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Some worry thousands of Mississippi children will lose health coverage as public health emergency ends

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Some worry thousands of Mississippi children will lose health coverage as public health emergency ends

In just over two weeks, the state's Division of Medicaid will begin the daunting of determining whether hundreds of thousands of low-income are still eligible for health coverage for the first time in three years.

As a result, Mississippians, adults and children, who have had coverage as the result of a federal pandemic-era policy of continuous enrollment could lose health insurance as soon as July, according to the division.

Mississippi's Medicaid division will begin examining its roughly 890,000 recipients to determine their eligibility starting April 1. But with a staff vacancy rate of 12% and an onslaught of work, national health care experts and local advocates are worried about eligible children, especially, falling through bureaucratic cracks and losing coverage.

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Those who work with Medicaid recipients have a litany of concerns: from the division's ability to effectively communicate with families known to frequently move to the low rate of automatic electronic renewals the state has done in the past.

“It's nothing new that , once they get over a very low income level, they have no coverage because the state hasn't expanded Medicaid,” said Joan Alker, the executive director and researcher at Georgetown 's Center for Children and Families. “What is new is we might see thousands of eligible children lose coverage during this process.”

The stakes are high.

Mississippi children in low-income families make up more than half of the state's overall Medicaid recipients. Some have coverage through Children's Health Insurance Program, or CHIP. During continuous coverage, Medicaid rolls in Mississippi have increased by more than 130,000 people – 80,000 of which are children.

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The U.S. Department of Health and Human Services said as many as 15 million people nationwide could lose Medicaid or CHIP coverage. About 6.8 million people could be disenrolled even though they are still eligible, the department estimates, because of enrollees struggling to navigate the renewal processes, states unable to successfully contact enrollees or other administrative hurdles.

On its end, the state's Medicaid division said it's hired 22 new workers in the past and has 100 contractors to help manage caseloads. The biggest push from the office so far has been asking recipients to ensure their contact information and mailing addresses are up-to-date.

“To raise awareness about redeterminations and the importance for members to update their contact information, (Mississippi Division of Medicaid) launched a Stay Covered campaign in January and invited community partners to sign up to be Coverage Champions,” spokesman Matt Westfield said in a statement. “Our Coverage Champions partners include a diverse mix of health centers and advocacy groups.”

Posts are all over Facebook. Flyers have been shared both online and in-person with scannable codes that link an online form.

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Medicaid coverage is determined by income, but the threshold for children to still qualify in Mississippi is higher than that of their parents and other adults.

Joy Hogge, the director of Families of Allies, a statewide nonprofit that supports children with health challenges, said her office is going to start asking every who contacts them if they're aware of the upcoming renewal process.

“We haven't had families ask questions (on their own),” Hogge said. “So, I don't know if it's not reaching them. I'm not sure of what the awareness level is from families being affected.”

So far, Mississippi hasn't published a detailed unwinding plan. The one document the division was required to upload for the federal includes a long checklist of measures where the agency could check “already adopted” or “planning or considering to adopt.”

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But details of where the state was in the process of adding improvements wasn't included. That makes it hard to decipher exactly what's going on, said Garrett Hall, a policy analysis at health advocacy organization Families USA.

Westfield said the state does plan to post a more detailed unwinding plan online once it's ready. This is something states such as California and Arizona have already done.

Mississippians, for example, don't have online accounts to easily login into Medicaid – something 48 other states have, according to KFF. In a tweet earlier this month, Mississippi Division of Medicaid Director Drew Snyder said it was something his office was testing and planned to deploy this year.

Mississippi is taking the full 12 months by the federal government to work through its redetermination process. Arkansas, for example, is planning to do the same process in only six months – something that raises major red flags for health care advocates.

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While Hall is glad Mississippi won't rush through the process in half the time, he does point out that Mississippi doesn't have a high percentage of “ex parte,” or automatic, renewals. The division told Mississippi Today its automatic renewal rate was 24% before the pandemic – though that's a rate they expect to go up over the next year.

Hall said states should hit a 50% ex parte rate at minimum.

Using state databases – like of families who qualify for food assistance or individuals receiving unemployment – Medicaid divisions can automatically enroll people they know are still eligible. Hall said it's the most seamless way to ensure people retain coverage who still qualify.

“No one who is still eligible for coverage should lose it because they are subjected to a confusing and cumbersome renewal process,” Hall said. “Looking at Mississippi's unwinding plan, they have some steps in the right direction but they need to follow through on some of those further steps.”

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Alker worries about whether notices will even reach families. Low-income families are often mobile, and may not know they need to update their address. If the letter does find them, she wonders what the language will be like and if it could be misleading. Alker pointed to a prior instance where Mississippi's Division of Medicaid shifted enrollees' coverage without making a public announcement.

“Is it going to be clear that even if a parent loses coverage, their child may still be eligible?” Alker said. “Is there going to be adequate support at the call center to work through the renewal process or questions? Sometimes there are just glitches and delays due to short staffing. All sorts of things can go wrong.”

Westfield said when the Mississippi division begins its redetermination process, it will first focus on auto-renewing benefits using state data systems for electronic verification. If someone can't be approved this way, they will be mailed a renewal form which they will have 30 days to return to the office.

If the Medicaid division determines someone no longer qualified they will receive a notice by mail explaining the decision and how to file an appeal, according to Wesftield. Their information will also be sent to the Health Insurance Marketplace, and they will be notified about their options through the Affordable Care Act.

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Michael Minor, the executive director of Oak Hill Regional Community Development Corporation, has been working closely with families who qualify for Medicaid or CHIP since 2019. The initiative is called “Healthy Kids MS,” and it aims to keep kids covered and up-to-date on doctor's visits.

“We see ourselves as being that unseen, invisible hand there that's helping folks to work with the system,” Minor said. “It's a matter of meeting folks where they are.”

That means churches, schools, and offices. Volunteers will even forms to Medicaid offices on behalf of families with transportation struggles. Hogge and Minor both said their workers will sit on a phone call to Medicaid with a recipient if that's the support families need.
Minor and his team of Medicaid navigators are bracing for the surge of questions – but they're not worried.

‘We're set up for this,” he said. “And we're just doing what we normally do.”

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

Mississippi Today

Lawsuit in death of man following Jackson police encounter may be headed to trial

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mississippitoday.org – Mina Corpuz – 2024-04-29 15:21:38

The of George Robinson plans to move forward with a wrongful death lawsuit against the of and three former after rejecting a nearly $18,000 settlement offer. 

Attorney Dennis Sweet III made the intentions of Bettersten Wade, Robinson's sister, and Vernice Robinson, Robinson's mother, clear in a Thursday letter sent the day after the City Council approved a $17,786 payment to settle the family's 2019 lawsuit. 

“This is more than anyone should have to endure. Much less have the City of Jackson tout the purported term of settlement as some sort of victory,” Sweet wrote in the letter. “Needless to say, no individual or party obtained a victory in this matter.”

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The financial terms of the settlement and plaintiffs' identities were not supposed to be disclosed publicly and the council did not approve the settlement in executive session, Sweet said. According to Mississippi's open meeting , any public body can enter executive session for a number of reasons, including for negotiations relating to litigation. 

Sweet was not immediately available to comment Monday. Last week, he told WLBT he would take it to trial. 

Council President Aaron , who was also not immediately available for comment, said the settlement was freely negotiated among the parties and signed by Wade and Vernice Robinson, who had their attorneys with them, according to a Friday statement to the Clarion Ledger. 

Banks disputed Sweet's claims that the city violated any terms of the settlement, such as a confidentiality agreement, saying the city didn't agree to one and that settlements are public records, according to the statement. 

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“The City intends to honor the agreement it reached and expects the Wade family to do so, also,” Banks said in the statement.

However, some city council members said after the meeting that they were not aware of a confidentiality agreement. 

City Attorney Drew Martin declined to comment Monday. 

All the parties met for mediation April 12. Sweet said that during the session, a representative from the city said it is in “financial straits and did not possess substantial funds in which to resolve Ms. Wade's claims against it.” The lawsuit complaint asked for a jury trial and damages to be determined by a jury. 

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Banks's statement did not address the attorney's claim about the city's finances.  

Wade agreed during mediation to settle with ambulance provider American Medical Response and to allow the city to join that settlement and end litigation, according to Sweet's letter. 

“Had AMR not agreed to a substantial settlement amount, Ms. Wade would not have settled with the City of Jackson,” he wrote in the letter.

The company settled for a different amount that was not disclosed, according to Sweet's letter.

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As of Monday, electronic court filings for the lawsuit do not show that the judge has signed off on a settlement.  

In January 2019, 62-year-old Robinson was pulled from a car and beaten by officers, leaving him with severe injuries. At the time, he was recovering from a stroke. Robinson died days later.

In 2022, former detective Anthony Fox was convicted culpable-negligence manslaughter for Robinson's death, while charges against officers Desmond Barney and Lincoln Lampley were dismissed a year earlier. 

Fox was until January when the Mississippi Supreme Court overturned his conviction and issued an acquittal, freeing him. Fox has returned to work for the Canton Police Department. 

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This isn't Wade's only loss and fraught experience with the city, Sweet said. 

Last year, her son Dexter died after being hit by a car driven by an off-duty Jackson police officer. He was buried unidentified in the pauper's field, despite identification on him. His family did not know he was there until months later. 

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

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Mississippi Today

Back-and-forth: House, Senate swap Medicaid expansion proposals, counter offers

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mississippitoday.org – Sophia Paffenroth – 2024-04-29 14:44:59

After lawmakers in the House and Senate compromised on several points of the expansion bill, there remains one major hurdle to be cleared: the necessity of a work requirement.

Any bill that makes expansion contingent on the approval of a work requirement will likely be null and void, due to federal regulations that have banned work requirements.

The House and Senate last week compromised on one major point of contention between the two chambers, income eligibility: the Senate conceded to people making up to 138% of the federal poverty level, about $20,000 for an individual, and the House agreed to having those who make more than 99% of the federal poverty level enrolled in subsidized private insurance – rather than straight Medicaid – which would be made affordable by state-federal Medicaid funds. 

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They are still far apart on the details of a work requirement. Monday afternoon, the House proposed a counter offer to the Senate's stringent work requirement, one in which Medicaid would be expanded either way, but Mississippi would be mandated to reapply for the work requirement every year, and would be required to immediately adopt a work requirement if the federal ever changed its policy.

READ MORE: House, Senate leaders swap Medicaid expansion proposals as Monday night deadline nears

Here's a breakdown of the various expansion plans proposed this to insurance for low-income, mostly working, people in the poorest and unhealthiest state in the country. 

Original House bill, Feb. 28

House Bill 1725, authored by Speaker Jason White and Medicaid Chairwoman Missy McGee, R-Hattiesburg, was originally written as a mostly-traditional expansion bill, similar to programs most other states have adopted. It would:

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  • cover income-eligible adults making up to 138% of the federal poverty level, about $20,000 for an individual.
  • include a work requirement that would be removed if the federal government did not approve it.
  • draw down $1 billion federal dollars by increasing the federal match rate.
  • qualify Mississippi for a two-year bonus of $650 million offered to newly-expanded states – which would make the program to the state for a total of four years.

It overwhelmingly passed the House 98-20 at the end of February. 

Original Senate proposal, March 28

In late March, the Senate Medicaid committee passed House Bill 1725 with a strike-all, and replaced the original bill's language with its own language, which Medicaid Chairman Kevin Blackwell, R-Southaven, referred to as “expansion lite.” 

The plan proposed:

  • covering working making up to 99% of the federal poverty level, about $15,060 annually for an individual. 
  • leaving out those making between 100% and 138% of the federal poverty, and as a result, would turn down the $1 billion in federal dollars 
  • calling for quarterly proof of employment, leaving experts worried that the plan would be administratively burdensome and costly – as well as confusing for enrollees. That's if the federal government approved the waiver necessary for the work requirement – an unlikely scenario under the Biden administration, which has rescinded such waivers previously granted under the Trump administration and has not approved new ones. 

This austere version of expansion passed the full Senate at the end of March with a veto-proof majority – an important detail since Gov. Tate Reeves has indicated he will veto any expansion bill that comes to his door. 

House's response to the Senate's strike-all, April 3

The House invited the Senate to conference in early April to hash out the details of House Bill 1725. 

House leadership countered the Senate's austere version of expansion with a compromise: a “hybrid model” which would cover those making up to 138% of the federal poverty level, but would put those making between 100% and 138% on private health insurance policies through the federal exchange. 

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The cost of these policies would be subsidized through federal-state Medicaid funds. 

Senate's response to the House's compromise, April 26

Senate conferees sent the House a plan with a “hybrid model,” similar to what the House pitched, but maintained a firm stance on a work requirement — although they dropped the quarterly employment verification to annually.

The Sunday, Senate conferees retracted the requirement in their initial proposal that Mississippi sue the federal government if the Centers for Medicaid and Medicare Services doesn't approve the work requirement waiver. 

Democrats in the House reportedly said they would not vote for any measure with the latter provision. 

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If initially turned down on the work waiver by the federal government, the new Senate proposal would require the state to appeal again to the agency if any other state gets a similar program approved later.

The latest offer from the House, April 29

House conferees countered the Senate's strict work requirement plan on Monday with a plan that would expand Medicaid with or without the work requirement, but would require the state to apply for the waiver initially and continue to do so once a year. It would also include a “trigger ,” similar to North Carolina's, mandating that if the federal government ever changed its policy on allowing states to implement a work requirement, Mississippi would move to implement one immediately.

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

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Mississippi Today

House, Senate leaders swap Medicaid expansion proposals as Monday night deadline nears

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mississippitoday.org – Taylor Vance – 2024-04-29 14:35:06

House and Senate ahead of a major Monday night deadline continued to trade proposals back and forth on Monday attempting to find a compromise plan to expand coverage to poor

House Medicaid Chair Missy McGee, a Republican from Hattiesburg, told Mississippi that she delivered another compromise proposal to Senate leaders Monday afternoon that would direct the Division of Medicaid to apply for a federal waiver to allow Mississippi to implement a work requirement for Medicaid recipients. 

However, if the Centers for Medicare and Medicaid Services denies the 's waiver for work requirements, the proposal would still expand either traditional Medicaid coverage or -subsidized private insurance policies to people who make up to 138% of the federal poverty level, or about $20,000 for an individual. 

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The House's latest measure also contains “trigger language,” similar to North Carolina's, which requires the division to reapply for a work requirement waiver as soon as the CMS approves work requirements in other states. 

The House's Monday offer follows a plan Senate leaders sent to the House on Sunday evening that also would expand eligibility to 138% of the federal poverty level still but contains an ironclad work requirement for expansion to take effect. 

READ MORE: Lawmakers negotiate Medicaid expansion behind closed doors, hit impasse on state budget

The reason the two chambers are haggling over work requirements in the bill is because the Affordable Care Act, the federal legislation that allows states to expand Medicaid coverage, does not authorize work requirements. However, states can seek a federal waiver to implement them. 

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CMS under the Trump administration did sign off on some states using work requirements, but under the Biden administration, the federal agency has not approved requests and rescinded the ones that had been approved. 

The House is willing to establish an expansion plan without a work requirement, but Senate leaders have maintained they will only an expansion program that mandates work requirements — a stance that would at the least delay expanded coverage — perhaps for years, or prevent it from ever .

House leaders have pointed out that people with income above the federal poverty level are likely working.

Lawmakers have for the past couple of months been debating on how to expand Medicaid coverage for poor working Mississippians and help the state's struggling hospitals. 

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The House initially voted to expand coverage to an estimated 200,000 people, and accept more than $1 a year in federal dollars to the cost, as most other states have done. The Senate initially passed a far more austere plan, that would cover about 40,000 people, and would decline the extra federal money to cover costs. 

Since those plans passed, each has offered counter proposals, but no deal has been reached.

Senate leaders have indicated they might not be able to secure enough votes for the House's proposals. Facing a threat of a veto from Gov. Tate Reeves, lawmakers would have to have a two-thirds vote in each chamber to override him.

The three senators and three House members tasked with reaching a compromise face an 8 p.m. deadline to agree on an initial Medicaid expansion plan, but that deadline could be suspended if two-thirds of the lawmakers in both chambers agree to the suspension. 

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The six negotiators could also agree to file a “dummy” bill, or a bill with no substantive plan, to meet the 8 p.m. deadline and continue to negotiate on a final plan. 

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

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