By Molly Matthews

  With the sudden departure of Mississippi Managed Care Network, the only health maintenance organization that
provided Medicaid coverage, how will the Delta be affected?
   Jana Clark, executive director of Diagnostic Imaging of Greenville, said time will tell.
   "In terms of managed care, it seems as though we're about three years behind larger markets like Jackson, Memphis and Little Rock," Clark said. "I don't know that we will ever feel the full effects of managed care to the degree that the largers do."
Felicia Warren, office manager for The Greenville Clinic, said the departure of MMCN will not affect
their practice.
   "Historically, we have tried to have as few Medicaid patients as possible because Medicaid is the worst
payer and their patients are ones we spend the most time with," she said. "We have not really been
affected like clinics that were dependent on Medicaid patients. You can make a decent living serving those
patients if that's all you do but if you're trying to do a lot of different things, you can't really count
on that to survive."
   In the last few years, four HMOs in the state that serve Medicaid patients have folded, Warren said.
   "All of us who work in healthcare knew it wouldn't last," she said. "It's a great concept to keep
patients well rather than wait until they're sick, but Medicaid patients in Mississippi are so accustomed to
going to an emergency room in the middle of the night. It surprised us that managed care hung in there."
   Nashville-based Access Health Systems, the parent company for MMCN, notified the Mississippi Department
of Insurance in November of its intent to leave the state by next April. After that, managed care
enrollees will have a year to file claims with the company for services received by April 30, 2000. The
Mississippi Legislature approved Medicaid managed care in 1995 to slow down rising Medicaid costs.
   With the departure of MMCN, that leaves United Health Care as the state's sole HMO and almost 8,000 Medicaid
recipients have lost unlimited prescription coverage, expanded doctors' visits and other benefits. United
Health Care has been criticized recently because of its refusal to acknowledge directives from HCFA to
reimburse emergency medical service providers on prudent layperson medical claims.
   HMOs have recently come under fire in a wake of lawsuits recently filed in U.S. District Court,
accusing five national HMOs of putting profits over patient care for 32 million customers. Offering
physicians bonuses to restrict patients" access to expensive procedures is one of the allegations in the
lawsuits.
   Only one of the five HMOs, Prudential, was licensed in Mississippi, but listed only 146 customers in the
company's 1998 annual report.
   "We want to put doctors back in the business of practicing medicine, not accountants," said Richard
Scruggs, a Gulf Coast attorney who is involved in eight of the class-action lawsuits and led the
infamous tobacco lawsuit.
   About 150 Medicaid patients were signed up through The Greenville Clinic's internal medicine/pediatric
physician, Warren said.
   "When the HMO folded, all of the children who were covered under the HMO were transferred to Health Max,
another version of managed care that Medicaid has had for several years," she said.
   Dr. Roderick Givens, radiation oncologist at Bethesda Cancer Center in Greenville said the clinic's policy
is "to accept any and all patients regardless of insurance standards."
   "From an economic standpoint, the departure of HMOs has probably affected us," Givens said. "I've never
turned down a patient or altered treatment because of insurance. Our accountants might not agree that it is
a economically viable policy but that's our policy."
   Connie Hill of Delta Regional Medical Center Hospice Agency, said the HMO situation "has not affected us at
this time."