Why is Mississippi Medicaid paying $57 million to out-of-state pediatric programs when that money could be used to grow our programs in Mississippi?
It’s just one example how the Medicaid bureaucracy has grown so huge that the right hand doesn’t know what the left hand is doing. As a result, huge amounts of money are wasted.
Medicaid is a unique federal-state beast. There are federal guidelines, but states have lots of room to tweak the rules as they see fit.
One Mississippi rule, encouraged by the feds, is to provide Medicaid coverage to severely disabled newborns, infants and young children. This is a good thing, preventing bankruptcy for young parents who face unforeseen catastrophic health problems with their young children. An example would be an infant born with a malformed heart valve requiring expensive heart surgery.
Medicaid is an insurance plan. Like all insurance plans, it has approved hospitals. Some of these approved hospitals are in Louisiana, Tennessee, Arkansas and Alabama.
In the past, the reason for this was access to care. For instance, Mississippi lacked the ability to provide cutting edge congenital pediatric surgical care, so it allowed Mississippians to go out of state.
Children with congenital heart problems were sent to the Children’s Hospital in Little Rock, Lebonheur in Memphis, UAB in Birmingham and Children’s of New Orleans. Ninety-five percent of the children were treated outside the state.
But that was then and this is now. Over the last five years, Mississippi has vastly improved its pediatric heart care at the Children’s Heart Center at the University of Mississippi Medical Center (UMMC).
Children of Mississippi is now a medium-sized program by national standards with 27 pediatric cardiology specialists, two surgeons and 350 surgeries a year.
All pediatric heart centers are required to send their data to the Society of Thoracic Surgeons, the leading quality control entity in the United States. UMMC’s program is now rated in the top five in the nation out of 65 programs.
But we’re still sending children out of state at the encouragement of Mississippi’s Division of Medicaid. That’s $57 million leaving the state for a lower level of care. That money could be going to build up our own programs. It makes no sense.
Even worse, our neighboring states are apparently not returning the favor. Each state Medicaid system can decide what hospitals to allow as a provider. Mississippi allows out-of-state hospitals to be providers, but our neighboring states don’t allow Mississippi hospitals to be providers.
Right now, Louisiana owes Mississippi $4 million for hospital care provided for Louisiana residents. They won’t pay. Our money is going out, but none of their money is coming in.
As one hospital official told me, “There is no reciprocity, even along the borders. It has gotten to the point where if today an out-of-state patient comes to us, unless it’s an absolute emergency, we send them back to their respective states because we know that if we do take care of them, we’re not going to get paid a cent. Yet if a Mississippian goes to their hospital, Mississippi pays them. It’s nuts.”
The $57 million outflow is just in pediatric care alone. If you included all aspects of health care, the outflow to out-of-state hospitals could be hundreds of millions.
The solution is simple. Mississippi Medicaid needs to quit allowing out-of-state hospitals to be providers to Mississippians. Mississippians need to go to Mississippi hospitals. There is no longer any major category of care that cannot be provided adequately by our state’s hospitals.
If there are rare cases when treatment could not be provided in state, then Mississippi Medicaid could carve out an exception for special situations.
Medicaid is an insurance program, similar to Blue Cross of Mississippi. Just like Blue Cross designates certain hospitals as care providers, Mississippi Medicaid can designate provider hospitals.
Since Mississippi Medicaid is funded by Mississippi taxpayers, Mississippi hospitals should be the health care providers for Mississippians. There is just no logic in taxing Mississippians and then sending the money to out-of-state hospitals.
If there are transportation issues, that could be resolved as well, but allowing hundreds of millions to flow out-of-state to save drive times is a perfect example of being penny wise and pound foolish.
This is an example of an old rule that is obsolete that nobody has paid enough attention to fix. The Medicaid office stated they had no idea whether out-of-state hospitals had reciprocity agreements with Mississippi or not.
Imagine, millions on the line and Mississippi Medicaid doesn’t even know what’s going on.
“Why should we be paying other states to take care of kids for a service that is actually being done much better by us,” one doctor told me.
Politics may be involved. The biggest chunk are Mississippians living near Memphis. Some of these voters have made it a point they want the option to go to Memphis hospitals. Gov. Bryant gets a lot of votes up there.
Fifty-seven million dollars is a lot of money to get a fraction of DeSoto County’s 28,000 Republican votes. If this issue is important to 10 percent of that county’s Republican voters, it comes to $20,000 per vote. Now that our incumbent governor is a shoe-in for re-election, perhaps he could put some pressure on the Division of Medicaid to correct this situation.
The Dispatch Editorial Board is made up of publisher Peter Imes, columnist Slim Smith, managing editor Zack Plair and senior newsroom staff.
You can help your community
Quality, in-depth journalism is essential to a healthy community. The Dispatch brings you the most complete reporting and insightful commentary in the Golden Triangle, but we need your help to continue our efforts. In the past week, our reporters have posted 41 articles to cdispatch.com. Please consider subscribing to our website for only $2.30 per week to help support local journalism and our community.