Mississippi Today

Medicaid switch confuses beneficiaries, providers and draws feds’ scrutiny

Published

3 years ago

November 21, 2022

Medicaid switch confuses beneficiaries, providers and draws feds’ scrutiny

by Isabelle Taft, Mississippi Today
November 17, 2022

During the COVID-19 pandemic, Mississippi was not allowed to kick anyone off Medicaid under federal regulations. In exchange, the state received extra federal funding.

But Mississippi didn’t simply maintain each person’s coverage. Instead, if enrollees on a managed care plan technically lost eligibility (like a new mom more than 60 days after giving birth) or failed to update their information to prove they were still eligible, the Division of Medicaid quietly moved them to “traditional” or “fee-for-service” Medicaid.

That saved the agency money, because it meant that rather than paying a managed care company a monthly rate for each enrollee, it paid providers directly only when the enrollee sought care.

The shift apparently affected tens of thousands of Mississippians, raised concerns with providers who didn’t understand why their patients’ coverage had changed with no public explanation, and drew the attention of federal authorities who wanted to make sure the state was complying with the requirement of maintaining coverage during the COVID-19 public health emergency.

Managed care enrollment has declined from about 490,000 in June 2021 to about 364,000 in September, a drop of 26%. Enrollment is now well below pre-pandemic levels of 434,000 in September 2019, according to statistics published on the Division of Medicaid website.

The change does not appear to have directly altered Medicaid participants’ access to care, because any provider who accepts a managed care plan must also accept traditional Medicaid. But managed care companies tout the benefits they offer members, like 24/7 nurse phone lines, incentives for going to appointments, and free fruits and vegetables, in addition to case management services.

The Division of Medicaid declined to respond to a detailed list of questions from Mississippi Today. The agency said Director Drew Snyder “is not giving interviews at this time,” though he appeared on the Paul Gallo talk show in late August. Instead, the agency provided statements through spokesperson Matt Westerfield.

“We didn’t feel it was responsible to pay per member per month capitation payments to the managed care companies for the continuous enrollment population, particularly at a time when utilization was expected to remain low due to the pandemic,” Westerfield said.

He did not respond to a question asking if the agency could estimate how much money it had saved by shifting coverage during the pandemic.

The three managed care companies – United Health Care, Molina and Magnolia – did not respond to emails and phone calls requesting comment.

Medicaid implemented the switch in a way that left some enrollees confused about whether they had coverage.

Mississippi Today previously reported that postpartum women received notices informing them they had lost eligibility for Medicaid. Though Medicaid later sent a second letter telling them coverage had been reinstated, several women told Mississippi Today they still thought they didn’t have Medicaid any longer, or they never received the second letter. That meant that some Mississippians who were entitled to coverage for things like postpartum depression and chronic conditions thought they didn’t have health insurance and went without care.

Now, it appears people in other eligibility categories also received the letters.

According to documents obtained through a records request, staff at the federal Centers for Medicare and Medicaid Services (CMS) in September asked the Division of Medicaid to pause the notices it was sending “to beneficiaries whom the state has determined no longer meet eligibility requirements”— a much larger number of people than postpartum women.

On Sept. 16 – well over two years into the public health emergency – Snyder told CMS that the automated notices were being paused.

Westerfield did not respond to a question asking exactly how many people had received the letters.

When the COVID-19 pandemic began in March 2020, Congress passed a law requiring states to keep everyone on Medicaid throughout the public health emergency. That meant states had to do something they had never done before: change their systems to ensure people who lost eligibility kept coverage.

Making things more complicated for states, no one knew how long the public health emergency would last. In spring 2020, it appeared possible that the emergency would end within a few months, so it wasn’t clear how long continuous coverage would last, a point Snyder made during his testimony before the Senate Study Group on Women, Children and Families in September.

Medicaid enrollment climbed each month as new people signed on and none of the usual churn took effect.

But for months, the Division of Medicaid did not inform providers or beneficiaries directly about the continuous coverage provision. It did not post a message on its website reminding people that they could use their coverage throughout the pandemic. It never explained continuous coverage in its quarterly bulletins to providers, nor in its news updates.

One provider bulletin in September 2020 described the additional federal funding Mississippi was receiving, increasing the match rate from 77 to 83 cents on the dollar.

“That should help us weather the storm despite an uptick in enrollment,” Director Drew Snyder wrote, not explaining that enrollment was up because no one could lose their Medicaid during the pandemic.

Westerfield said the agency expects providers to check patients’ Medicaid eligibility during or before their appointment, and that providers can check eligibility at any time online. Since providers would be able to see their patients had Medicaid, the agency assumed the continuous coverage requirement wouldn’t make a difference on their end.

“Any insinuation that the Division of Medicaid attempted to conceal information about the availability of continuous enrollment for (the) duration of the public health emergency is simply not true,” Westerfield said.

In September 2022, a website post titled "Preparing for the COVID-19 Public Health Emergency Unwinding" mentioned continuous coverage and urged stakeholders to help get the message out.

But some providers told Mississippi Today they learned about continuous coverage through word of mouth.

Dr. Emily Johnson, an OB-GYN in the Jackson area, learned about it for the first time from a Mississippi Today reporter in October. She did not know that her patients are not losing coverage 60 days postpartum as they normally do.

“It’s always been an issue that women are very focused, that their Medicaid is going to run out and they want to get their postpartum contraception plan established before their Medicaid runs out,” she said. “I had no idea that that was no longer a pressure – that once their six-week or eight-week time was over, that they had continued access.

“It’s really sad that this is the first time I’m hearing about that,” she said.

Enrollment in managed care peaked at 490,408 people in June 2021. The total number of Medicaid enrollees was 820,602, according to statistics on the Medicaid website.

Then, it began to fall, apparently because Medicaid began conducting eligibility redeterminations and moving people off of managed care if they would have been disqualified without the PHE, or failed to update their information. Westerfield did not respond to a question from Mississippi Today asking why managed care enrollment started to fall when it did.

By September 2022, managed care enrollment had fallen 26% from its June 2021 peak. Total Medicaid enrollment was just over 867,000.

Doctors started to notice that some of their patients’ coverage status had changed.

Leaders of the Mississippi Chapter of the American Academy of Pediatrics wrote to Snyder in May 2022 asking what was going on. Physicians had reported “some pediatric patients are being transferred from the MississippiCAN programs to fee-for-service Medicaid."

“Unfortunately, the families are unaware of why this is happening,” wrote Hattiesburg pediatrician and chapter President Dr. Anita Henderson in an email obtained by Mississippi Today through a records request. “Recipients rotating off and on to the MississippiCAN or the FFS program are at risk of losing continuity of care, creating confusion for their families, and suffering avoidable medical complications. In addition, this can cause undue administrative and financial burdens for healthcare providers and possibly to the Division of Medicaid.”

Snyder responded that same day. He wrote that when Medicaid reviewed eligibility before the public health emergency, anyone who was not eligible or who didn’t respond to requests for documentation would lose their coverage, but that could no longer happen.

“During the PHE, when the state conducts renewals, beneficiaries who are determined not eligible or who are not responding to requests for documentation get to keep their Medicaid coverage, but still may be moved from a managed care delivery system to fee-for-service,” he said.

Dr. Tami Brooks, a Starkville pediatrician, was CC’d in the email chain between Henderson and Snyder. Brooks is part of a group of pediatricians that holds regular meetings with Medicaid staff to discuss issues and concerns. She said she was glad that the switch to fee-for-service did not affect children’s access to health care.

But she wants to make sure people understand that if they are on fee-for-service Medicaid, it means the agency has determined they’re not eligible, and the only thing protecting their coverage is the public health emergency.

“We’re letting our providers know, if you see a fee-for-service child, that likely means that mom needs to get back and recertify them,” Brooks said.

Federal authorities in early September reached out to the Division of Medicaid with concerns about how Mississippi was handling postpartum women’s Medicaid coverage during the emergency.

“We received a complaint regarding the state’s 60th day postpartum period policy,” wrote a Medicaid official in an email to Snyder. “We would like to set up a call to confirm our understanding on how the state processes coverage after the 60th day postpartum period.”

But within a few days, and after a call between Medicaid officials, including Snyder and CMS staff, the email correspondence broadened to a discussion of the notices Medicaid was sending people who were switched off of managed care coverage during the pandemic, not just postpartum women.

The notice people got when they were switched off managed care was headlined “MississippiCAN TERMINATION NOTICE – Loss of Eligibility.” It contained no information about continuous coverage during the public health emergency.

In an email, federal officials listed two regulations that they wanted to make sure Mississippi had not been violating when it moved people off managed care during the pandemic.

One rule requires managed care companies to inform beneficiaries of “significant” changes to their coverage at least 30 days in advance.

“We assume these enrollees received advanced notice of the transition back to FFS, but would ask the state to confirm that notices were sent to the managed care enrollees at least 30 days in advance of the transition,” a CMS official wrote.

But Mississippi Medicaid Deputy Administrator for Health Policy and Services Wil Ervin wrote that this rule didn’t apply because the agency found it only concerned "significant" changes to information included in the managed care enrollees' handbook. Since the shift didn't affect anything in the handbook but instead changed enrollees' coverage entirely, the agency said it did not need to provide advance notice.

CMS also asked Mississippi Medicaid to confirm that the transition from managed care to fee-for-service Medicaid had not disrupted beneficiaries’ access to care. Ervin said it had not.

After the meeting with the feds, Medicaid changed the managed care termination notice letter to clearly describe the recipient’s ongoing coverage.

“This letter is to inform you that you are no longer eligible for MississippiCAN,” the revised notice read. “You will continue to receive full Medicaid benefits through original Medicaid until the end of the federal COVID-19 public health emergency.”

It’s not clear whether Medicaid is sending people the revised notices or has paused them entirely. Westerfield did not respond to that question from Mississippi Today.

“CMS has met with Mississippi several times since the problem was identified to provide technical assistance regarding Medicaid notices,” a CMS spokesperson told Mississippi Today in late October. “The state agreed to pause the use of these notices pending further internal review and discussion.”

The spokesperson did not respond to Mississippi Today’s request to interview CMS staffers who participated in the meetings with Mississippi Medicaid.

The public health emergency is currently slated to expire in mid-January. But the Biden administration has said it will give states at least 60 days’ notice before lifting the emergency, and since no notice arrived in mid-November, it will be extended again.

When it ends, Mississippi and every other state will begin kicking people off Medicaid rolls once again. Nationally, between 5 and 14 million people could lose their coverage, according to the health policy nonprofit KFF.

States will have at least a year to complete their review of enrollees’ eligibility, but they have a good deal of flexibility in how they conduct the reviews and how much time they take.

As of November, Mississippi still did not have a plan for this process, called the “unwinding,” Westerfield told Mississippi Today.According to KFF, 17 states lack such a plan currently.

“We have been in the process of developing a plan while actively reviewing all CMS guidance surrounding the PHE,” he said. “We are also aware that CMS has committed to giving states 60 days advanced (sic) notice before lifting the PHE. Upon completion, we will post our unwinding plan on our website.”

Doctors around Mississippi are concerned that when the public health emergency ends, hundreds of thousands of patients could quickly lose Medicaid coverage.

And people who were switched from managed care to fee-for-service could more quickly lose coverage, since the state has already determined they’re no longer eligible or that they need to update their information to prove they still qualify.

Westerfield did not respond when asked whether the agency will prioritize ending coverage for people who have been moved to fee-for-service Medicaid.

“We are trying as pediatricians to try and get parents to make sure they have their information and go ahead and turn that back into the state,” Henderson told Mississippi Today in September. “We know there will be a grace period with the Division of Medicaid … But we certainly are concerned that when the PHE lifts, we will all of a sudden have thousands of children who may lose benefits, lose coverage and lose access to health care, which would obviously be detrimental to their health and wellbeing.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

‘Will you trust us?’: JPS plan for stricter cellphone policy makes some parents anxious

Published

23 hours ago

July 11, 2025

Staff Editor

mississippitoday.org – @mintamolly – 2025-07-11 15:25:00

by Molly Minta, Mississippi Today
July 11, 2025

Superintendent Errick Greene wanted to be very clear with the roughly 50 parents who attended Thursday night’s community listening session: Jackson Public Schools already has a policy banning students from using cellphones at school.

Aaliyah McIntyre, left, and her mother Ashley McIntyre attend a Jackson Public Schools listening session on July 10, 2025, about the district’s new policy on cellphone use. They raised concerns about how parents would be notified in the event of an emergency.

But the leadership of Mississippi’s third-largest school district has decided that a new approach is in order, citing a series of incidents in recent years involving students using their cellphones to bully others, organize fights or text their parents inaccurate information about violence happening at or near their school.

“To be clear, it’s not the majority of our scholars, but I can’t look at a class and know who’s gonna be bullying today, who’s gonna be scheduling a meetup to cut up today,” Greene said toward the end of the hour-long meeting held at the JPS board room. “I can’t look at a group of scholars and say, ‘OK, yeah, you’re the one, let me take your phone, the rest of you can keep it.’”

Under the rewritten policy, students who take their phone out of their backpacks during the instructional day will lose it for five days for the first infraction, 10 days for the second and 45 days for the third. Currently, the longest the school will hold a phone is 10 days.

The Jackson school board is expected to consider the new policy at its meeting next week and the district hopes to implement the change when the new school year starts later this month, said Sherwin Johnson, the district’s communications director.

Students also currently have the option to pay up to a $25 fine to get their phone back, but the district wants to rescind that aspect of the policy.

“We’ve discovered that’s not equitable,” said Larrisa Harris, the JPS general counsel. “Not everybody has the resources to come and pay the fine.”

Support for the new policy among the parents who spoke at the listening session varied, but all had questions. How will students access the internet on their laptops if the WiFi is spotty at their school and they need to use their cellphone hotspot? If students are required to keep their phones in their backpacks during lunch, how will teachers prevent stealing? How will JPS enforce the ban on using cellphones on the bus?

One mother said she watches her daughter’s location while she rides the bus to Jim Hill High School so she knows her daughter made it safely.

“If they can’t have it on the bus, who’s gonna enforce that?” she said. “I’m just gonna be real, the bus driver got to drive.”

A common theme among parents was anxiety at the prospect of losing direct contact with their kids in the event of an emergency. A Pew Research survey found that most adults, regardless of political affiliation, support cellphone bans in middle and high school classes. But those who don’t say it’s because their child can use their phone during emergencies.

“If something happened, will we get an automatic alert to notify us? Because a lot of the time we see things on social media first,” said Ashley McIntyre, a mother of three JPS students. She attended the meeting with her eldest daughter, Aaliyah, who recently graduated from Powell Middle School.

Though JPS does have an alert system for parents, McIntyre said she didn’t know if it existed. She cited a bomb threat at Powell last year that she found out about because Aaliyah texted her, not through a school alert.

“We didn’t know what was going on, and she texted me, ‘Mom, I’m scared,’ so I went up there,” McIntyre said. “So that puts us on edge.”

Aaliyah said she uses her phone to text her mom and watch TikTok, but she feels like her classmates use their phones to be popular or to fit in. When a fight happens, she said many students pull out their phones to record instead of trying to get an adult who can stop it. Then the videos end up on Instagram pages dedicated to posting fights in JPS.

“Once the principal found out about the fight pages, they came around looking inside our videos and camera rolls,” she said. “It happened to me last year. They thought I had a fight on my phone.”

Toward the end of the meeting, Laketia Marshall-Thomas, the assistant superintendent for high schools, took the mic to respond to one parent who said she was concerned that older students would not come to school if they knew their phone could be taken.

“What we have seen is, it’s the older students—” Marshall-Thomas began.

“They are the problem,” someone from the audience chimed in.

“We’re not saying they cannot have them,” she continued. “We know that they have after school activities and they need to communicate with their moms … but we have had major, major issues with cellphones and issues that have even resulted in criminal outcomes for our scholars, but most importantly, our students … have experienced a lot of learning loss.”

While the district leadership did not go into detail about the criminal incidents, several pointed to instances where students have texted their parents inaccurate information, such as an unsubstantiated rumor there was a gun during a fight at Callaway High School or that a shooting outside Whitten Middle School occurred on school property.

“Having phones actually creates far more chaos than they help anyone,” Greene said.

While cellphones have been banned to varying degrees in U.S. schools for decades, youth mental health concerns have renewed interest in more widespread bans across the country. Cellphone and social media usage among school-aged kids is linked to negative mental health outcomes and instances of cyberbullying, research shows.

At least 11 states restrict or ban cellphone use in schools. After Mississippi’s youth mental health task force recommended that all school districts implement policies that limited cellphone and social media usage in classrooms, a bill that would’ve required school boards to create cellphone policies died during the legislative session. Still, several Mississippi school districts have passed their own policies, including Marshall County and Madison County.

Another concern about the ban was a belief among a couple of speakers at the meeting that cellphones can help parents hold the district accountable for misdeeds it may want to hide.

“I just saw a video today. It was not in JPS, but it was a child being yelled at by the teacher and had he not recorded it, his momma would have never known that this sweet lady that they go to church with is degrading her child like that,” one mother said.

Statements like these prompted responses from teachers and other parents who urged the skeptical attendees to be more trusting or to make sure the district has updated contact information for them in case school officials need to reach parents during an emergency.

“I think we have to trust the people watching over our children,” said one of the few fathers who spoke. “When I grew up, what the teacher said was gold.”

One teacher asked the audience, “Will you trust us?”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post ‘Will you trust us?’: JPS plan for stricter cellphone policy makes some parents anxious appeared first on mississippitoday.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Centrist

The article presents a balanced report on Jackson Public Schools’ proposed stricter cellphone policy without taking a clear ideological stance. It fairly conveys the perspectives of school officials emphasizing discipline and safety, alongside parental concerns about communication and emergency access. The tone remains neutral, focusing on factual details such as policy changes, reasons behind them, and community reactions. While it includes some skepticism from parents and responses from district staff, the language does not endorse or oppose either side. Overall, the coverage adheres to neutral, factual reporting by presenting multiple viewpoints without editorializing.

Mississippi Today

Hospitals see danger in Medicaid spending cuts

Published

2 days ago

July 10, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-07-10 15:30:00

by Sophia Paffenroth, Mississippi Today
July 10, 2025

Mississippi hospitals could lose up to $1 billion over the next decade under the sweeping, multitrillion-dollar tax and policy bill President Donald Trump signed into law last week, according to leaders at the Mississippi Hospital Association.

The leaders say the cuts could force some already-struggling rural hospitals to reduce services or close their doors.

The law includes the largest reduction in federal health and social safety net programs in history. It passed 218-214, with all Democrats voting against the measure and all but five Republicans voting for it.

In the short term, these cuts will make health care less accessible to poor Mississippians by making the eligibility requirements for Medicaid insurance stiffer, likely increasing people’s medical debt.

In the long run, the cuts could lead to worsening chronic health conditions such as diabetes and obesity for which Mississippi already leads the nation, and making private insurance more expensive for many people, experts say.

“We’ve got about a billion dollars that are potentially hanging in the balance over the next 10 years,” Mississippi Hospital Association President Richard Roberson said Wednesday during a panel discussion at his organization’s headquarters.

Richard Roberson, Mississippi Hospital Association president and CEO, discusses the impact of what the White House calls “One Big Beautiful Bill,” Wednesday, July 9, 2025, at the Mississippi Hospital Association Conference Center in Madison.

“If folks were being honest, the entire system depends on those rural hospitals,” he said.

Mississippi’s uninsured population could increase by 160,000 people as a combined result of the new law and the expiration of Biden-era enhanced subsidies that made marketplace insurance affordable – and which Trump is not expected to renew – according to KFF, a health policy research group.

That could make things even worse for those who are left on the marketplace plans.

“Younger, healthier people are going to leave the risk pool, and that’s going to mean it’s more expensive to insure the patients that remain,” said Lucy Dagneau, senior director of state and local campaigns at the American Cancer Society.

Among the biggest changes facing Medicaid-eligible patients are stiffer eligibility requirements, including proof of work. The new law requires able-bodied adults ages 19 to 64 to work, do community service or attend an educational program at least 80 hours a month to qualify for, or keep, Medicaid coverage and federal food aid.

Opponents say qualified recipients could be stripped of benefits if they lose a job or fail to complete paperwork attesting to their time commitment.

Georgia became the case study for work requirements with a program called Pathways to Coverage, which was touted as a conservative alternative to Medicaid expansion.

Ironically, the 54-year-old mechanic chosen by Georgia Gov. Brian Kemp to be the face of the program got so fed up with the work requirements he went from praising the program on television to saying “I’m done with it” after his benefits were allegedly cancelled twice due to red tape.

Roberson sent several letters to Mississippi’s congressional members in weeks leading up to the final vote on the sweeping federal legislation, sounding the alarm on what it would mean for hospitals and patients.

Among Roberson’s chief concerns is a change in the mechanism called state directed payments, which allows states to beef up Medicaid reimbursement rates – typically the lowest among insurance payors. The new law will reduce those enhanced rates to nearly as low as the Medicare rate, costing the state at least $500 million and putting rural hospitals in a bind, Roberson told Mississippi Today.

That change will happen over 10 years starting in 2028. That, in conjunction with the new law’s one-time payment program called the Rural Health Care Fund, means if the next few years look normal, it doesn’t mean Mississippi is safe, stakeholders warn.

“We’re going to have a sort of deceiving situation in Mississippi where we look a little flush with cash with the rural fund and the state directed payments in 2027 and 2028, and then all of a sudden our state directed payments start going down and that fund ends and then we’re going to start dipping,” said Leah Rupp Smith, vice president for policy and advocacy at the Mississippi Hospital Association.

Leah Rupp Smith, Mississippi Hospital Association general counsel and vice president for policy and advocacy, breaks down a timeline for what the White House calls “One Big Beautiful Bill,” during an event to discuss the impact of the law on health care in the state, Wednesday, July 9, 2025, at the Mississippi Hospital Association Conference Center in Madison.

Even with that buffer time, immediate changes are on the horizon for health care in Mississippi because of fear and uncertainty around ever-changing rules.

“Hospitals can’t budget when we have these one-off programs that start and stop and the rules change – and there’s a cost to administering a program like this,” Smith said.

Since hospitals are major employers – and they also provide a sense of safety for incoming businesses – their closure, especially in rural areas, affects not just patients but local economies and communities.

U.S. Rep. Bennie Thompson is the only Democrat in Mississippi’s congressional delegation. He voted against the bill, while the state’s two Republican senators and three Republican House members voted for it. Thompson said in a statement that the new law does not bode well for the Delta, one of the poorest regions in the U.S.

“For my district, this means closed hospitals, nursing homes, families struggling to afford groceries, and educational opportunities deferred,” Thompson said. “Republicans’ priorities are very simple: tax cuts for (the) wealthy and nothing for the people who make this country work.”

While still colloquially referred to as the One Big Beautiful Bill Act, the name was changed by Democrats invoking a maneuver that has been used by lawmakers in both chambers to oppose a bill on principle.

“Democrats are forcing Republicans to delete their farcical bill name,” Senate Democratic Leader Charles Schumer of New York said in a statement. “Nothing about this bill is beautiful — it’s a betrayal to American families and it’s undeserving of such a stupid name.”

The law is expected to add at least $3.3 trillion to the nation’s debt over the next 10 years, according to the most recent estimate from the Congressional Budget Office.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Hospitals see danger in Medicaid spending cuts appeared first on mississippitoday.org

Political Bias Rating: Center-Left

This article reports on the negative impacts of a major federal tax and policy bill on Medicaid funding and rural hospitals in Mississippi. While it presents factual details and statements from stakeholders, the tone and framing emphasize the harmful consequences for vulnerable populations and health care access, aligning with concerns typically raised by center-left perspectives. The article highlights opposition by Democrats and critiques the bill’s priorities, particularly its effect on poor and rural communities, suggesting sympathy toward social safety net preservation. However, it maintains mostly factual reporting without overt partisan language, resulting in a moderate center-left bias.