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Pressure grows for lawmakers to pass postpartum Medicaid extension

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Pressure grows for lawmakers to pass postpartum Medicaid extension

As the first major legislative deadline of 2023 nears, legislative leaders face growing pressure to extend coverage for moms on Medicaid from two months to one year.

After Speaker of the House Philip Gunn killed the effort last year, a bipartisan coalition of lawmakers, mothers across the state and care professionals are ratcheting up the conversation at the Capitol this session about the benefits of the bill for Mississippi mothers and children. Mississippi, as it has for many years in a row, has the highest infant mortality rate and among the highest maternal mortality rates in the nation.

Several lawmakers — Republicans and Democrats in both the House and Senate — filed bills early this year to extend the Medicaid coverage to one year. This would put Mississippi on the same page as 29 other states, most of the Southeast. Eight additional states are currently considering full extended coverage or a limited extension of coverage.

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The Senate last year overwhelmingly passed the legislation and has since held hearings where experts and physicians spoke to its positive impact on women and babies' health. Several senators filed bills early this year to extend postpartum Medicaid coverage, and Lt. Gov. Delbert Hosemann said he would usher it through his chamber.

And in the House, Rep. Missy McGee, R-Hattiesburg, filed a bill this year to extend the coverage. Several of her Republican colleagues, including Rep. Rob Roberson, R-Starkville, co-authored the bill.

“I really think that this is a pro-family position and certainly a pro-life position to take care of these moms who are carrying and delivering and bringing these babies into the world,” McGee said. “Healthy moms equal healthy babies. They go hand in hand, so I really believe it's currently the most impactful thing we can do for women and children.”

Roberson, who authored the main postpartum bill last year that the House never had the to vote on, also cited being pro-life as a reason he fully supports the extension.

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“I feel like if you're pro-life, then this is a pro-life issue,” Robertson said. “You the baby and the mother for as long as we can, and obviously we have financial constraints that enter into this, but I do think in the long run it would be less expensive and more conducive to the health of that child and that mother.”

But that momentum could halt, as it did last year, at the House dais, where Gunn wields immense power. He could, as he did last year, block the issue from ever coming up for a full vote.

Gunn spoke to Mississippi Today this week about his stance on the proposal. He said he believes the Mississippi Division of Medicaid should act — not the Legislature — to extend the coverage.

“My point is, any time I can call an agency and say, ‘Fix this by regulation, it doesn't take legislation,' that's the best way to do it,” Gunn told Mississippi Today on Monday. “Legislation is the hardest way to get it done. If the Division of Medicaid felt like it was a good idea, they could've submitted a request a year ago and I believe CMS would grant it in a heartbeat.”

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The Division of Medicaid has not taken a stance on extending postpartum coverage. But even a committee appointed by Republican leaders, including Gunn, to advise on Medicaid policy recommended that the Legislature extend postpartum coverage.

Dr. David Reeves, a pediatrician from the Coast whom Gunn appointed to the committee tasked by law to advise and make recommendations to the agency, penned a letter to state leaders, including Gunn, earlier this year urging them to extend postpartum Medicaid coverage to 12 months. 

“I see moms that lost postnatal care after a few months and ended up pregnant again, or have postpartum depression and couldn't get treatment,” Reeves told Mississippi Today. “A lot of women do have complications during pregnancy, and they need follow up (care) that will take more than two months — like for gestational diabetes, hypertension … These things need continued coverage.”

Gunn said he had not seen Dr. Reeves' letter. The Division of Medicaid, which is housed under the governor's office, did not respond to questions Mississippi Today sent over a five-day period. Medicaid Executive Director Drew Snyder did not return text messages to his personal cell phone about the issue.

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Staffers for Gov. Tate Reeves, who oversees the Division of Medicaid and appointed Snyder, also ignored questions from Mississippi Today on the topic of extending postpartum coverage.

In the Mississippi Today interview this week, Gunn said he has asked the Division of Medicaid for data on how continuous coverage during the federal public health emergency impacted health outcomes for women and babies, but he has not received it. Trey Dellinger, Gunn's chief of staff, told Mississippi Today he wanted to see data that covers whether there was “any actual change in maternal or infant mortality.”

Experts say Gunn's office hasn't seen that data because it does not exist yet.

“The research for … what the full impact of the postpartum coverage extension has been — those were just awarded, and they're five year grants,” said Maggie Clark, senior state health policy analyst for Georgetown Center for Children and Families. “We're not going to know the impact of this (extended coverage during the Public Health Emergency) nationally and definitely at the state level for many years.”

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In Mississippi, for example, the latest maternal mortality data available is for the time period of 2013-2016. The Health Department has said it plans to release a for 2017 through 2019 soon.

Clark made another point about making decisions around postpartum based solely on mortality numbers.

“The goal of extending postpartum coverage is to support maternal health. There's a lot more to maternal health than, ‘Did you die?'” she said. “That's just the absolute bare minimum.”

A recent study, however, showed postpartum women with continuous coverage used twice as many postpartum services, up to 10 times as many preventive, contraceptive and mental health services, and 37% fewer services related to what's called “short interval pregnancies” within the first year postpartum compared to before continuous coverage was in place.

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Short interval pregnancies are defined as becoming pregnant within six months after giving birth – and they are associated with a higher risk for preterm birth. For mothers over 35 with short interval pregnancies, there's an increased risk of death and serious illness. 

Dellinger, Gunn's chief of staff, said they had reviewed that study but concluded it was not the data they needed to see.

“The Texas study you sent us, it showed there was increased utilization of health care services,” Dellinger said. “But what it didn't cover was whether there was any improvement in outcomes.”

But according to Clark, the Texas study is “one of the only, if not the only” such study. She also pointed out the time frame researchers looked at was early in the pandemic (March to December 2020) — when health care utilization as a whole was down.

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A reduction in short interval pregnancies, Clark said, is a positive health outcome.

The Texas study also showed an increase in the use of mental health and substance use services. Data shows mental health conditions (including substance use disorder) are the leading underlying cause in maternal mortality.

“The Texas study showing increases in services for mental health and substance use disorder is significant, because these conditions are drivers of maternal mortality,” said Clark.

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

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Mississippi Today

On this day in 1973

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mississippitoday.org – Jerry Mitchell – 2024-03-29 07:00:00

March 29, 1973

The statue of Bradley stands in front of the Tom Bradley International Terminal at the Los Angeles International Airport. Credit: Courtesy of LAX Public Relations

Tom Bradley became mayor of Los Angeles — the first Black mayor of a predominantly white major in the U.S. 

He was born into poverty in , the son of sharecroppers and the grandson of slaves. Seven years after his birth, his moved to Los Angeles. He attended UCLA on a track scholarship and left there to join the Los Angeles Department. 

After his 21 years at the department, he became a lieutenant — the highest rank achieved by a black officer at the time. In 1963, he became the first Black member elected to the Los Angeles City Council. After losing his first race for mayor in 1969, he returned to defeat incumbent Sam Yorty, building a coalition with White voters. 

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His 20 years in office marked the longest tenure of any mayor in the city's history. During his time, he oversaw great expansion of the city and the 1984 Summer Olympics. He also appointed Myrlie Evers to the Public Works Commission. 

“His mayoralty was a time in which Los Angeles reconfigured itself, redefined itself,” historian Kevin Starr told the Los Angeles Times

But the humble politician saw his share of disappointment, falling thousands of votes short of becoming California's first Black governor in 1982. He also endured his share of criticism for his “nearly expressionless demeanor,” receiving the nickname “The Sphinx of City Hall.” Criticism came nine years later after four White police beat Rodney King — an assault captured on videotape. 

Bradley died in the hospital in 1998 after suffering an unexpected heart attack — his second. Raphael J. Sonenshein, the author of “ in Black and White: Race and Power in Los Angeles,” called Bradley “the most important political figure in Los Angeles in the last three decades.” 

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The Los Angeles International Airport now features a bust of Bradley, and the international terminal bears his name.

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

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Mississippi Today

Senate passes Medicaid expansion ‘lite’ with veto-proof majority

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mississippitoday.org – Sophia Paffenroth and Taylor Vance – 2024-03-28 17:37:35

An austere version of Medicaid expansion, which for more than a decade has been blocked by legislative , passed the Senate on Thursday 36-16 – a veto-proof majority – with significant changes to the original bill and now heads back to the House for consideration.

House Bill 1725, with the Senate's strike-all amendment, would increase Medicaid eligibility to those making up to 99% of the federal poverty level, about $15,000 annually for an individual, and would be entirely contingent on the federal government approving a work requirement of 120 hours a month. 

That's significantly different from the version of the bill that passed the House, which increased eligibility to those making up to 138% of the federal poverty level, about $20,000 annually for an individual, and would expand Medicaid regardless of whether or not the work requirement was approved. 

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Senate Medicaid Chairman Kevin Blackwell, R-Southaven, called the strike-all a more “conservative, responsible” option and described  it a “hand up, not a handout.” The Senate plan turns down roughly $1 federal dollars a year since it doesn't qualify as “expansion” according to the Affordable Care Act.

Republican Lt. Gov. Delbert Hosemann, who oversees the Senate, said that covering more low-income Mississippians under Medicaid would improve the 's dismal labor participation rate – the lowest in the country

“If we as a society, as a state, believe we should have individuals who are working, stay in the workforce, pick up our labor force participation rate, then we need to do what Sen. Blackwell and the Senate did today.” 

Senate Democrats introduced several amendments, which Republicans, who hold a majority in the chamber, successfully opposed. The amendments called for: increasing the income eligibility threshold, changing the work requirement from 120 hours a month to 80 hours a month, and lowering a recertification requirement from four times a year to twice a year. 

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The Democratic senators strongly criticized the Senate plan to reporters after it passed but voted in favor of it to keep the bill alive – in hopes that the plan will improve later during House and Senate haggling. 

“This bill was not perfect,” Senate Minority Leader Derrick Simmons said. “We would love to see more individuals covered. We would love not to have any hurdles or restrictions on additional access to health care coverage. But we did not want to lose an to keep this bill alive as we work through this .”

Sen. Joey Fillingane, R-Sumrall, also attempted to amend the bill by removing two of the exemptions to the work requirement – for primary caregivers of under six years old and those diagnosed by a doctor to have a disability – and requiring co-payments for individuals fulfilling the work requirement. A few hardline conservatives supported his efforts, but both amendments were ultimately shot down by senators. 

Sixteen senators voted ‘No' on the plan: Jason Barrett, R-Brookhaven; Andy Berry, R-Magee; Jenifer Branning, R-Philadelphia; Lydia Chassaniol, R-Winona; Kathy Chism, R-New Albany; Joey Fillingane, R-Sumrall; Angela Burks Hill, R-; Chris Johnson, R-Hattiesburg; Tyler McCaughn, R-Newton; Michael McLendon, R-Hernando; Rita Potts Parks, R-Corinth; Brian Rhodes, R-Pelahatchie; Joseph Seymour, R-Vancleave; Daniel Sparks, R-Belmont; Ben Suber, R-Bruce; Neil Whaley, R-Potts Camp. 

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House Medicaid Chair Missy McGee, R-Hattiesburg, told that she does not intend to agree with the Senate's amendment and plans to hammer out a compromise in a conference committee. 

“I'm happy the Senate passed a bill,” McGee said. 

Though the Senate's plan has stricter eligibility requirements than the House version, Republican Gov. Tate Reeves, a longtime opponent of expansion, privately told senators at the Governor's Mansion on Tuesday that he would veto the bill if it reached his desk.

If the second-term governor does veto the bill, a two-thirds majority of lawmakers in both legislative chambers would need to join together to successfully override him and pass the measure into . Both chambers passed their versions with veto-proof majorities.

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Hosemann did not directly answer whether he believes there is an appetite in the GOP-controlled Senate to override a potential veto, but he said the work requirement in the Senate bill is a “good first step” toward addressing Reeves' concerns about the bill. 

“We're going to get with our House counterparts here and maybe that step forward is sufficient for the governor,” Hosemann said. “I don't think there was anybody here that didn't feel the weight of having people who are working have a catastrophic and not get back into the workforce.” 

House members have until April 19 to either agree with the Senate plan or to work on a compromise in a conference committee.

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

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Judge erred, double jeopardy shouldn’t apply, say AG attorneys seekng to retry acquitted assailant

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mississippitoday.org – Mina Corpuz – 2024-03-28 13:30:00

Nearly a year after a north Mississippi judge acquitted a 22-year-old who stabbed a man in the neck, nearly killing him, 's office lawyers want to re-prosecute the case. 

They are appealing the ruling, saying the victim's absence at trial, the reasoning the judge used for his ruling, did not violate the defendant's constitutional rights and prevent trial from proceeding.

But legal experts say a retrial can be a high barrier to overcome because of double jeopardy,  a clause in the U.S. and Constitution that prevents defendants from being retried for the same crime following an acquittal or conviction. 

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“This is a textbook case of double jeopardy,” said Matt Steffey, a professor at Mississippi College School of

In his May 11, 2023 dismissal of the attempted murder indictment and acquittal for Lane Mitchell, Union County Circuit Court Judge Kent Smith focused on the victim's absence, finding that it violated the defendant's due process and compulsory process rights, which is the ability to subpoena and secure favorable witnesses to testify. 

“This precedent thus makes the state responsible for and unable to go forward on nearly every criminal cause when a recalcitrant victim refuses to appear at trial,” the state wrote in a March 4 appellant's brief filed with the Court of Appeals. 

The victim, Russell Rogers of Tennessee, nearly bled out and suffered a stroke. As a result of the stabbing, he was diagnosed with post-traumatic stress disorder and other mental issues and placed under a conservatorship. 

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The state is asking the Court of Appeals to correct the trial court's “misstatements of law.” Alternatively, the state is asking the court to reverse and remand the trial judge's order and in its place issue an order that would allow the state to retry Mitchell. 

The defense has 30 days to respond to the appellant's brief, which is expected sometime early next month if no extensions are granted. The state will then have time to reply, and then the case can be submitted. Oral arguments were not requested. 

The 2019 stabbing

On Feb. 9, 2019, Rogers spent several hours in  Tallahatchie Gourmet in New Albany. When then-18-year-old Mitchell arrived there, he joined his parents and their friends in the bar area. 

presented in court and included in records as pictures shows Mitchell, about an hour after his arrival, taking a knife from the bar and holding it behind his back as Rogers talked with a waitress. The manager  – Mitchell's father – and Rogers then talked, and when Rogers reacted negatively, Mitchell approached from behind and stabbed Rogers in the neck three times. 

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Mitchell testified he was to defend his father and the waitress, according to court records. The defendant said he thought Rogers had a gun, but in fact he was unarmed. 

Mitchell and Rogers had not met or talked prior to the stabbing, according to court records. 

Months after the stabbing, a Tennessee probate court found Rogers met criteria to be considered disabled and appointed his father, Robert Rogers, as his conservator. Russell Rogers remains under the conservatorship. 

Mitchell enrolled in two colleges while under indictment, first at the University of Mississippi and then Mid-America Baptist Theological Seminary in Cordova, Tennessee, where he graduated days before his 2023 trial began. 

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The attorney general's office took over the case in 2021 when the district attorney recused himself from the case. 

Victim testimony central in case 

Mississippi law states victims can exercise their right to be present and heard in court proceedings, but their absence does not prevent the court from moving forward with a proceeding. Victims can be served with a subpoena, which Mitchell's attorneys sought to do with Rogers.

The state argues the trial court seemed to ignore the Tennessee probate court's order quashing the defense's attempt to subpoena Rogers, saying his mental problems stemming from the attack made him incapable of testifying.

The state argues the trial court only determined Rogers “appear[ed] to be intentionally unavailable” to testify in court, but it did not find what from his testimony would be favorable to the defense. 

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The defense wanted to question Rogers about his behavior the night of the stabbing and prior conduct and mental health issues, but the state wrote these factors “would not be material to a showing that Michell acted reasonably or that [Rogers] was the initial aggressor.”

Additionally, Rogers didn't witness the stabbing because Mitchell approached him from behind, the brief states. Regardless, the state argues, Mitchell's intent to defend others was already presented to the jury through other witnesses. 

The defense has argued in court filings and at trial that the conservator inserted himself into the case, including accusing him of working with the prosecution and denying access to the victim. 

The state had denied these claims, noting Robert Rogers was following his fiduciary duties as conservator when fighting the subpoena and other efforts. 

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Acquittal and double jeopardy

 Another issue raised in the state's brief is how the trial court violated the Mississippi Rules of Criminal Procedure by dismissing the indictment against Mitchell and entering an acquittal.

No rule of criminal procedure allows an indictment to be dismissed because a witness failed to appear, and acquittal isn't the proper remedy under the rules, the state argues. Instead, the valid remedies for a discovery violation are continuance or mistrial, which would have needed to have happened before a jury was sworn in and double jeopardy was in place. 

In its alternative remedy, the state asks the Court of Appeals to reverse and remand the trial court's and order a mistrial, which the state says would preserve its right to retry Mitchell. 

Former Mississippi Court of Appeals judge and Supreme Court Justice Oliver Diaz called acquittal an unusual position for a trial court and an example of how Judge Smith of the Union County court acted in a way that other trial courts don't tend to do. 

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He said the state may be asking the Court of Appeals to clarify the law and find that the judge ruled improperly, instead of seeking retrial and running into double jeopardy. 

“(A)ny judges in the future who consider this issue can know clearly and [it's] well stated by the court [that] you can't just order an acquittal if a victim doesn't show up,” he said. 

Crime victims' rights

Rogers and his conservator are asking the Court of Appeals to allow them to file an amicus curiae brief for the court to consider additional information, including victim's rights. 

A March 11 proposed amicus brief argues the trial judge's refusal to submit the case to the jury stripped Rogers of his constitutionally-protected rights as a victim. As of Thursday, the brief has not been approved. 

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Meg Garvin, executive director of the National Crime Victim Law Institute at Lewis & Clark College in Oregon, provided feedback to craft the amicus brief. 

She said the Mississippi Constitution gives crime victims the right to be treated with fairness, dignity and respect, and just because those terms are broad, it doesn't mean they are empty. 

Mitchell's attorneys want the court to deny the amicus brief, citing a May 2023 Supreme Court order denying an emergency petition filed by the conservator to halt the trial court from filing a judgment of acquittal. In it, Justice Leslie King said the victim and conservator lack standing to contest the disposition of Mitchell's case, or any charge. 

Garvin said this highlights a misunderstanding about what victims' rights are. Victims asking for their rights to be protected doesn't make them a party. 

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She said it is possible for someone to exercise another's rights on their behalf, such as what happens for parents acting on behalf of their or on behalf of someone who is mentally incapacitated, including someone under a conservatorship. 

If Mitchell's case is upheld, it would be a sign that Mississippi victims' rights aren't meaningful or are being adequately considered, Garvin said. 

“The statement to the victim would be you actually don't have rights, you are just a piece of evidence in a case against someone else,” she said.

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

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