Mississippi Today
MAP: Mississippi makes it uniquely hard for low-income new moms to get health care
MAP: Mississippi makes it uniquely hard for low-income new moms to get health care
Low-income women in Mississippi have less access to health care in the months after giving birth than their counterparts in every state except Wyoming.
Mississippi and Wyoming are now the only two states in the country that have neither expanded Medicaid eligibility to low-income working adults, nor extended postpartum Medicaid coverage for new mothers beyond 60 days after birth, according to data compiled by the health nonprofit KFF.
The other nine states that have not expanded Medicaid eligibility have all sought to extend postpartum coverage in recent years. Seven of them, including Alabama, Tennessee, Georgia and South Carolina, have extended coverage to a year after birth. Texas and Wisconsin have sought federal approval to implement shorter extensions of six months and 90 days, respectively.
“We know infant mortality and maternal health are challenges for our state,” said Tennessee Gov. Bill Lee, a Republican who opposes Medicaid expansion, when he introduced his proposal to extend postpartum coverage in 2020. “One in two Tennessee births are covered through our Medicaid program.”
In Mississippi, that number is higher: about six in 10 births are covered by Medicaid.
During the ongoing COVID-19 federal public health emergency, states are not allowed to kick anyone off Medicaid. As a result, women who have given birth since March 2020 will have coverage until the emergency is lifted, potentially as soon as early 2023.
But ordinarily, a Mississippi woman with two kids and a partner together earning $3,000 a month, for example, would lose her Medicaid coverage two months after her baby is born.
The same woman living in Alabama, which has not expanded Medicaid eligibility but approved a 12-month postpartum coverage extension earlier this year, would have health insurance until her baby is a year old. And the same woman living in Arkansas, which has expanded Medicaid but not extended postpartum coverage, would have health insurance before and after her pregnancy, because she would be eligible based solely on her income.
In Mississippi, women whose pregnancies are covered by Medicaid lose the ability to go to check-ups, get treatment for postpartum depression, and receive care for chronic conditions when their babies are just two months old.
House Speaker Philip Gunn, R-Clinton, has repeatedly rejected postpartum Medicaid extension, which easily passed the Senate last session. He has described the proposal as Medicaid expansion, though it would not make more people eligible for Medicaid. Almost every other state that has refused to expand Medicaid has nevertheless extended postpartum coverage.
Last week, some of the state's leading doctors told the Senate Medicaid Committee that extending postpartum Medicaid would not only improve abysmal maternal and infant health outcomes but also save money.
Mississippi has the country's highest infant mortality rate and highest rate of premature births. Dr. Anita Henderson, a pediatrician and president of the Mississippi Chapter of the American Academy of Pediatrics, said the hospital cost of delivering a healthy baby at full term is typically around $5,000 to $6,000. But an extremely preterm baby requires a long stay in a neonatal intensive care unit (NICU), at an average cost of $600,000.
State Health Officer Dr. Daniel P. Edney mentioned that Mississippi is one of just two states that has neither extended postpartum coverage nor expanded Medicaid eligibility.
“What I would beg us to consider is the fact it makes much more economic sense to let Medicaid pay for this rather than the state having to pay for it – either state agencies such as the health department paying, or hospitals paying for it with uncompensated care,” he said.
Pregnant women in Mississippi qualify for Medicaid as long as their family income is below 194% of the federal poverty level– about $4,600 per month for a family of four.
But after giving birth, a Mississippian with kids qualifies for Medicaid only if she has a very low income, earning $578 or less monthly for a family of four.
With such a strict income eligibility requirement, it's all but impossible for anyone with a full-time job to qualify for Medicaid coverage. (And healthy adults without kids never qualify for Medicaid in Mississippi.)
In states that have expanded Medicaid, including Louisiana and Arkansas, adults with incomes below 138% of the federal poverty level, or about $3,200 for a family of four, qualify for health insurance.
An analysis by the consulting firm Manatt found that expanding eligibility for Medicaid would cut enrollment in pregnancy Medicaid by about half, because many women would qualify based on income alone.
Wil Ervin, deputy administrator for health policy for Mississippi Medicaid, told the Senate Medicaid Committee last week that extending postpartum coverage to a year would cost the state about $7 million.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1951
April 28, 1951
Ruby Hurley opened the first permanent office of the NAACP in the South.
Her introduction to civil rights activism began when she helped organize Marian Anderson's 1939 concert at the Lincoln Memorial. Four years later, she became national youth secretary for the NAACP. In 1951, she opened the organization's office in Birmingham to grow memberships in Alabama, Florida, Georgia, Mississippi and Tennessee.
When she arrived in Mississippi, there were only 800 NAACP members. After the governor made remarks she disagreed with, she wrote a letter to the editor that was published in a Mississippi newspaper. After that step in courage, membership grew to 4,000.
“They were surprised and glad to find someone to challenge the governor,” she told the Chicago Defender. “No Negro had ever challenged the governor before.”
She helped Medgar Evers investigate the 1955 murder of Emmett Till and other violence against Black Americans. Despite threats, she pushed on.
“When you're in the middle of these situations, there's no room for fear,” she said. “If you have fear in your heart or mind, you can't do a good job.”
After an all-white jury acquitted Till's killers, she appeared on the front cover of Jet magazine with the headline, “Most Militant Negro Woman in the South.”
Months later, she helped Autherine Lucy become the first Black student at the University of Alabama.
For her work, she received many threats, including a bombing attempt on her home. She opened an NAACP office in Atlanta, where she served as a mentor for civil rights leader Vernon Jordan, with whom she worked extensively and who went on to serve as an adviser to President Bill Clinton.
After learning of Evers' assassination in 1963, she became overwhelmed with sorrow. “I cried for three hours,” she said. “I shall always remember that pool of blood in which he lay and that spattered blood over the car where he tried to drag himself into the house.”
She died two years after retiring from the NAACP in 1978, and the U.S. Post Office recognized her work in the Civil Rights Pioneers stamp series. In 2022, she was portrayed in the ABC miniseries, “Women of the Movement.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Rare open negotiations occur on important Medicaid expansion issue
The curtain was pulled back last week for the first time in years on the Mississippi Legislature's often mysterious conferencing process.
A conference committee consists of three representatives and three senators appointed to try to reach agreement when the two chambers pass differing versions of the same bill. Last week, a conference committee formed to try to reach agreement on Medicaid expansion caused a stir by meeting in a public setting.
Even though the joint rules of the Mississippi Legislature call for an open conferencing process, the conferees seldom meet in public. They usually meet and negotiate their differences near the end of the session behind closed doors.
That was not always the case.
For a period in the late 1990s and early 2000s, the Legislature, under intense pressure from the Mississippi Press Association, made open conference committees the norm.
Some major issues have been played out in public conference committees. Notable open conferences include:
- The infamous, excruciatingly long special session in 2002 where businesses received more protection from lawsuits.
- Budget fights when Haley Barbour was governor when legislators often would reach an impasse in the negotiations process and spend the bulk of their time talking about their cars and eating candy.
- The major rewrite of the state's economic development package under then-Gov. Ronnie Musgrove called Advantage Mississippi.
- The Mississippi Adequate Education Program, which for decades has provided the state's share for the basic operation of local school districts. It was hammered out in an open conference process in 1997 even before the joint rules mandated the open process.
Then-state Sen. Musgrove and former House Speaker Billy McCoy deserve credit or blame, according to one's perspective, for proving the open conference process could work. When they chaired their respective chamber's education committees, they insisted on having an open conference process.
But in more recent years, open conference committees have been few and far between. The joint rule has been largely ignored.
The fact that the three House and three Senate conferees agreed to meet at least once in public on Medicaid expansion — one of the most pivotal issues facing the Legislature in recent years — drew considerable attention.
If nothing else, the open conference committee provided a raw and unedited view of how far apart the two chambers were at the time on an issue that would provide additional health care coverage to primarily the working poor.
The House wanted to provide coverage to those earning up to 138% of the federal poverty level, or about $20,000 annually for an individual, while the Senate had proposed providing coverage to those earning less than 100% of the federal poverty level, or about $15,000 per year.
According to various experts, the House plan would provide coverage to many more working Mississippians and cost less to the state than would the Senate plan. The reason for the lower cost to the state is that when expanding to 138%, the federal government will pay 90% of the costs and provide the state an additional roughly $700 million over two years as an enticement to expand.
Under the Senate plan, the federal government will pay 77% of the cost and offer no incentives. It is important to understand that in the expensive world of health care, the difference in 77% of the cost and 90% means tens of millions to Mississippi state coffers.
The House conferees repeatedly pointed out those numbers — their plan covering more at less cost — during last week's open conference committee.
One of the reasons legislators through the years have not been enamored with an open conference process is that it has often turned into efforts by the negotiators to sell their position to the public.
Once the open conference process starts, the side that feels the most comfortable with its position wants to meet more often in full view of the public to make sure the public understands where each side stands.
For whatever it is worth, the House conferees were more enthusiastic about continuing the open process after the initial Medicaid expansion conference committee.
And after that initial open conference, the Senate offered a compromise to cover those earning up to 138% of the federal poverty level — just as the House proposed.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Legislation to strip key power of PERS Board passes both chambers
Legislation that strips significant power from the board that governs the state's public employee pension program has passed both chambers of the Legislature.
Under the legislation set to go to Gov. Tate Reeves during the final days of the 2024 session, the Public Employees Retirement System Board would no longer have the authority to increase the contribution rate levied on governments (both on the state and local level) to help pay for the massive retirement system.
The legislation, which passed both chambers in recent days, was a reaction to the decision by the board to increase by 5% over a three-year period the amount local governments contribute to each employee's paycheck for their retirement. Under the PERS Board plan, the employer contribution rate would have been increased to 22.4% over three years, starting with a 2% increase on July 1.
The board said the increase was needed to ensure the long-term financial stability of the system that pays retirement benefits for most public employees on the state and local levels, including staff of local school districts and universities and community colleges.
City and county government officials in particular argued that the 5% increase would force them to cut government services and lay off employees.
Under the bill passed by the Legislature there still would be a 2.5% increase over five years — a .5% increase in the employer contribution rate each year for five years.
In addition, legislative leaders said they plan to put another $100 million or more in state tax dollars into the retirement system in the coming days during the appropriations process.
Under current law, the PERS Board can act unilaterally to increase the amount of money governmental entities must contribute to the system. But under the new bill that passed both chambers, the board can only make a recommendation to the Legislature on increasing the employer contribution rate.
The PERS Board also would be required to include an analysis by its actuary and independent actuaries on the reason the increase was needed and the impact the increase would have on governmental entities.
In the 52-member Senate, 14 Democrats voted against the bill. Only one House member voted against the proposal.
Sen. David Blount, D-Jackson, said the bill failed to address the financial issues facing the system. He said a permanent funding stream is needed.
Blount said, “You are moving in the wrong direction and weakening the system” with the bill the Legislature approved. “Is it painful? Is it going to cost more money? Yes, but we need to do it” to fix the system.
The system has assets of about $32 billion, but debt of about $25 billion. But Sen. Daniel Sparks, R-Belmont, and others argued that the debt was “a snapshot” that could be reduced by strong performance from the stock market. The system depends on its investments and contributions from employers and employees as sources of revenue.
The system has about 360,000 members including current public employees and former employees and retirees.
The legislation states that no changes would be made for current members of the system. The legislation does reference looking at possibly changing the system for new employees. But that would be debated in future legislative sessions.
The bill does not include an earlier House proposal to dissolve the PERS Board, which consists primarily of people elected by the members of the system, and replace them with political appointees.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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