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A quarter of Mississippi’s rural hospitals could close within three years, report shows

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A quarter of Mississippi's rural hospitals could close within three years, report shows

Mississippi's struggling rural hospitals haven't improved their financial outlook much over the past quarter, a newly updated report shows.

A report from the Center for Healthcare Quality and Payment Reform shows that about a third of Mississippi's rural hospitals are still at risk of closure, and over a half of those still at risk of immediate closure. 

The report, which the organization updates every three months, shows 27 hospitals are currently at risk of closure in Mississippi, with 20 of those at risk of immediate closure. 

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The January version of the report previously showed that 28 of Mississippi's 74 rural hospitals were at risk of closure. Of those, 19 were at risk of closing immediately.

Only four other states — Oklahoma, South Carolina, Alabama and Connecticut — have poorer statistics regarding immediate closure risk, while Mississippi and Tennessee are tied for fifth place. In both states, 27% of overall rural hospitals are at risk of immediate closure.

Harold Miller, CEO of the center behind the report, said the situation is largely due to low payments from private health insurance companies. His organization advocates for hospital payment reform. 

READ MORE: Lawmakers approved $104 million for Mississippi hospitals. Some say it's not nearly enough.

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The center judges closure threat by how long hospitals can continue operations while losing money. The center says hospitals are at risk when they can sustain losses for six to seven years, and at immediate risk when they can offset those losses for only two to three years. 

More than half of Mississippi's rural hospitals are losing money serving , according to the report.

Many of the 's hospitals were already financially vulnerable, and during the pandemic, the cost to run hospitals went up — supplies and labor became more expensive, but hospital profit did not increase.

The situation siphoned money out of the state's struggling hospitals, and now the state's is crumbling.

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When rural hospitals close, it can be disastrous to their communities. Residents are forced to longer distances for what is sometimes life-changing care. It's a thorny situation in a state with already some of the country's worst health outcomes.

Hospitals are taking different approaches in an effort to stay open. Some are closing certain departments to cut costs, such as 's hospital, while others are applying for a new federal designation to bring in more money, such as Alliance Healthcare System in Holly Springs.

This year, state lawmakers passed a plan to send millions in grant money to hospitals, and a change in Medicaid supplemental payments brought in slightly more money. The influx of money, along with a big credit line, has helped Greenwood Leflore Hospital stay open.

But that money is temporary, hospital administrators have stressed, and isn't a long term solution to the state's health care crisis.

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While experts agree it's not a silver bullet, Medicaid expansion would bring an influx of millions to Mississippi's struggling hospitals. Though a majority of Mississippians support Medicaid expansion, Republican state leadership has adamantly opposed the idea and blocked serious debate about it. 

“Many of these hospitals could be forced to close in the near future if they don't payments that are adequate to their costs,” Miller said. 

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

Mississippi Today

On this day in 1862

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MAY 13, 1862

During the Civil War, Robert Smalls and other Black Americans who were enslaved commandeered an armed ship in Charleston. Wearing a straw hat to his face, Smalls disguised himself as a Confederate captain. His wife, Hannah, and members of other families joined them.

Smalls sailed safely through Confederate territory by using hand contained in the captain's code book, and when he and the 17 Black passengers landed in Union territory, they went from slavery to . He became a in the North, helped convince Union leaders to permit Black soldiers to fight and became part of the war effort.

After the war ended, he returned to his native Beaufort, South Carolina, where he bought his former slaveholder's home (and his widow to there until her ). He served five terms in , one of more than a dozen Black Americans to serve during Reconstruction. He also authored legislation that enabled South Carolina to have one of the nation's first and compulsory public school systems and bought a building to use as a school for Black children.

After Reconstruction ended, however, white lawmakers passed laws to disenfranchise Black voters.

“My race needs no special defense for the past history of them and this country,” he said. “All they need is an equal chance in the battle of life.”

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He survived slavery, the Civil War, Reconstruction and the beginnings of Jim Crow. He died in 1915, the same year Hollywood's racist epic film, “Birth of a Nation”, was released.

A century later, his hometown of Beaufort opened the Reconstruction Era National Monument, which features a bust of Smalls — the only known statue in the South of any of the pioneering congressmen of Reconstruction. In 2004, the U.S. named a ship after Smalls. It was the first Army ship named after a Black American. A highway into Beaufort now bears his name.

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

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Podcast: House Minority Leader reflects on breakdown of Medicaid expansion negotiations

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Rep. Robert Johnson, D-Natchez, the House minority leader, talks with Mississippi 's Bobby Harrison and Taylor Vance on how efforts to expand broke down during the chaotic final days of the 2024 legislative . He hopes those efforts are revived in the 2025 session.


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

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Lawmakers move to limit jail detentions during civil commitment

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mississippitoday.org – Kate Royals – 2024-05-13 05:00:00

This article was produced for ProPublica's Local Network in partnership with Mississippi TodaySign up for Dispatches to get stories like this one as soon as they are published.

Mississippi lawmakers have overhauled the state's civil commitment laws after and ProPublica reported that hundreds of people in the state are jailed without criminal charges every year as they wait for court-ordered mental health treatment.

Right now, anyone going through the civil commitment can be jailed if county officials decide they have no other place to hold them. House Bill 1640, which Gov. Tate Reeves  signed Wednesday, would limit the practice. It says people can be jailed as they go through the civil commitment process only if they are “actively violent” and for a maximum of 48 hours. It requires the mental health professional who recommends commitment to document why less-restrictive treatment is not an option. And before paperwork can be filed to initiate the commitment process, a staffer with a local community mental health center must assess the person's

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Supporters described the , which goes into effect July 1, as a step forward in limiting jail detentions. Those praising it included county officials who handle commitments, associations representing sheriffs and county supervisors, and the state Department of Mental Health.

“This new process puts the person first,” said Adam Moore, a spokesperson for the Department of Mental Health, which provides , along with some and services related to the commitment process. “It connects someone in need of mental health services with a mental health professional as the first step in the process, before the chancery court or law enforcement becomes involved.”

But some officials involved in the commitment process said that unless the state expands the number of treatment beds, the effect of the legislation will be limited. “Just because you've got a diversion program doesn't mean you have anywhere to divert them to,” said Jamie Aultman, who handles commitments as chancery clerk in Lamar County, just of Hattiesburg.

Although every state allows people to be involuntarily committed, most don't jail people during the process unless they face criminal charges, and some prohibit the practice. Even among the few states that do jail people without charges, Mississippi is unique in how regularly it does so and for how long. Under Mississippi law, people going through the commitment process can be jailed if there is “no reasonable alternative.” State psychiatric hospitals usually have a waiting list, and short-term crisis units are often full or turn people away. Officials in many counties see jail as the only place to hold people as they await publicly funded treatment.

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Idaho lawmakers recently dealt with a similar issue. There, some people deemed “dangerously mentally ill” have been imprisoned for months at a time; this spring, lawmakers funded the construction of a facility to house them

Nearly every county in Mississippi reported jailing someone going through the commitment process at least once in the year ending in June 2023, according to the state Department of Mental Health. In just 19 of the state's 82 counties, people awaiting treatment were jailed without criminal charges at least 2,000 times from 2019 to 2022, according to a of jail dockets by Mississippi Today and ProPublica. (Those figures, which included counties that provided jail dockets identifying civil commitment bookings, include detentions for both mental illness and substance abuse; the legislation addresses only the commitment process for mental illness.)

Sheriffs have decried the practice, saying jails aren't equipped to handle people with severe mental illness. Since 2006, at least 17 people have died after being held in jail during the civil commitment process; nine were suicides.

The bill's sponsors said Mississippi Today and ProPublica's reporting prompted them to act. “The deficiencies have been outlined and they're being corrected,” said state Rep. Kevin Felsher, R-Biloxi, a co-author of the bill. 

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An affidavit of someone who was committed and held in a Mississippi jail for mental health issues. Credit: Obtained by Mississippi Today and ProPublica. Highlighting by ProPublica.

Under current law, anyone can walk into a county office and fill out an affidavit alleging that someone, often a family member, is so seriously mentally ill that they must be forced into treatment. A judge or special master issues an order directing sheriff's deputies to take the person into custody for evaluations, a court hearing and sometimes inpatient treatment. Those screenings take place after the person is in custody — and often while they are in jail. 

The legislation adds several steps to the civil commitment process in order to weed out unnecessary commitments. When someone seeks to file paperwork to commit another person, a county official will direct them to the local community mental health center. There, a mental health professional will try to interview the person alleged to be mentally ill and others who are familiar with their condition. Staff can recommend commitment or other services, intervention by mental health professionals who will travel to the patient or inpatient treatment at a crisis stabilization unit. 

As a chancery clerk in northeastern Mississippi's Lee County, Bill Benson has long dealt with people seeking to file commitment affidavits.

He said first requiring a screening by a mental health professional is a good move. “I'm an accountant. I'm not going to try and make a determination” about whether someone needs to be committed, he said. He generally allows people to file commitment papers so he can “let the judge make that call.”             

The bill says that if the community mental health center recommends commitment after the initial screening, someone can't be jailed while awaiting treatment unless all other options have been exhausted and a judge specifically orders the person to be jailed. The legislation also says people can be held in jail for only 24 hours unless the community mental health center requests an additional 24-hour hold and a judge agrees. Roughly two-thirds of the people jailed over four years were held longer than 48 hours, according to Mississippi Today and ProPublica's analysis. 

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However, the bill does not address the underlying reason that many people are jailed as they await a treatment bed. “I'm not certain there are enough beds and personnel available to take everybody,” Benson said. “I think everyone will attempt to comply, but there are going to be some instances where somebody's going to have to be housed in the jail.”

Nor does the legislation say anything about how the provisions will be enforced. House Public Health Chair Sam Creekmore, R-New Albany, the primary sponsor of the bill, said the Department of Mental Health will “police this.” He also said he hopes the law's new reporting requirements for community mental health centers will encourage county supervisors to monitor compliance. 

Moore, at the Department of Mental Health, said the agency won't enforce the law, although it will educate county officials, who are responsible for housing people going through civil commitment until they are transferred to a state hospital. “We sincerely hope all stakeholders will abide by the new processes and restrictions,” Moore said. “But DMH does not have oversight over county courts or law enforcement.”

Several mental health experts and advocates for people with mental illness say the law doesn't go far enough to ban a practice that many contend is unconstitutional. For that reason, representatives of Disability Rights Mississippi have said they're planning to sue the state and several counties.

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“The basic flaw remains,” said Dr. Paul Appelbaum, a professor of psychiatry at Columbia University and former president of the American Psychiatric Association. “There is no justification for putting someone who needs hospital-level care in jail, not even for 24 hours.”

Agnel Philip of ProPublica and Isabelle Taft, formerly of Mississippi Today, contributed reporting.

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

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