Crystal Springs resident Shan Copeland suffers from pseudotumor cerebri, a condition in which pressure inside the skull increases for no obvious reason. Copeland credits Medicaid with saving her life
Wochit
Gov. Phil Bryant has instructed officials to develop plans to transfer all Medicaid eligibility verification responsibilities to the Department of Human Services.
If the change is made, Human Services will be responsible for determining the eligibility of Medicaid applicants, alongside applicants for the services they already provide like Temporary Assistance for Needy Families and Supplemental Nutrition Assistance Program.
At the same time, talk of implementing a work requirement for Medicaid recipients, something the federal government has not previously approved, is gaining traction.
“I anticipate the Department of Human Services assuming full responsibility and authority over Medicaid enrollment and eligibility by amending the code,” Bryant wrote in a letter to both agencies Oct. 12.
The federal Medicaid agency, the Centers for Medicare & Medicaid Services, has for years encouraged states to consolidate the eligibility process for Medicaid with other government benefits.
Related: The who, what and how much of Mississippi Medicaid
“They’re ultimately two different things, but there’s an overlap of who receives the benefits,” said Senate Medicaid Chairman Brice Wiggins, R-Pascagoula. “It makes sense to try to streamline the process.”
Instead of going to multiple agencies, applicants would prove their eligibility with Human Services and become qualified for various benefits.
In his letter, Bryant also asked the Mississippi Division of Medicaid to draft legislation that would amend the Mississippi Code section regarding eligibility, to place eligibility determinations under Human Services.
“The governor believes doing so would increase efficiency and ultimately save taxpayers money. This method was successfully used until 2004,” said Bryant’s spokesman, Clay Chandler.
While Medicaid is under the governor’s authority, he clearly intends to work with the Legislature on the changes, said Wiggins, who was copied on Bryant’s letter.
Bryant’s instructions come as lawmakers gear up to consider the “Medicaid technical amendments bill,” which they must pass during the 2018 session to reauthorize the Division of Medicaid.
The bill is a possible vehicle for major overhauls to the state’s Medicaid program, including changes to managed care.
Foreshadowing new requirements
Bryant’s letter could foreshadow other changes to come: “By Oct. 27, DHS and DOM shall present written plans to me outlining the steps to transfer to DHS all staff, funding, contracts, contract authority, and responsibility related to Medicaid enrollment and eligibility,” he wrote, “as well as all waiver authority related to Medicaid enrollment and eligibility, including any work requirements related to eligibility.”
No state has a work requirement to become eligible for Medicaid, said Rep. Jarvis Dortch, D-Jackson, formerly of the Mississippi Health Advocacy Program, because Centers for Medicare & Medicaid Services has never approved a request for one.
Now, states are waiting to see if President Donald Trump’s administration will approve a waiver allowing work requirements for Medicaid, said Jameson Taylor, Mississippi Center for Public Policy vice president for policy.
Wiggins said he wasn’t certain if waiver authority fell to the Legislature, but, “I can say that we are always interested in looking at making sure people who are receiving benefits are not gaming the system and are entitled to those benefits they’re receiving.”
“Working is one of those ways that we can ensure that people aren’t along without some skin in the game, so to speak,” Wiggins said. “It’s not out of the question that the Legislature would consider (work requirements).”
Conflating services
Dortch said putting Medicaid eligibility verification functions under Human Services is to conflate health insurance with services like food assistance.
“My concern off the bat is this idea that Medicaid is a welfare program. So many legislators think like that,” Dortch said. “It’s health insurance. People do not receive any money for qualifying for Medicaid. The money goes to providers … There’s no incentive for you to have Medicaid and not work. You can’t eat with an insurance card.”
Then there’s the fact that Human Services has been denying services to most TANF applicants — 98.5 percent of applicants were rejected in 2016.
“DHS isn’t approving anyone for TANF. They are putting up every barrier in the world for child care subsidies,” Dortch said. “Eligibility wise, if you look at the track record with DHS over the last three years, you would be concerned … I guess I just don’t have any faith in them doing Medicaid eligibility.”
Roy Mitchell, director of the Mississippi Health Advocacy Program, said Medicaid eligibility used to be a function of Human Services and, back then, he witnessed verification officers overburdened with cases. Mitchell said this resulted in some Medicaid recipients erroneously losing their coverage.
Taylor said the change shouldn’t affect an eligible person from receiving Medicaid because health insurance is more strictly regulated by the federal government than other assistance programs.
“Medicaid and TANF, for instance, are funded in fundamentally different ways,” Taylor said. “Medicaid is an entitlement. If you’re eligible, the state has to extend Medicaid to you, whereas with TANF, you have block grants. States have more liberty to restrict eligibility and restrict benefits to those on the program.”
Mississippi lawmakers have expressed support for a Medicaid block grant, a provision included in federal health care bills that died over the summer.
While lawmakers stress the need to decrease the state’s Medicaid rolls, “it’s erroneous to say that we want to kick people off the rolls,” Wiggins said.
“There are objectors who want to create this cloudy atmosphere and say we’re trying to kick people off the (Medicaid) rolls and all that kind of stuff, when we’re actually trying to be transparent and efficient with taxpayers’ dollars,” Wiggins said.
Longtime former chairman of the appropriations subcommittee on health care, Rep. Steve Holland, D-Plantersville, said lawmakers have yet to hold hearings regarding possible changes to Medicaid in this coming legislative session.
“I’m real apprehensive about what’s going to happen to Medicaid in 2018,” Holland said. “Of all the programs in state government that doesn’t need to undergo a change without hours upon hours of hearings, with all stakeholders, it’s Medicaid. You simply don’t need to play toes with it.”