Negotiations ongoing in Medicaid coverage – Jackson Clarion Ledger
Almost two months after an Alabama children’s hospital stopped accepting Mississippi Medicaid, the state director said negotiations are ongoing.
In early March, Alabama Children’s Hospital announced it would no longer be accepting Mississippi Medicaid patients due to failed negotiations.
“We are saddened that, after more than 18 months of trying, we have not been able to successfully negotiate provider agreements with acceptable terms with the managed care contractors,” the hospital said in a statement on their website.
From Jan 1, 2015 to March 2017, Alabama Children’s treated 143 unique Mississippi Medicaid patients, according to Adam Kelley, manager of corporate communications.
However, Dr. David Dzielak, executive director of the Division of Medicaid, said the suspension of service was affecting 300 of Mississippi’s Medicaid beneficiaries.
Dzielak said the Alabama children’s hospital was inaccurate when it said it had not been receiving payments. “Children’s Hospital of Alabama was not part of the managed care company network” and “didn’t want to be.” But it was receiving a reduced rate for claims reimbursement. He added that negotiations are ongoing and he feels there is some movement on the hospital’s part to participate.
Kelley confirmed there are conversations regarding Children’s becoming an in network provider.
While the hospital is currently not accepting Mississippi Medicaid, it is still an enrolled provider.
“Our staff, along with the coordinated care organizations, have been working directly with beneficiaries to ensure a smooth transition of care throughout this disruption,” said Erin Barham, the Medicaid division’s deputy administrator for communications.
Multiple out-of-state hospitals, including hospitals in south Alabama, Tennessee, Arkansas and Louisiana, participate in the state’s managed care network, which Dzielak said has saved the state $210 million since 2011.
None of those hospitals has had a problem participating in the network, he said.
East Tennessee Children’s Hospitals is an “an active provider for Mississippi Medicaid,” according to public relations manager Erica Estep.
Estep said for non-emergent care, the hospital has more than 30 subspecialties and some of the physicians may not be a provider for a specific insurance. If an out-of-network provider agrees to treat a child, there is an option to work out an agreement with the insurance company prior to care,” she said.