cannot tax or cut enough in three and a half months to cover a $268 million deficit—that is not a political statement, it is a mathematical fact," he told the media. "The longer the Legislature waits, the more dire the circumstances become for Mississippi's Medicaid recipients." He added: "The decision is not 'tax hike' versus 'trust fund.' The decision is 'trust fund' versus 'no more Medicaid'—and that shouldn't be a tough decision."

This statement follows Barbour's steadfast refusal to negotiate one inch on how to pay for Medicaid—beyond robbing the health-care trust fund that, in part, funds anti-smoking programs for children. The Legislature, however, has been looking for a middle ground even if Barbour refuses to. The Medicaid conference between the House and the Senate has been going on for more than a week now.

In the first couple of meetings, the situation looked bleak for Medicaid in Mississippi. Dr. Warren Jones, the director of Mississippi's Medicaid Division, explained the situation with Medicaid as being "the perfect storm." He said, "There are more individuals than we thought enrolling in the program and much less money." There were talks of a special session being preferred on the House side if the Senate side didn't give in on some revenue-producing proposals such as the cigarette tax in HB 410.

Rep. George Flaggs, D-Vicksburg, even said, "It's not a joke; the Senate is holding this bill [HB 410] hostage." Flaggs walked out of one meeting because of the Senate side's lack of an effort to even consider such measures.

But last Wednesday, March 2, the compromising finally began.

Medicaid originally estimated a savings of $9 million by lowering allowable in-patient days from 30 to 15. Instead of making this cut, hospitals will pay an increased bed tax and UPL (upper payment limit) assessment to Medicaid to maintain the 30-day benefit. Medicaid also originally made an estimate of $2.1 million in savings by lowering the allowable emergency room visits from six to three. Instead of making this cut, the bed taxes and UPL assessment will cover this, too.

Increasing the hospital bed tax from $1.50 to $3.25 per licensed bed will generate about $7.9 million in additional state funds. This is one-half of what is needed to fund the maintenance of benefits and the 2005 rate update for hospitals. The other $7.9 million will be collected using Upper Payment Limit assessment—legislative changes made last year give them the needed flexibility in this area. Hospitals will ultimately be paying $15.8 million in additional taxes to Medicaid to maintain the current level of 30 in-patient days, six ER visits and the 2005 payment rate update. The key here is the splitting the $15.8 million up in halves. This allows for the -impact on any particular type or size of hospital to be minimized.

Finally, the conferees have talked about changing the Medicaid structure for daily medications. The current law is a 5+2 formula. That means you can get five medications on the Preferred Drug List (PDL) or five generics basically, and then you can get two more for medical necessity that are not on the PDL. They agreed to change this to a 2+3 formula, which works out fine because the average adult in Mississippi on Medicaid gets an average of three prescriptions a day. Therefore, allowing five a day would cover more than 95 percent of all their needs. These changes will take place either by a notification date set by Medicaid, when it can educate the state's health professionals and doctors on how to best help their patients on these new policies and make sure they will follow them, or by July 1.

Flaggs wanted the July 1 date because he argued that people like his mother will not listen to him when it comes to advice on how to do her prescriptions, but he says she will listen to her doctor. All the other legislators saw his point, and Dr. Jones said: "He understands the relationship a patient has with a trusted physician. That's why we will need time to educate the state's physicians about these policies in order for them to take effect." However, he was convinced when Sen. Terry Burton, R-Newton, suggested letting it take effect earlier if Medicaid could make it happen, in order to start saving as soon as possible.

Still, the big question is will the money come from the tobacco trust fund or from the 50-cent-per-pack cigarette tax? A real compromise would be from both, especially since the Senate is claiming the tax would not cover all the costs. The Senate says they will not give in and raise the tobacco tax, but that tax is a big goal for the House side. Who will win this tug-o-war? The House of the people or the Senate, which has the governor tailing behind them with the rope tied around his waist?

This week shall tell. The Medicaid fund officially runs out of money at the end of the week.

Previous Comments

ID

64553

Comment

Today Barbour announced a special session for tomorrow. you can read his statement at http://www.governorbarbour.com/StateMed.htm He is blaming this on the House, but the thing that a lot of people don't see is that taking the money out of the trust is not what the money was intended for. We are supposed to use the money earned off the interest...not take half of it out. Plus, this would be a one time fix...what about the rest of the deficit for this year? What about next year's deficit and Medicaid crisis? The House is right that we need to raise the tobacco tax. It's a program that will let people end up paying for their own habits later in life, and it affects a smaller population than the whole state. It spreads across all income brackets. It is a solution--not a full one--but a start, at least. Haley calls these every time he doesn't get his way or he is afraid that he'll have to sign something with the word "tax" on it. He is costing the state more money, and he is being a hypocrite by not letting Medicaid borrow more money to keep funding the program until the legislature takes care of this. He expects the health professionals, pharmacies and nursing homes to give the 780,000 Mississippians on Medicaid credit and not charge them but bill Medicaid with no guarantee of being paid back, but he himself won't authorize Mediciad to take out another small loan from the state. If he is so sure this will be taken care of in the legislature, especially in a special session, then why doesn't he go ahead and lend them the money?

Author

Brett Potter

Date

2005-03-11T18:11:26-06:00

ID

64554

Comment

To my knowledge, three people have died this week in this state because of this Medicaid crisis. An article about one of the deaths is here. http://www.sunherald.com/mld/sunherald/news/politics/11090449.htm

Author

Brett Potter

Date

2005-03-11T18:15:27-06:00

ID

64555

Comment

I heard about someone dying today because their meds were rejected at a Wal-Greens because the business didn't feel their money would be reimbursed. Makes you question if the medical/pharmaceutical industry really is in it to "help" others or to make a profit...

Author

kaust

Date

2005-03-11T18:21:14-06:00

ID

64556

Comment

What they are saying at Walgreen's now is that the computer system was down for the daily updates from Medicaid and that the family misunderstood. I don't know if this is true, or just to cover themselves, but even they say that if the family misunderstood, it was beause they were worried about the Medicaid crisis and that's why they misunderstood. Boils right back down to the same thing.

Author

C.W.

Date

2005-03-12T16:22:50-06:00