May 20, 2005
JACKSON, Miss. (AP) -- Adult Mississippi Medicaid patients who need liver or lung transplants are being told they might not get the lifesaving organs they need unless they move to another state and sign up for Medicaid there.
The University of Mississippi Medical Center in Jackson performs only bone marrow, adult heart and adult kidney transplants. Anyone needing a lung or liver transplant must go out of state, as must children who need transplants.
Mississippi Medicaid's policies allow the agency to negotiate payments for transplants for people 21 and younger. But for most adult cases, the hospitals have to be willing to accept Medicaid's standard reimbursement rates.
Apparently, a growing number of hospitals are not willing to accept the rates for transplants in adults.
Transplants usually cost much more than the regular reimbursement rate. A liver transplant, for instance, can cost $175,000 or more. No figures were available on how many Medicaid enrollees are awaiting transplants.
"We're having to tell people to leave Mississippi and set up residency in another state to get on their Medicaid and get a transplant center to accept them," said James Laird of the nonprofit Mississippi Organ Recovery Agency.
"This has been a problem, to some extent, for years, but I think we're seeing it worse right now," he said. "(University of Alabama-Birmingham) pretty well told me they're not accepting anyone over 21, with Mississippi Medicaid coverage only, for liver transplants. We're hearing the same thing from the social workers we deal with, and transplant coordinators."
Medicaid officials are working on solutions. Some lawmakers said they were surprised to learn of the problem and they may try to expedite the process.
"(Medicaid) is obviously not making transplants a priority," said House Public Health Committee Chairman Steve Holland, D-Plantersville. "It sounds like it's just about shut down for adults right now."
Holland said as the Legislature deals with state budgets in the current special session, he will likely try to include a provision to mandate Medicaid to change its policies to help adults get out-of-state transplants.
But Sharon Myers, Medicaid deputy administrator for health services, says legislation isn't required; negotiation with regional hospitals is. She said Medicaid is already addressing the issue.
"We need a different approach," Myers said. "I think the problem is right now it's handled on a case-by-case basis, and we need a more regional approach, a global approach."
Myers said working out standardized Medicaid transplant agreements with regional medical centers such as UAB and Tulane in New Orleans would not only ensure patients would receive the transplants they need, but it would likely save the state money in the long run.
"For a liver transplant, for instance, our negotiated rate might be 70 percent of that $175,000," Myers said. "If you buy a fleet of cars from a dealer, you get a better price, because they know you're coming back to them. It's the same with transplants. They are going to come off the price, if they know we are dealing with them."
Myers said Medicaid officials have had conferences with UAB and a medical center in Nebraska recently about establishing such agreements.
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