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Hospital owner: federal agency may reject governor’s proposal if Medicaid is not expanded

The U.S. Centers for Medicare and Medicaid Services operates under the Department of Health and Human Services

A solution to Mississippi’s ongoing healthcare crisis offered by Gov. Tate Reeves may not receive the federal greenlight if Medicaid coverage is not fully expanded, according to a powerful hospital owner.

Reeves announced in September what he called “sweeping Medicaid reimbursement reforms” that could generate an estimated $689 million for hospitals throughout the state if the proposal is approved by the Centers for Medicare and Medicaid Services (CMS).

In response to the plan, hospital owner and administrator Quentin Whitwell said during a recent appearance on MidDays with Gerard Gibert that he’s thankful for the Republican governor’s efforts. However, he is worried federal officials might deny it unless lawmakers and Reeves decide to move forward with full Medicaid expansion.

“If I’m the feds, I’m probably saying, ‘Wait a minute. You want your cake, but you want to eat it too,’ because you’re not expanding for the population and the actual persons that need the insurance,” Whitwell said.

Whitwell, who owns Panola Medical Center and operates other hospitals throughout Mississippi, explained that Reeves’ plan does not provide a solution for every low-income working adult in the state.

The former politician believes lawmakers will have to look harder than ever at Medicaid expansion – which would give the state more than $1 billion in federal funding at a cost of just over $100 million – if a real answer is going to be provided to the state’s struggling hospitals. Last session, 17 bills that included expansions were thrown out without being taken up for a vote.

“I wouldn’t be surprised if we don’t end up in a situation where we have to look at both in the legislature this year before it’s over with,” Whitwell said of the likelihood of the legislature having to examine full Medicaid expansion as well as the governor’s plan.

With arguably a more open-minded speaker of the House set to take over in Rep. Jason White, lawmakers have already been discussing taking the prospect of expansion more seriously than in years past. Sen. Chad McMahan, R-Guntown, confirmed this recently.

“I’m neither for, nor against Medicaid expansion. What I’m for is having hearings on it,” McMahan said. “Bring in professionals. Bring in Mississippians that have healthcare, some that don’t have healthcare. Bring in professionals from across the state. Let’s look at what modernization of Medicaid would look like.”

Reeves’ proposal, which CMS has not yet given an update to SuperTalk Mississippi News on, would include the following:

  • The Mississippi Hospital Access Program will provide direct payments to hospitals serving patients in the Mississippi Medicaid managed care delivery system. With these direct payments, hospitals would be reimbursed at the same rate compensated by private insurance, which has been considered the federal ceiling for Medicaid reimbursements in managed care.
  • The second initiative will supplement Medicaid base payments for hospitals by reimbursing inpatient and outpatient hospital services at rates in the upper payment limit. Hospitals will pay more to cover the costs of bed taxes and uninsured patients but will be reimbursed at a much higher rate than what they put in.

Another issue with the plan that Whitwell pointed out is that CMS may not approve it unless more funding goes to rural health systems such as Greenwood Leflore Hospital. GLH is one of 25 rural hospitals in danger of closing in the coming years, according to a recent report from the Center for Healthcare Quality and Payment Reform.

As part of the proposal from Reeves, 42 percent of the funds ($291 million) will be dispersed among 16 hospitals. The other 58 percent ($398 million) will be distributed among 95 hospitals, most of which are small or in rural areas. That would equal out to $18.19 million per hospital in the first category and $4.19 million per hospital in the second.

“CMS, as a federal entity that relinquishes the funds for our hospitals, is going to want to make sure that we’re a fully honest broker in what we’re doing and what we’re applying for,” Whitwell added.

To date, 40 states have expanded Medicaid coverage. Mississippi is one of 10 nationwide that has refused to adopt expansion.

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