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Executive Summary
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The Children’s Health Insurance Program (CHIP) is a joint federal/state program funded primarily through a block grant from the federal government that is based on the number of children in low-income families, the number of those children who are uninsured, and the state cost factor. The federal government provides the majority of the funding for the program through an enhanced federal match rate, which was 83.4% for Federal Fiscal Year 2008.
States have the authority to design their own CHIPs. Mississippi law sets out minimum requirements for the state’s CHIP and authorized a CHIP Commission to set up the structure of the program. The CHIP Commission recommended that Mississippi’s Children’s Health Insurance Program operate as a separate, fully insured program under the direction of the State and School Employees’ Health Insurance Management Board. The Division of Medicaid also has CHIP responsibilities and the division’s officials are ultimately held responsible by the federal Centers for Medicare and Medicaid Services for program administration and oversight.
Mississippi operates a separate CHIP that provides benchmark equivalent “plus” coverage, which means that Mississippi’s CHIP provides all of the benefits provided by the benchmark plan (i. e., the State and School Employees’ Life and Health Plan), as well as additional benefits (e. g., dental and vision coverage).
The current CHIP insurer, Blue Cross Blue Shield of Mississippi (BCBSMS), was selected through a competitive bidding process. The current agreement allows the insurer to operate similar to a third-party administrator. BCBSMS is allowed to set aside a portion of premiums paid by the state for administration and then pay claims out of the remaining amount. If the amount of claims paid out is more than the set-aside amount of the premium, BCBSMS is allowed to recover that amount.
From January 2004 through June 2008, the total cost of Mississippi’s CHIP was approximately $605 million, with the federal government contributing $505 million and the state contributing approximately $100 million. The cost of CHIP varies yearly and depends largely on the premium rate structure charge by the insurer.
PEER believes that Mississippi’s CHIP has opportunities for cost savings that the state has not yet achieved, including restructuring benefits, increasing cost sharing, implementing prescription drug cost containment measures, and implementing enrollment controls.
Given that no clear best practice model for a state CHIP emerged from a national survey and PEER’s own survey of selected states and given that Mississippi’s present contract with BCBSMS ends December 2009, PEER recommends that the state issue a request for proposals for a new service delivery structure to be effective for 2010. This structure should incorporate PEER’s recommended cost savings measures and changes in contract terms.
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Executive Summary
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For Fiscal Year 2008, the Department of Corrections’ general cost per inmate day (for all security levels combined) in a 1,000-bed facility was $49.13, including debt service for a facility. FY 2008 costs per inmate day for individual security classifications were as follows: minimum security, $46.76; medium security, $43.75; and maximum security, $91.93. MDOC’s FY 2008 costs per inmate day for security classifications in a 500-bed psychiatric correctional facility were $59.20 for medium security and $94.03 for maximum security.
Cost figures presented in this report represent the actual costs to MDOC as required by law and do not represent costs for service delivery under a “most efficient organization.” When MDOC negotiates private prison payments, items borne solely by the state should be eliminated and due consideration given to reducing other costs in which the state bears additional or different costs than the cost incurred by private prisons. PEER believes that private prison contracts could yield savings significantly above the ten percent required by law. This report includes a schedule of considerations of areas where savings could be achieved from more efficient contracting.
Executive Summary
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In FY 2004, the Board of Trustees of State Institutions of Higher Learning (IHL) adopted a new funding formula for allocating state support funds to the state’s eight public universities. The formula, primarily based on instructional costs by discipline and level of education, was implemented gradually from FY 2005 to FY 2008. In FY 2009, IHL began to apply the formula to the full amount of general fund support allocated to the universities (less legislative mandates and board initiatives). However, because full implementation of the formula would have resulted in significant immediate funding reductions for some universities, IHL decided to pro-rate the funding adjustments over six years to give universities more time to react to funding changes.
After deducting funds for separately budgeted units, legislative mandates, and board initiatives, IHL allocated $385,873,404 in state support funds to the universities for FY 2009, representing approximately 13% of IHL’s total operating budget for that fiscal year. Five of the eight universities received lower allocations from the funding formula for FY 2009 than for FY 2008 (with differences ranging from $10,129 to $175,886 less), two universities received the same amount, and one university received approximately $1.8 million more for FY 2009.
IHL’s use of the funding formula to allocate state support funds to the universities represents a potential improvement over the method that was in place prior to FY 2005. However, IHL’s current implementation of the funding formula raises concerns regarding fairness, including:
Also, IHL’s lack of uniformity in defining an “underfunded” university for the rebalancing process creates confusion and results in the potentially contradictory requirement of having “underfunded” universities yield resources to other universities.
Executive Summary
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The Mississippi Technology Alliance (MTA) was created as part of the state’s strategy to provide high–technology products and services for a global market, resulting in more high-paying jobs. Programs and services are delivered through three programmatic centers, each with its own respective goals designed to help achieve MTA’s mission.
MTA’s funding comes from a combination of state, federal, and private sources. MTA received approximately $2.8 million in state funds in FY 2008. While the majority of MTA’s 2008 federal and private funding was expended directly for programs and services, approximately thirty-nine percent of its FY 2008 expenditures from state funds were in the General and Administration category.
PEER found that the Mississippi Technology Alliance has a need for additional accountability measures, both for efficiency and effectiveness. MTA’s current efficiency measures do not contain a complete estimate of return on investment and MTA does not collect the data needed to assess duplication of effort with other entities. Also:
Based on these observations, PEER concludes that MTA has not had a data collection/reporting system in place to produce the information needed to monitor programs. Thus a third party such as the Mississippi Development Authority, the Legislature, or the public cannot determine whether MTA expends state funds efficiently or effectively.
Executive Summary
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Mississippi’s medicolegal death investigation system has evolved from a purely local system to a mixed system in which local officials and a central State Medical Examiner’s Office share authority. State law makes the State Medical Examiner the state’s expert in forensic death investigations. Under the Mississippi Medical Examiner Act, the State Medical Examiner must be a physician board-certified in forensic pathology. The State Medical Examiner is to have authority over physician county medical examiners and non-physician county medical examiner investigators and responsibility for medicolegal death investigation training and rule promulgation.
PEER found that because of the long-time vacancy in the position of State Medical Examiner (since 1995), an insufficient number of staff, and underfunding of the office, the State Medical Examiner’s Office has not been able to ensure that all of its statutory responsibilities have been addressed.
The lack of a State Medical Examiner or adequate staffing impairs the state’s ability to ensure that issues surrounding deaths affecting the public interest are resolved competently. Also, several sections of the MISSISSIPPI CODE addressing the authority of the State Medical Examiner are unclear as to the office’s authority in critical areas of death investigation.
Full Text PDF of Volume II: 1/1/2000-9/1/2008 (720K), 85 pages
Full Text PDF of previously published Volume I: 1973-1999 (604K), 159 pages
Since 1973, the PEER (Performance Evaluation and Expenditure Review) Committee has been reviewing the state’s public entities and making recommendations to improve Mississippi government.
PEER reports have proven to have archival value over an extended period and, in response, the Committee annually publishes a compilation of summaries of PEER reports issued to date. This compilation has become a useful tool for the Legislature and general public.
This volume contains an introduction to the PEER Committee, PEER’s enabling legislation, and an index to PEER reports by subject. Summaries of reports, in chronological order from January 1, 2000, until the present, begin on page 137. (Volume I contains summaries and indexing for PEER reports published from 1973 through 1999.)
Legislators, state and local government employees, and private citizens are encouraged to contact our offices (601-359-1226) or search this website for copies of PEER reports or for more information about the PEER Committee.
Executive Summary
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In Mississippi, authority to hire contract lobbyists varies by type of state entity. State agencies must determine whether their enabling legislation contains the authority for them to hire contract lobbyists. State law and policy of the Board of Trustees of Institutions of Higher Learning require that the board determine whether contractors for individual institutions may lobby. An Attorney General’s opinion allows community and junior colleges to use public funds to pay their presidents’ association to hire lobbyists.
Regarding the amount of public funds state entities spent for contract lobbyists during the last five years, according to information on file at the Secretary of State’s Office, state agencies and institutions of higher learning spent approximately $1,293,586 in public funds for contract lobbyists during calendar years 2003 through 2007. However, because lobbying expenditures are self-reported and because lobbying by the community and junior college presidents’ association removes those institutions from direct reporting of lobbying expenditures, all expenditures for lobbying paid with public funds are not presently being captured.
The practice of state entities’ using public funds for contract lobbyists raises a stewardship concern in that state entities are using taxpayers’ money to lobby when those entities’ managers have the expert knowledge to respond to any information needs that the Legislature might have. In such cases, the use of a contractor to do what veteran executive-level employees should be competent to do constitutes a waste of the state’s scarce resources. The money used for contract lobbyists could be used for ongoing programs and services.
Executive Summary
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Although the mental health environment in the United States has dramatically changed from an institution-based system to a community-based system in recent years, Mississippi’s mental health system has not reflected the shift in service delivery methods. Due to implications of the U. S. Supreme Court’s 1999 Olmstead decision, which supports the drive toward integrating people with disabilities into the least restrictive settings, the state will be forced to move toward providing more community-based care in the near future. Also, the state’s Board of Mental Health and Department of Mental Health will face other critical issues that will continue to impact their roles in providing and regulating mental health services in Mississippi.
According to PEER’s analysis of the current state mental health planning effort, strategic planning does not appear to be at the core of the Board of Mental Health’s management strategy, nor could it be without key changes in orientation and available information. There is little evidence that the planning process properly focuses the board on data needed to identify and prioritize critical issues and policy challenges. Rather, the board’s focus is on administrative details and issues of program implementation.
While the board’s minutes properly reflect a concern with the stability and health of current programs, there is less evidence of visionary, future-focused concerns. The board has not aggressively sought plans for reallocation of resources to meet emerging needs in addition to efforts to seek additional funding to meet those needs. While the current process may ensure that the Department of Mental Health will reach the community it intends to serve in the ways that have been established and are traditional, it does not question the composition or mode of service for possible needed change.
Also, it appears that the board has authorized programs that could be marginal to its mission while allowing the development of community-oriented programs to fall behind. This seems to evidence the possibility that the board currently has no identifiable process for deciding whether current or proposed programs and services fall within its mission, allowing the department to be pushed in directions that fragment its mission and increase competition for critical resources.
Executive Summary
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MISS. CODE ANN. Section 43-13-117 (1972) makes the Office of the Governor, Division of Medicaid responsible for the Non-Emergency Transportation Services (NET) program, a federally mandated program for providing non-emergency transport to approved medical services for Medicaid beneficiaries who have no other means of transportation. In November 2006, the Division of Medicaid outsourced the NET program to LogistiCare Solutions LLC, a private, for-profit corporation. Subsequently, during the 2007 Regular Session, the Legislature mandated that PEER determine the impact of this new method of service delivery on the NET program’s costs and service quality.
Using a conservative method of estimation, PEER projects that the Division of Medicaid’s brokered contract yielded $1.1 million in cost avoidance during the last eight months of FY 2007. In the future, such a contract should achieve at least a comparable amount annually.
PEER found no basis for concern that service delivery of the NET program has suffered under the brokered contract between the Division of Medicaid and LogistiCare. Beneficiaries should experience no detectable changes in program operation. However, PEER notes minor administrative deficiencies regarding the accurate coding of denials and the validity of timeliness data that have not affected the delivery of services.