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Mississippi Today

Medicaid’s managed care contracts at a standstill after two companies cry foul

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More than a year after Mississippi announced it was contracting with three companies to manage the care of their beneficiaries, those contracts have not been awarded.

That's because two companies that weren't chosen say the selection process was unfair.

UnitedHealthcare and Amerigroup, two for-profit managed care companies, were not chosen by Mississippi Medicaid as one of its contracted companies entrusted with managing beneficiaries' health care. The two organizations have subsequently filed protests with the state, alleging the selection process was flawed, leading to a months-long stalemate over who will manage Mississippi Medicaid beneficiaries' care after next summer.

The stakes are high: the contracts, funded by state and federal dollars, are worth billions.

The majority of Medicaid recipients in most states are enrolled in managed care organizations. Through a lucrative contract agreement, divisions pay these companies to deliver services to beneficiaries.

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In exchange for a monthly payments — regardless of whether services were or were not used by a beneficiary during that period — the managed care organization must maintain a network of providers for its enrollees and ensure enrollees are not billed for covered services.

Managed care for Mississippi Medicaid beneficiaries began in 2011 with the inception of the division's “coordinated care program,” or its managed care system called MississippiCAN.

According to its website, MississippiCAN currently provides health insurance for more than 480,000 of the state's most vulnerable citizens, including poor adults and children, people who are disabled and pregnant people. Medicaid insures about 837,000 Mississippians total as of September.

The Mississippi Division of Medicaid is located in the Walter Sillers Building, seen here on Monday, Oct. 16, 2023, in Jackson, Miss. Credit: Eric J. Shelton/Mississippi

Though they're theoretically well-intentioned — to increase services for beneficiaries and reduce costs for Medicaid — managed care organizations have been criticized by politicians, patients and health care leaders for prioritizing profit and hindering patient care.

Managed care organizations' performances can vary greatly, and which ones the Medicaid agencies contract with is up to them. That's decided through a process called procurement.

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In December 2021, the Division of Medicaid began seeking new contracts and solicited “requests for qualifications” from managed care companies. Five prospective contractors submitted proposals in March 2022.

Mississippi Medicaid announced in August 2022 that it intended to award contracts to three of those: TrueCare, Magnolia Health and Molina .

TrueCare, a not-for-profit company, was created by hospitals along with the state hospital association to what they believe is better care to patients, compared to traditional managed care organizations.

Molina Healthcare and Magnolia Health are both privately-owned companies that already administer services to Medicaid beneficiaries, along with UnitedHealthcare.

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Magnolia has gotten the biggest contracts of all three — almost $9.3 billion for its contracts with Medicaid since 2017, which includes $1.2 billion in the emergency contract.

Magnolia is a subsidiary of health giant Centene. The St. Louis-based company is the nation's largest Medicaid managed care company and one of Gov. Tate Reeves largest campaign donors.

Centene was previously investigated over suspicions it was over-inflating bills to Mississippi's Medicaid division. The company never admitted wrongdoing, though Centene settled with the state in June of 2021 for $55.5 million.

Medicaid spokesperson Matt Westerfield said there were no “rules that would exclude Magnolia from the process due to the Centene settlement” when asked why, if the company was previously investigated, it was awarded one of the contracts.

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Since 2017, Molina has been paid $2.8 billion to provide services for MississippiCAN and Medicaid's Mississippi Children's Health Insurance Program, according to the state's contract database. In the most recent contract, the emergency contract that runs from 2023 until 2024, the company is getting paid more than half a billion dollars.

For the same services in the same time period, United received nearly $8.4 billion. The current emergency contract pays out more than a billion dollars for their services over the course of a year.

Companies involved in the process have seven days to file protests before the agency can officially award the contracts. Then, the contracts go to the state's procurement board for final approval.

Following Medicaid's announcement about the new contracts in August, UnitedHealthcare, which had a contract with the agency the prior year, and Amerigroup, the two companies that were not chosen, submitted protests.

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It's unclear what United's claims are. Mississippi Today did not have a copy of their protest at the time of publication.

Amerigroup's protest alleges that Mississippi Medicaid failed to conduct a “blind” evaluation process, didn't follow the state's rules for contract procurement, the process was structurally flawed and “outside influences” affected its fairness.

Amerigroup cites several instances where it says companies shared identifying information. According to the protest, TrueCare revealed its connection to the Mississippi Hospital Association by mentioning the health information exchange program, which allows hospitals to share important information about patients with each other. It's the only company with access to the exchange because of its association with hospitals.

Amerigroup also takes issue with Molina including a company-specific vaccine incentive program, “curved” graphics similar to their logo and “well-known” Molina food insecurity initiatives in its proposal. Magnolia's proposal included mentions of its partnership with Adelade and AT&T, which would have been enough to identify them, the protest claims.

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Magnolia and Molina did not respond to Mississippi Today's requests for comment regarding these allegations. TrueCare's Richard Roberson declined to answer questions because “under the Division of Medicaid's rules, all offerors are prohibited from making public disclosures to the media regarding the procurement.”

The “outside influences” cited by Amerigroup's protest refers to a letter Sen. Kevin Blackwell, R-Southaven and chairman of the Senate Medicaid Committee, sent to Mississippi Medicaid Executive Director Drew Snyder on Dec. 3, 2021, a few weeks before the procurement process began. Blackwell in the letter vouches for TrueCare and criticizes the performances of the current managed care organizations.

Westerfield said the letter was “never seen by any evaluator, nor was any evaluator made aware that it had even been written.”

“It had no effect on the RFQ process or outcome,” he said.

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The protest also includes a screenshot of texts between Drew Weiskopf, a consultant assisting with the evaluation, and Margaret Middleton, a lawyer for Mississippi Medicaid. In the texts, Weiskopf appears to insinuate that the evaluators were able to identify the companies — he refers to their “urge to standup (sic) and shout ‘I know who this is!'” and uses a GIF from the Elf in which a character identifies Santa Claus. The texts were allegedly sent during the evaluation meetings scoring the blind proposals.

“The texts do not reflect that any evaluator expressed knowledge of any Offeror, nor could the texts have done so, as no expression was ever made,” Westerfield said.

The Division of Medicaid's response to the protests, which was to affirm its decision to award the contracts to the three managed care organizations, were issued this past summer. Both organizations appealed the agency's decision to the procurement review board, and both of those protests are still pending.

As a result of the ongoing complaints, Medicaid extended the contracts of the current managed care organizations — United, Molina and Magnolia — and then issued one-year emergency contracts to them. Those contracts, which began in 2017, will be in place until June 2024.

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Violations during the “blind” portion of the process have previously derailed Mississippi Medicaid's procurement process.

Medicaid Executive Director Drew Snyder told lawmakers at a Senate Medicaid Committee hearing last February that “following the instructions for blind evaluations is one of the perilous spots where procurements can go off the rails.”

“I'm sure more than one agency can share a story of a lengthy procurement that had to be terminated because every vendor revealed some kind of identifying information about itself,” he said.

During a Medicaid procurement for different services two years ago, the agency confirmed that a company's name appeared in a footnote, which delayed the process.

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During the current procurement for managed care contracts, Medicaid said it took several steps to ensure the process was fair, including extensively reviewing submissions, including an independent review by a office that plays a major role in state procurement processes, which found no problems. The agency also required mandatory for procurement evaluators, who were “told repeatedly to inform [the Division] if they found any identifying information,” according to the agency.

“No evaluator ever notified DOM that he or she knew the identity of any Offeror, nor did any evaluator make any statement in the evaluation process inferring that he or she knew the identity of any Offeror,” Westerfield said via email.

The fate of the contracts now rests with the procurement review board, which has not yet set a date to hear the protests.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Mississippi’s ‘reading miracle’ has been out of reach for some schools

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mississippitoday.org – Julia James – 2024-05-21 14:38:37

CLARKSDALE — On a Tuesday afternoon in the fall, Jessica Johnson held up index cards of words as students crowded around the table to identify the type of vowel sound and sort them into buckets.

In another classroom, Shalandria Ivy guided students as they identified images, sounded out the first letter of the item in the drawing, and found that letter in their cards. These teachers at Kirkpatrick & Medical Science Magnet, an elementary school in the Clarksdale Municipal School District, are also tutors in the Reading Roadmap after-school literacy program. 

Johnson and Ivy are among hundreds of Mississippi reading teachers and leaders that helped create a rise in test scores after the passage of the Literacy-Based Promotion Act in 2013. Mississippi, which has long struggled with reading outcomes for students, has been showered with international acclaim for its gains that some dubbed the “Mississippi Miracle.”

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But in several school districts across the state, here in Clarksdale, the drastic reading gains haven't been as strong. For the teachers and students, the effects have felt less than miraculous, for reasons ranging from resources to teacher turnover.

“We're in a where students need hardcore remediation, (we) can't really teach the grade-level themes because their comprehension is not there,” said Janice Citchens, a first-year English teacher in the Tallahatchie School District. “My students are 100% capable, if they had the resources and the right people … then the sky is the limit.”

‘The science of reading'

The 2013 state law created a more robust infrastructure around helping children learn to read and holding them back at the end of third grade if they didn't hit a certain benchmark. While the law did not create a mandatory curriculum, the State Board of Education promoted, and in some cases required, teacher on the principles of the “science of reading.” This term refers to a body of research that demonstrates the importance of phonics instruction in learning to read.

The success of the new system, which includes targeted teacher training, more parent communication and interventions for lower-performing students, brought much national attention to the state. 

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These test score improvements have come primarily on the National Assessment of Educational Progress, a test administered by the federal government in the fourth and eighth grades that is often used to compare between states. A decade ago, Mississippi ranked near the bottom of the list for its fourth-grade reading scores. In 2019, the state made headlines for making the most gains in the nation on fourth-grade reading. Again in 2022 and 2023, Mississippi has been lauded for surpassing the national average in this area.

Nearly every district in the state has seen some amount of improvement: A recent analysis by Mississippi First, an education policy nonprofit, found that 97% of school districts improved third-grade reading scores since the passage of the 2013 state law. 

Despite this success, many districts across Mississippi are still struggling to get all their students to be successful readers, with 24 10 percent fewer students passing the third-grade “gate” on the first try than the state average. Teachers and policy experts attribute the challenge to multiple factors, including higher teacher turnover rates and fewer resources in low-income communities.

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“One of the things I think we did with the Literacy-Based Promotion Act is prove … that Black kids and low-income kids can learn to read just like everybody else,” said Kelly Butler, former CEO of the Barksdale Reading Institute that workeds to improve Mississippi students' pre-literacy and reading skills. “So when you think about those districts that still have big pockets of low performance, I think part of it has to do with being able to attract (educators) in these hard-to-serve schools.”

Citchens, the West Tallahatchie teacher, said she can see in the data that many of her seventh- and eighth-grade students have regularly been behind grade level. She attributes this to her students receiving inconsistent reading instruction and a disparity in resources.

Citchens also said the teaching coaching she received has been some of the most influential training in her career, as it covered resources and best practices as well as how to use them in her classroom. She believes the benefits of these trainings are stemmed when teachers regularly a district. 

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“They're pouring into the teacher, they're getting these coaches, but if (the teachers) don't stay long enough to perfect these practices … then the students are still at a disadvantage,” she said. 

A recent Mississippi First analysis had similar findings. Its review of state testing and teacher turnover data for the 2022-23 school year found districts with higher rates of turnover were more likely to have low proficiency on state tests. While this analysis does not prove one factor is causing the other, it also points to research on the negative impacts on student learning when teachers leave. 

Other educators have also observed this pattern. Rosemary Collins, a reading interventionist working in Leland, said that, while some districts have more resources, knowledge and experts to implement new tools, other districts are “asked to do more with less.”

Collins works with third-grade students who are projected to fail the reading assessment, or “third-grade gate” as it is colloquially known. She said she would like to see a highly structured literacy curriculum implemented for all students, not just those she works with, as she believes it would decrease the need for intense intervention. She also discussed the need for effective and equitable teaching training to make this happen, something that is stymied by turnover.

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“To keep teachers in the classroom, it has to be a mindset change about what educators are and who they are for the community,” Collins said. “You have to feel respected and valued as an individual to want to stay in an environment.”

Both Citchens and Collins described an increased investment from parents in helping their children pass the third-grade test after all of the discussion and positive press related to Mississippi's “reading miracle.”

“With the growth, and with all of the positive promotion of the growth, I see parents in my community … willing to be more active in their child's education because they're not only proud for their child, it's like a sense of pride for themselves as well,” Citchens said.

‘The gains aren't zero-sum'

‘The science of reading'Reading Roadmap, founded in Kansas, came to the Mississippi Delta in 2017. The interactive program places students in small groups based on their skill level and uses instructional materials that follow the “science of reading” principles promoted by the state education board.

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Taurean Morton, state director of Reading Roadmap, helps students practice sounding out the first letter in a word during the afterschool literacy program in the Mississippi Delta, Oct. 10, 2023. Credit: Julia James/Mississippi

“Mississippi as a whole has done it successfully, but here in this area, an area that's sort of marginalized or stigmatized, I think we wanted to bring equity and bring a better light to this area,” said Taurean Morton, Mississippi state director with Reading Roadmap. 

The excitement and investment around reading is something Clarksdale Municipal Superintendent Toya Harrell-Matthews said Reading Roadmap helped bring to her district. While COVID-19 interrupted some of it, she said she is working to see the energy return and the program thrive. 

“The first training they did in that little boardroom right over there, just the excitement (of) the teachers learning a new approach and the science of what they were actually going to be doing … I want to get back to that,” Harrell-Matthews said. 

Morton, the state director for Reading Roadmap, said the program uses the local district's benchmark testing results to sort students into skill groups and track their movement to ensure they are getting the interventions they need. Activities at each skill level are interactive or gamified, which allows students and teachers to reset from the school day. 

He also said he's noticed a gap in higher education teacher training programs around phonics and “the science of reading.” Morton said he hopes that if they can show the effectiveness of these strategies in their work, it will help create a shift at the post-secondary level. 

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Butler, the former CEO of the Barksdale Reading Institute, also said strengthening Mississippi's teacher training programs remains one of her key focuses. She said the programs have made improvements but there is still a lack of accountability for higher education programs. 

“Until they are required to do something differently, we're always going to be retraining teachers,” Butler said. 

The Mississippi Department of Education attempted to address this issue in 2016 by requiring candidates to pass the Foundations of Reading assessment to an elementary education license. 

Elizabeth Streeter, a teacher with Reading Roadmap, helps students practice sounding out words on Oct. 10, 2023 in Clarksdale. Credit: Julia James/Mississippi Today

Morton is excited by the growth students in the program are experiencing, with some of the schools they serve in Clarksdale also seeing improvements in their accountability grades. But even in the years where the program hasn't seen huge improvements, his team still considers it a success. 

“Each year we've seen movement and growth,” said Becky Nider, director of programs for Reading Roadmap. “Maybe a kid doesn't go from being in the red to the green like we want, but we see them move through the red… We get to celebrate those small successes because it's not a small success for that child.”

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This mindset of incremental progress is one that some teachers would like to see more consistently represented in discussions of the so-called “miracle.” 

Langly Dunn, an elementary librarian in the West Tallahatchie School District, said her district can have both a celebratory attitude and a clear understanding of the work they have left to do. It's something she wishes politicians would also embody instead of “weaponizing and politicizing” the reading gains for their own benefit. 

“When it comes to reading, the gains aren't zero-sum,” she said. “It's not like ‘we solved all problems and the way that we teach reading in Mississippi is perfect in every district, in every school, in every classroom all the time' or ‘the results are unreliable'. It doesn't have to be one of those two things. We can have made great strides and still interrogate what's left for us to do.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1892

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mississippitoday.org – Jerry Mitchell – 2024-05-21 07:00:00

MAY 21, 1892

of Ida B. Wells, circa 1893 Credit: Courtesy of National Park Service

Crusading journalist Ida B. Wells published a column exposing the lynchings of African-American and denouncing claims that the lynchings were meant to protect white women.

Her anti-lynching campaign came after a mob killed three of her friends, who had reportedly opened a grocery store that competed with a white-owned store in Memphis.

Upset by Wells' writings, a white mob destroyed her presses and threatened to kill her if she ever published again. She left Memphis for Chicago, but she continued to expose lynchings, calling for national legislation to make lynching a .

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In 1898, she took her protest to the White House.

“Nowhere in the civilized world save the United States of America do men, possessing all civil and political power, go out in bands of 50 and 5,000 to hunt down, shoot, hang or burn to a single individual, unarmed and absolutely powerless,” she wrote. “We refuse to believe this country, so powerful to defend its citizens abroad, is unable to protect its citizens at home.”

The National Memorial for Peace and Justice in Montgomery, which opened in 2018, features a reflection in honor of her.

finally passed an anti-lyncing in the 2021-22 . The Emmett Till Antilynching Act defines lynching as a federal hate crime.

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1961

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mississippitoday.org – Jerry Mitchell – 2024-05-20 07:00:00

MAY 20, 1961

In this 1961 , leader John Lewis, left, stands next to James Zwerg, a Fisk student. Both were attacked during the Rides. Credit: AP

A white mob of more than 300, Klansmen, attacked Freedom Riders at the Greyhound Bus Station in Montgomery, Alabama. Future Congressman John Lewis was among them. 

“An angry mob came out of nowhere, hundreds of people, with bricks and balls, chains,” Lewis recalled. 

After beating on the riders, the mob turned on reporters and then Justice Department official John Seigenthaler, who was beaten unconscious and left in the street after helping two riders. 

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“Then they turned on my colleagues and started beating us and beat us so severely, we were left bloodied and unconscious in the streets of Montgomery,” Lewis recalled. 

As the mob headed his way, Freedom Rider James Zwerg said he asked for God to be with him, and “I felt absolutely surrounded by love. I knew that whether I lived or died, I was going to be OK.” 

The mob beat him so badly that his suit was soaked in blood. 

“There was nothing particularly heroic in what I did,” he said. “If you want to about heroism, consider the Black man who probably saved my . This man in coveralls, just off of work, happened to walk by as my beating was going on and said ‘Stop beating that kid. If you want to beat someone, beat me.' And they did. He was still unconscious when I left the hospital.” 

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To quell the violence, Robert Kennedy sent in 450 federal marshals.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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