Barker bill would examine Medicaid, health care costs

Medicaid in Mississippi becomes a major debate come state budget time, with proponents arguing for the federal dollars that would feed the health care pool for those in need and detractors decrying a seemingly ever-escalating supply of state dollars required to prime the program's pump.

A Pine Belt legislator wants to formalize and focus those discussions in Jackson, drilling down to what is driving the program's costs and what the state might be able to do to curtail expenses.

Rep. Toby Barker, R-Hattiesburg, introduced House Bill 957 that would create a 13-person "Commission on the Future of Medicaid and Health Care in Mississippi."

The bill passed the House 96-22 and now moves to the Senate.

"Medicaid is going to continue to grow until we address some of the cost drivers," Barker said. "This will be a platform for that."

Other than spending on education, Medicaid is the largest general fund expense in the state budget.

The federal Affordable Care Act, better known as Obamacare, is expected to add another 75,000 to 80,000 people to the Medicaid rolls, with the state having to come up with another $80 million to $100 million as match money.

That would put state Medicaid spending at about $1 billion. The state budget for Fiscal Year 2016 is expected to be just more than $6 billion.

With revenue collections through January running more than $91 million ahead of projections, Mississippi may be better able to absorb that additional cost this year.

But as an annual expense, the concerns lie not only with expansion of the Medicaid program but continually-rising medical costs.

"Medicaid is going to be little more than $900 million (in 2014-15), and what we have, because of the Affordable Care Act, we've got some 74,000 more people on the Medicaid program," said Rep. Larry Byrd, R-Petal. "The state has to come up with the match money, and I know we're drawing dollars down, but the match money has to come out of our pockets."

Barker's envisioned commission would meet monthly through 2015-16, with an initial report of findings, conclusions and recommendations submitted to the Legislature and the governor by Sept. 1, 2016.

In the ensuing years, the commission would meet at least quarterly and submit annual follow-up reports by Sept. 1.

The commission would include three Senate members, three House members, two non-legislative members appointed by the lieutenant governor, two non-legislative members appointed by the Speaker of the House, one member of the governor's office, the executive director of the Division of Medicaid and the executive director of the Mississippi Department of Health.

The bill specifies that with "the goal of ensuring access, increasing quality and controlling costs of Medicaid and other health programs," the commission will meet and study various factors, including:

•Assessment of quality of care indicators and return on investment of the current Medicaid program, including hospital readmissions, chronic disease management and overuse of the emergency room for non-emergency conditions

•Examination of the state's current use of managed care, and whether increased use of managed care is needed

•Current Medicaid eligibility and whether further adjustments in eligibility are needed and/or manageable

•Potential innovative payment and delivery models for Medicaid and other insurance plans

•Continuation of federally-run health insurance exchange or creation of state-run exchange

•Future of State and School Employees Life and Health Insurance Plan

•Increasing capacity for primary care in Mississippi.

Barker said one legislator told him that the bill would create a conversation about Medicaid.

"(Medicaid) expansion is a piece of the conversation, but it's more looking at health care as a whole," Barker said, "looking at the changes that are happening and trying to help our system navigate through them."