This week, we reviewed the request for proposals (RFP) issued by the Mississippi Division of Medicaid (DOM) for the reprocurement of Mississippi Coordinated Access Network (MississippiCAN) Medicaid managed care plans. Under the RFP, the DOM is adding 1915(i) Intellectual/Developmental Disabilities Community Support Program (IDD CSP) and Mississippi Youth Programs Around the Clock (MYPAC) services to the MississippiCAN benefit package. As of February 2017, MississippiCAN enrolls roughly 490,000 Medicaid members across all 82 counties in the state, with annual spending of more than $2.7 billion.
MississippiCAN has undergone a significant expansion in recent years. Legislation passed in 2012 allowed the program to expand to enroll up to 45 percent of the state’s Medicaid beneficiaries in managed care, with additional expansions approved in 2014 and 2015. Roughly 490,000 out of 690,000 total Medicaid beneficiaries (70 percent) are enrolled in one of two MississippiCAN managed care plans.
MississippiCAN allows for optional disenrollment for the following eligibility groups:
- Children with SSI aged 0 to 19;
- Children ages 0 to 19 with disabilities who live at home
- DHS-Foster Care children and individuals receiving Adoption Assistance, ages 0 to 19; and
- Native Americans, regardless of age.
Members are excluded from MississippiCAN if they are:
- Residing in a nursing home (excluding those residing in a Psychiatric Residential Treatment Facility (PRTF) or in a intermediate care facility for individuals with intellectual or development disabilities (ICF/IID);
- Enrolled in a waiver program; or
- Dual eligible for Medicaid and Medicare.
Estimated Capitation Rates
Projected membership and capitation rate data for July 2016 through June 2017 is provided in the RFP documents. Based on projected average monthly membership of 494,000, and a blended per-member-per-month capitation rate of $473, projected fiscal year (FY) 2017 spending for MississippiCAN should surpass $2.8 billion. It is likely that the inclusion of IDD CSP and MYPAC services to the benefit package would increase overall spending and the average blended capitation rate.
Note: Total projected annual spending includes delivery kick payment
Source: SFY 2017 MississippiCAN CCO Rate Calculation and Certification
RFP, Contract Timing
Interested bidders must submit a mandatory letter of intent (LOI) to the Mississippi DOM by February 24, 2017, to be considered for a contract award. Proposals are due to the state on April 7, 2017, with awards to be announced in June and contracts to be in effect by July 1, 2017, when current MississippiCAN contracts expire. However, awarded plans will not begin providing services under the new contracts until July 1, 2018.
The RFP provides no indication of the number of contract awards that will be made. Contracts run from July 1, 2017 through June 30, 2020, with two one-year extension options.
Bidders will be primarily evaluated on the “methodology and work statement” section of the response. This section includes:
- Processes and requirements for completion of the project.
- Data management plan, including hardware, software, communications links, and data needs and proposed coordination plan.
- Processes for maintaining confidentiality of patient health information.
- Processes for development and submission of required deliverables.
- Scope of services provided through partnerships or subcontractors.
- Quality Assurance processes.
Current MississippiCAN Market Summary
As noted above, there are two plans currently under contract and serving the MississippiCAN program – Centene’s Magnolia Health Plan and UnitedHealthcare. Each has a roughly 50 percent market share of the roughly 489,000 members as of February 2017 and operates across all 82 counties statewide.