Efforts to fund a multi-million dollar Medicaid shortfall havecome full circle in the Legislature, and the state government isback to square one with only one week before the regular sessionends Saturday, area lawmakers said.

The choices in the Legislature to fund Medicaid remaining arethe same, or at least very similar, to the same opposing optionsthat have been presented all session – a tax or assessment onhospitals or patients or a tax increase on tobacco and liquor.

The past few weeks have seen the Legislature come as close as ithad all session to devising a plan to produce the needed $87million, as the Mississippi Hospital Association and a hiredconsultant ironed out a deal to collect a daily $155 assessment onall hospitals’ occupied, non-Medicare beds. Last week, however, theassociation withdrew its support from the plan after the Senateamended the proposal.

“The wheels fell off with the amendment,” said District 39 Sen.Cindy Hyde-Smith, D-Brookhaven. “We were very, very close.”

The amendment proposed to the legislation went against arecommendation that created a seven-member board to overseeMedicaid, with four of the seats occupied by the hospitalassociation. The association’s attempt was shot down, with Gov.Haley Barbour pointing out that the state was the only entity thatwould run Medicaid.

Despite the association’s withdrawal, the $155 per bed plan isgoing forward.

“If the hospital association was happy with $155 on occupiedbeds, then I still think that’s probably the closest we’ll get to asolution on this thing,” Hyde-Smith said.

Hyde-Smith is optimistic that Medicaid will be funded before thesession ends Saturday, as the $155 per bed assessment is debatedthroughout the week. She said the hospital association may comeback to the Legislature and reinstate its support if the rightcompromise is reached.

“Even though the hospital association walked away from thetable, they didn’t go far,” she said. “They’re still in thebuilding.”

Not all area legislators are sharing Hyde-Smith’s optimism. Infact, all three local House members are preparing for a specialsession.

The $155 per bed proposal is similar to plans put forwardearlier in the session, such as the governor’s gross revenue taxincrease, which have been strongly opposed by the House eachtime.

Instead, many House members are continuing to support anincrease in the tobacco and liquor taxes, which was sent again tothe Senate last week. The sin tax bill will likely die for thesecond time this session, said District 92. Rep. Becky Currie,R-Brookhaven.

“The Senate never took up the cigarette tax the first time – itnever came out of committee,” she said. “I doubt they’re going tobring this one out of committee.”

If the tax dies in the Senate, then the $155 per bed assessmentwill be the only vehicle remaining to attempt to fund Medicaid, andit may come to defeat in the House as its hospital tax predecessorshave done.

“If the governor or the Senate comes back to us with anotherhospital fee – not a tax, God forbid, but a fee – we in the Housewon’t agree,” said District 91 Rep. Bob Evans, D-Monticello. “Ifthe bed assessment is the only thing still available, and it takesmy vote to fund it, then it ain’t gonna get funded.”

Evans said the House’s proposal to increase sin taxes would havefunded the Medicaid gap with money to spare. He blamed the Senateand the governor for defeating the measures, which he felt werewidely supported across the state. Evans, like many hospitaltax/bed assessment opponents in the House, is worried about theimpact such legislation would have on smaller, rural hospitals.

“If the only choice is between assessing the patients inhospitals and not funding Medicaid, then I say shut her down,”Evans said. “I say that, of course, knowing that Medicaid is notgoing to be shut down. The whole thing is just a powerstruggle.”

District 53 Rep. Bobby Moak, D-Bogue Chitto, does not believethe tobacco tax or the bed assessment will be enough to fixMedicaid. He believes some compromise will be reached – either thisweek or in special session – that will serve as a temporaryfix.

“With such a heavy load, not one particular funding source cancarry it more than likely,” Moak said. “What I think will probablywork out, if we even get to that point, is that we’ll find enoughfunds to put in there to get us past January 2009, when theLegislature is back in session to deal with the remainder of theproblem.”

Moak said the problem of funding Medicaid has been exacerbatedby the shortened session.

Normally, he said, the Legislature would have until May 5 towork on the funding solution. He said the shortened session hastaken the legislative process out of sync.

“There’s a reason that, back in the 1800s, these guys decidedwhen we’d come into session – because calender-wise, it workedout,” Moak said. “The constitutional deadlines fall at the propertimes.

“This year, the sequence to making legislation has been thrownoff very badly I believe,” he continued. “It’s been like abasketball team that doesn’t have its court plan together thissession – it just hasn’t flowed very smoothly at all.”