Mississippi Today
‘So medieval’: Man with mental illness jailed for 20 days without charges
In January, the head of Mississippi’s Department of Mental Health told lawmakers that people who aren’t charged with a crime are spending less time in jail than they used to: The average wait time for a state hospital bed was down to three days after a court hearing.
At that moment, a young man was on his 16th day locked in the DeSoto County Jail with no criminal charges. He was waiting for mental health treatment.
His mother, Sarah, was still trying to understand why he was there at all.
David, 29, was diagnosed with schizoaffective disorder about a decade ago. Since then, he has cycled through hospital stays and group homes. Sarah can rattle off the low points. There was the time her son was walking in the street and got hit by a car and broke his neck. And the time he called her from a Megabus in Texas, nearly at the border with Mexico.
But this was something new: a three-week detention that began after he called 911 seeking treatment and eventually wound up jailed at the request of his providers.
Her son’s treatment in DeSoto County – where a county website still uses the phrase “lunacy” hearings to refer to the proceedings where judges order people like David to receive psychiatric treatment – reminded Sarah of a different era.
“When they, you know, lock them in the dungeon or whatever and put chains on them and just let them live the rest of their lives there,” she said. “This is so medieval, what they’re doing.”
In the end, David was jailed for a total of three weeks before being transported to North Mississippi State Hospital at the end of January. Mississippi Today is not using his or his family’s real names to protect his privacy.
It is far from unusual in Mississippi and particularly in DeSoto County for people to be jailed solely because they are awaiting treatment through the state’s involuntary commitment process. No other state jails so many people for such lengths of time, solely on the basis of mental illness. Mississippi Today and ProPublica previously reported that hundreds of people are jailed without criminal charges every year while they await evaluations and treatment through the involuntary commitment process.
From 2019 through 2022, DeSoto County jailed people without criminal charges just under 500 times, more than any other county in the news organizations’ analysis.
As lawmakers debate changing Mississippi’s commitment laws to reduce jail detentions, David’s path through the state’s mental health system shows how it can funnel a sick person into jail, and how long it can take for them to get out once locked up.
A publicly funded facility established to treat people in crisis sent David to jail. Though the Department of Mental Health says commitment hearings should take place within 10 days, county officials instead kept him locked up for 14 days before he saw a judge, as winter weather shut down the county court system. The state hospital where the judge ordered him to receive treatment would not admit him for six more days – all of which he spent in jail.
The county is working on opening a crisis center to treat people suffering mental health crises – and keep them out of jail during the commitment process – and supervisors recently voted to hire an architect to draw up renovation plans for the county building that will house the center. The county is currently the largest in the state without one.
County administrator Vanessa Lynchard noted that reforming the commitment process is a priority for the Legislature this year, and that could hopefully bring some relief.
“Nobody likes mental commitments in the jail,” she said.
But officials involved in the process say jail is sometimes the only place they have to detain people during the commitment process, and that jailing people is safer than sending them home. And so every year, the county jails well over 100 people solely because they may be mentally ill – including people like David.
‘He really wants to live a normal life’
In early January, David walked away from his mother’s home in a tidy subdivision in DeSoto County. He knocked on a neighbor’s door and used the phone to call 911 for an ambulance to take him to the hospital.
When Sarah found out he was at Baptist Memorial Hospital-DeSoto, she decided to let him stay there and get treatment. That he had been able to get himself there was a sign of progress. When his mental illness became severe about 10 years ago, “he used to just let himself spin out of control,” Sarah said.
When David was a teenager, he developed phobias that his mother found strange. He stopped wanting to go to school, claiming his breath smelled bad. After he ran away from home, he was hospitalized at Lakeside, a psychiatric hospital in Memphis.
He graduated from high school and got a job working at a warehouse, riding his bicycle more than an hour each way to arrive by 5 or 6 o’clock in the morning.
Then, when he was about 19, “stuff went totally to the left with him,” his mother said. He would disappear from home for days at a time. If he wound up at a hospital, staff wouldn’t tell her he was there, citing patient privacy protections. At home, he would refuse to take medications.
A few years ago, Sarah spent $2,500 to go through the legal process to gain conservatorship over her son so that she would always be included in conversations about his treatment.
“When the dust settles and the smoke clears, he always comes back to me,” she said. “If you’ve got him and put him on the wrong medication and overmedicated him, then I’ve got to help him get back on track.”
David belongs to a tight-knit family: He has siblings, a doting grandfather, aunts and uncles. Sarah’s phone is full of pictures of her son. There’s a shot of him getting his face painted at a family party and another of him wearing a Mickey Mouse t-shirt at Disneyland. A video shows him chasing his sister’s kids around his mother’s backyard.
His family tries to help him manage his symptoms. When he lived with his older sister Beth recently, he would go into the backyard to pace and talk to himself.
“I’d go out there like every 15 minutes, like, ‘Hey, you’re too loud, you need to calm down,’ but I don’t interrupt,” she said. “That’s his way of calming himself down.”
David has told his sister that he doesn’t like depending on her and their mom, that he feels bad he doesn’t drive or hold a job – something that has been a goal for years.
“He’ll tell you that he really wants to live a normal life,” Beth said.
From the crisis unit to a jail cell
One day in January, after a few days at Baptist Memorial Hospital-DeSoto, David was transported to a crisis stabilization unit in Corinth, where he had agreed to get treatment. Operated by the community mental health center Region IV, which serves residents of DeSoto and four other counties, the facility is one of more than a dozen around the state designed to serve people closer to their homes, ideally keeping them out of the state hospitals – and out of jail.
For David, the crisis unit did the opposite.
Sarah sent over her conservatorship paperwork so she could be updated about his treatment. She expected to hear from her son not long after he arrived there, because he always calls her once he feels more like himself. When that didn’t happen, she called the crisis unit.
“He’s in the DeSoto County Jail,” staff told her.
Documents filed with the DeSoto County Chancery Court and reviewed by Mississippi Today show that after refusing medications twice, David had taken them and said he thought it was helping. There were no indications of violence or physical aggression. But not long after he arrived, staff requested a writ – a document allowing the sheriff’s department to take custody of a patient – because of his “agitation and inappropriate sexual conduct.”
Staff reported that he was experiencing “Psychosis including delusions, irritability. He is continually masterbating (sic).” They wrote that he had masturbated in front of other patients and a staff member.
It’s not clear from the documents exactly how long David was at the crisis unit before staff requested the writ, and Sarah said she was not contacted when he arrived there. It may have been as little as a day or two: The court order committing him says he arrived at Corinth “on or about 01/08/24.”
On Jan. 8, Catherine Davis, crisis coordinator at Region IV, which runs the crisis center, wrote: “At Corinth Crisis they are requesting he go to DeSoto County Jail.”
The next afternoon, deputies arrived to take David into custody and drive him 90 minutes back to DeSoto County. He was booked into the county jail with his charge listed as “Writ to take custody.”
Psychiatrists told Mississippi Today that people with David’s condition may exhibit sexually inappropriate behavior like public masturbation, stepping from hypersexuality and impulsivity that can be symptoms of mania.
“All they want to focus on is what he was doing wrong there,” Sarah said. “I understand that. But that’s because he needs psychiatric treatment. He’s mentally unstable. You’re a crisis center. Isn’t that what you do? But instead you ship him off to jail.”
Jason Ramey, executive director of Region IV, the community mental health center that runs the crisis unit, said he can’t discuss a specific client, citing HIPAA.
“At no point in time is it our goal to have somebody sitting in jail, but we also have to think about the wellbeing of the whole CSU, whether it’s the other clients there and things like that,” he said.
Ramey said that in 2023, the crisis unit staff initiated commitment proceedings on only three patients. The facility treated nearly 300 people in the most recent fiscal year.
“We want them to continue to receive treatment,” he said of patients awaiting transfer to a different facility. “If we’re not able to provide that, we want to get them to the state hospital as quickly as possible. It’s not like we file a writ just to have them go sit in jail.”
But in David’s case, that’s exactly what happened.
Dr. Paul Appelbaum, a professor of psychiatry at Columbia and former president of the American Psychiatric Association, reviewed the commitment paperwork and initial evaluation filed with the chancery court in David’s case. He said sending David to jail was wrong.
“The sexually inappropriate behavior is a function of his current acute psychosis, and so the proper response to it is to treat the psychosis, which doesn’t happen overnight,” he said.
Dr. Marvin Swartz, a professor of psychiatry at Duke University, said it may have been appropriate to transfer David to another facility, but that elsewhere in the United States, such a transfer would not involve waiting in jail.
Dr. Lauren Stossel, a forensic psychiatrist and former chief of mental health for New York City jails, said that mental health providers have a responsibility to transfer patients to a higher level of care if they can’t provide safe and effective treatment.
Mississippi’s practice of routinely jailing people without criminal charges while they await psychiatric treatment demands systemic change, she said. But in the meantime, crisis center staff shouldn’t avoid commitment at all costs.
“Clinicians need to consider all their patients and staff and make a decision about what they can manage in their facility,” she said. “The fact that jail is a possible alternative is appalling and needs to be factored in, but they also have to be careful about getting in over their heads trying to manage patients they have no way of treating safely or effectively.”
When reviewing the information crisis center staff provided to the chancery court to justify their decision to initiate commitment proceedings, however, Stossel didn’t see a clear explanation of what staff believed the patient needed that they weren’t equipped to provide.
“It’s not clear to me based on this information: what symptoms or behaviors is this patient exhibiting that you can’t manage? What interventions have you already tried? How long did you allow him to respond to treatment before determining a higher level of care was necessary? It’s crucial to require a clear justification to protect the patient from an unnecessarily restrictive outcome.”
Adam Moore, spokesman for the Department of Mental Health, which funds the crisis units, did not answer specific questions about what happened to David. He said in an email statement that a crisis unit may initiate commitment proceedings when their clinical staff feels that someone served there meets commitment criteria or is in need of a higher level of care.
‘I didn’t know I was gonna get sent to jail’
While her son was in jail, Sarah wondered what medications he was taking, concerned that any disruption could worsen his symptoms. She and her daughter, Beth, worried about what he might experience as a young Black man locked up – with no criminal charges – in a Mississippi county jail. They prayed for God to keep him safe.
Sarah called the jail every day to find out how David was doing. During one of those calls, on Jan. 22, a staffer at the jail told her David would have a hearing in court the next day.
It had been 14 days since he was jailed, and 15 since the affidavit requesting his commitment was filed. The Department of Mental Health publishes guidelines saying that the entire process should wrap up within 10 days, but it doesn’t track whether that actually happens.
Special master Adam Emerson, the attorney appointed by a chancellor to preside over commitment hearings, said the county normally holds commitment hearings every Thursday, and sometimes on Tuesdays as well to meet the statutory deadline. Most hearings take place within a week of the writ being served, he said.
He would not comment on David’s case because it is his policy not to discuss specific commitment proceedings, but said that the week of Jan. 15, the entire county court system was shut down due to winter weather, postponing all hearings to the following week.
Emerson said he serves as special master as a way to serve the community where he has lived for nearly his entire life. During a decade as a public defender in the county, he realized many of his clients had mental health or addiction issues that led to criminal charges.
“I continue to believe that early intervention in situations where mental health issues are involved will lead to better outcomes to the individuals and society at large,” he wrote in an email to Mississippi Today.
To make it to the hearing, Sarah had to take the day off of work. At the courthouse in Hernando, she sat in the hallway with three other families of people going through the commitment process.
Eventually, she was called into the courtroom and took a seat in the front row. Deputies escorted her son into the room. He was shackled, with his hands chained to his waist and another chain running down to his feet.
Sarah noticed that almost everyone else in the courtroom was white. She suspected that racism had played a role in her son’s treatment. He is 6-foot-7, and though she knows him as “a gentle giant” who acts like one of her grandchildren, she worries other people are scared of him.
“It’s three strikes against you right there,” she said. “You’re African-American– strike one. African-American male– strike two. Then you’re an African-American male with a mental health disease. You just struck out.”
Emerson said he could not speak to David’s treatment outside of his courtroom, but that race had not played a role in his decision.
“I can only tell you that everyone who comes before my court is treated equally and with dignity and respect,” he said. “A person’s race, ethnicity, gender, religion, sexual preference, etc. is never a factor in our decisions.”
Mississippi Today reviewed the recording of the hearing after filing a motion to unseal it, with a letter of support from Sarah.
At the beginning of the 10-minute hearing, Catherine Davis, the Region IV crisis coordinator who had filed the affidavit against David, explained why she believed commitment was necessary.
Davis said that David had been masturbating at the crisis center, and that he was “hostile,” without saying what that meant exactly.
“When he was redirected he was becoming hostile,” Davis said. “He was pacing, responding to internal stimuli. So they felt at that point he wasn’t safe with the staff and the other clients. So they asked us to do a court commitment.”
When it was his turn to speak, David offered a different account of how he reacted to instructions from staff.
“After they told me the first time, I stopped,” he said, forming his sentences slowly and softly. “I really didn’t know it was a problem. I didn’t know I was gonna get sent to jail. I was just trying to get to the hospital.”
He told the judge he didn’t need more treatment.
Emerson called on Sarah to speak as well. She described the frustration and stress of sending her conservatorship paperwork to the crisis center only to learn days later her son had been taken to jail with no one informing her.
“I have been left out of this the entire time, and I don’t understand why,” she said.
On the recommendation of Davis and two physicians, Emerson ordered David into treatment at a state hospital.
“I’m doing that for your own good, to try to get you stabilized and get you back out,” he said to David.
To Sarah, he added: “Certainly based on where he’s sent, if I were you I’d try to get those records down to them so maybe they can keep you in the loop, OK?”
Before she could talk to or hug her son, Sarah was ushered out of the courtroom. David went back to jail for six more days.
‘How does being incarcerated support one’s mental health?’
On Jan. 29, 20 days after he was first jailed, David was transported to North Mississippi State Hospital.
Moore, the Department of Mental Health spokesman, said that the wait time information the agency had shared with lawmakers was an average and that it does not include any time a person is jailed before their hearing.
“Any individual’s wait time may be more or less than the average wait time for all admissions from a given period of time,” he wrote.
By early April, David was still at the state hospital in Tupelo. When Sarah visited him, she was disturbed that he had little energy, which she attributes to his long list of medications prescribed by the hospital staff. He told her he’s ready to come home, and he talked about trying to get a job.
His mother filed a complaint with the Mississippi Department of Health and with the Attorney General’s Public Integrity Division, which is responsible for prosecuting cases involving the exploitation of vulnerable adults.
She also emailed Wendy Bailey, head of the Department of Mental Health.
“As I deal with DeSoto County, which happens to be one of the fastest growing counties in the state, I am appalled at their antiquated systems of mental health support,” she wrote.
“How does being incarcerated support one’s mental health? What immediate changes can be made to improve upon this system?”
Bailey connected Sarah with Falisha Stewart, director of the Office of Consumer Supports. Stewart said there had been a communication “breakdown” when the Corinth crisis stabilization unit failed to contact Sarah about her son’s transfer to jail. She said the agency had enacted a plan to prevent communication lapses from happening in the future.
“It is unfortunate individuals who deal with mental health issues have to wait in jails for an available bed while being committed,” Stewart wrote. “These laws can only change through the process of speaking with your state representatives.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Crooked Letter Sports Podcast
Podcast: The Mississippi Sports Hall of Fame Class of ’25
The MSHOF will induct eight new members on Aug 2. Rick Cleveland has covered them all and he and son Tyler talk about what makes them all special.
Stream all episodes here.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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Mississippi Today
‘You’re not going to be able to do that anymore’: Jackson police chief visits food kitchen to discuss new public sleeping, panhandling laws
Diners turned watchful eyes to the stage as Jackson Police Chief Joseph Wade took to the podium. He visited Stewpot Community Services during its daily free lunch hour Thursday to discuss new state laws, which took effect two days earlier, targeting Mississippians experiencing homelessness.
“I understand that you are going through some hard times right now. That’s why I’m here,” Wade said to the crowd. “I felt it was important to come out here and speak with you directly.”
Wade laid out the three bills that passed earlier this year: House Bill 1197, the “Safe Solicitation Act,” HB 1200, the “Real Property Owners Protection Act” and HB 1203, a bill that prohibits camping on public property.
“Sleeping and laying in public places, you’re not going to be able to do that anymore,” he said. “There’s a law that has been passed that you can’t just set up encampments on public or private properties where it’s a public nuisance, it’s a problem.”
The “Real Property Owners Protection Act,” authored by Rep. Brent Powell, R-Brandon, is a bill that expedites the process of removing squatters. The “Safe Solicitation Act,” authored by Rep. Shanda Yates, I-Jackson, requires a permit for panhandling and allows people to be charged with a misdemeanor if they violate this law. The offense is punishable by a fine not to exceed $300 and an offender could face up to six months in jail. Wade said he’s currently working with his legal department to determine the best strategy for creating and issuing permits.
“We’re going to navigate these legal challenges, get some interpretations, not only from our legal department, but the Attorney General’s office to ensure that we are doing it legally and lawfully, because I understand that these are citizens,” he said. “I understand that they deserve to be treated with respect, and I understand that we are going to do this without violating their constitutional rights.”
Wade said the Jackson Police Department is steadily fielding reports of squatters in abandoned properties and the law change gives officers new power to remove them more quickly. The added challenge? Figuring out what to do with a person’s belongings.
“These people are carrying around what they own, but we are not a repository for all of their stuff,” he said. “So, when we make that arrest, we’ve got to have a strategic plan as to what we do with their stuff.”
Wade said there needs to be a deeper conversation around the issues that lead someone to becoming homeless.
“A lot of people that we’re running across that are homeless are also suffering from medical conditions, mental health issues, and they’re also suffering from drug addiction and substance abuse. We’ve got to have a strategic approach, but we also can’t log jam our jail down in Raymond,” Wade said.
He estimates that more than 800 people are currently incarcerated at the Raymond Detention Center, and any increase could strain the system as the laws continue to be enforced.
“I think there’s layers that we have to work through, there’s hurdles that we are going to overcome, but we’ve got to make sure that we do it and make sure that my team and JPD is consistent in how we enforce these laws,” Wade said.
Diners applauded Wade after he spoke, in between bites of fried chicken, salad, corn and 4th of July-themed packaged cakes. Wade offered to answer questions, but no one asked any.
Rev. Jill Buckley, executive director of Stewpot, said that the legislation is a good tool to address issues around homelessness and community needs. She doesn’t want to see people who are homeless be criminalized, but she also wants communities to be safe.
“I support people’s right to self determine, and we can’t impose our choices on other people, but there are some cases in which that impinges on community safety, and so to the extent that anyone who is camping or panhandling or squatting and is a danger to themselves and others, of course, I fully support that kind of law. I don’t support homelessness being criminalized as such,” Buckley said.
Many of the people Wade addressed while they ate Thursday said they have housing, don’t panhandle, and shouldn’t be directly impacted by the legislation. But Marcus Willis, 42, said it would make more sense if elected officials wanted to combat the negative impacts of homelessness that they help more people secure employment.
“There ain’t enough jobs,” said Willis, who was having lunch with his girlfriend Amber Ivy.
The two live in an apartment together nearby on Capitol Street, where Ivy landed after her mother, whom Ivy had been living with, suffered a stroke and lost the property. Similarly, Willis started coming to eat at Stewpot after his grandmother, whose house he used to visit for lunch, passed away.
Willis holds odd jobs – cutting grass, home and auto repair – so the income is inconsistent, and every opportunity for stable employment he said he’s found is outside of Jackson in the suburbs. The couple doesn’t have a car.
Making rent every month usually depends on their ability to find someone to help chip in, said Ivy, who is in recovery from substance abuse. She said she’s watched problems surrounding homelessness grow over the years in Jackson. Ivy grew up near Stewpot and has lived in various neighborhoods across the city – except for the times she moved out of state when things got too rough.
“There was just moments where I just had to leave,” Ivy said. “Sometimes if you hit a slump here, there’s almost no way for you to get out of it.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The post 'You're not going to be able to do that anymore': Jackson police chief visits food kitchen to discuss new public sleeping, panhandling laws 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: Center-Right
This article primarily reports on new laws in Jackson, Mississippi, targeting public sleeping, panhandling, and squatting, focusing on statements by Police Chief Joseph Wade and community perspectives. The coverage presents the legislative measures—authored by Republican and independent lawmakers—with a tone that emphasizes law enforcement challenges and community safety, reflecting a conservative approach to homelessness as a public order issue. While it includes voices concerned about criminalization and the need for social support, the overall framing centers on law enforcement and property protection. The article maintains factual reporting without overt editorializing but leans slightly toward a center-right perspective by highlighting legal enforcement as a solution.
Mississippi Today
Medicaid cuts could be devastating for the Delta and the rest of rural America
Note: This story first published in Stateline, which is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
LAKE PROVIDENCE, La. — East Carroll Parish sits in the northeastern corner of Louisiana, along the winding Mississippi River. Its seat, Lake Providence, was a thriving agricultural center of the Delta. Now, the town is a shell of its former self. Charred and dilapidated buildings dot the small city center. There are a few gas stations, a handful of restaurants — and little to no industry.
Mayor Bobby Amacker, 79, says at one point “you couldn’t even walk down the street” in Lake Providence’s main business district because “there were so many people.”
“It’s gone down tremendously in the last 50 years,” said Amacker, a Democrat. “The town, it looks like it’s drying up. And it’s almost unstoppable, as far as I can tell.”
Now, East Carroll residents stand to lose even more. Like many people in Louisiana, they received a lifeline when the state expanded Medicaid to more low-income adults in 2016. Expansion drove Louisiana’s uninsured rate to the lowest in the Deep South, at 8% in 2023 for working-age adults, according to state data, despite it having the highest poverty rate in the U.S. that year.
This week, both chambers of Congress approved President Donald Trump’s “big, beautiful” tax and spending bill. It includes more than $1 trillion in cuts to Medicaid, the joint state-federal health insurance program for poor families and individuals, to help pay for tax cuts that mostly benefit the rich. The legislation would cause 11.8 million more Americans to become uninsured by 2034, according to the Congressional Budget Office.
The bill includes new work rules for Medicaid recipients and would require them to verify their eligibility more frequently. It also would limit a financing strategy that states have used to boost Medicaid payments to hospitals.
Republicans say enrollees are taking advantage of the Medicaid program and getting benefits when they shouldn’t be. They say the program costs too much and states are not paying their fair share.
The Delta region, which includes communities in both Louisiana and Mississippi, would suffer under such large cuts. But in Louisiana — where almost half of the state depended on Medicaid in 2023, the Louisiana Department of Health reported — the cuts could be ruinous. Louisiana could lose up to $35 billion in federal Medicaid support over the next decade, according to KFF, a health policy research group. Mississippi, which never expanded Medicaid, could still lose up to $5 billion.
Residents are watching with apprehension, fear and, sometimes, anger, wondering how Congress could be so blind to how much they are struggling.
“If they take that away from us and everyone that really needs it, that’s going to be bad,” said Sherila Ervin, who lives 20 minutes up the road from Lake Providence in Oak Grove and has Medicaid coverage.
Medicaid work requirements and other health care provisions in the bill ignore the reality of living in poorer rural communities, where people struggle to find the jobs, transportation and internet access required to meet the rules, according to interviews with people and providers in the Delta region.
Even though Louisiana and Mississippi have taken very different approaches to Medicaid — one expanded eligibility under the 2010 Affordable Care Act and the other didn’t — both rely heavily on the program to sustain access to medical care for all their residents.
On a hot summer day in June, Ervin walks into the bare-bones 99-cent store in downtown Lake Providence. As she looks over some clothing, she says she’s heard about the potential Medicaid cuts. But she hadn’t heard about the work requirements, and is shocked they’re even on the table.
“I don’t like that. I don’t think they should put a stipulation on that,” Ervin says, exasperated that she would have to report her work hours. It’s hard enough as it is, she says, to thrive in this community.
READ MORE: In the Deep South, health care fights echo civil rights battles
Ervin, 58, has been working at Oak Grove High School in the cafeteria, serving hot plates to children for two decades. She says it’s one of the good, steady jobs available in this area, but her income is only around $1,500 per month.
Ervin’s job offers health benefits, but she can’t afford the premiums on her salary. She relies on Medicaid for care, including medications for her high blood pressure.
In East Carroll Parish, around 46.5% of people live below the poverty level, meaning the area is overwhelmingly poor, at over four times the national poverty rate, with a median income of $28,321. For Black households, the figure is a mere $16,690.
Expansion was a lifeline for people such as Ervin. Louisiana offers Medicaid to people who earn below 138% of the federal poverty line — currently about $22,000 a year for an individual.
“Sometimes you can work, but then when you work, you still can’t pay to get help,” Ervin said.
It’s a similar economic situation an hour away across the river. Poverty is about three times the national rate in Washington County, Mississippi, where residents in the city of Greenville lament the consequences of not being able to avoid destructive medical debt, which can keep them stuck in a cycle of gig work and of living paycheck to paycheck.
Greenville, the county seat, is among the fastest-shrinking cities in the U.S. It’s still one of the larger rural cities in Mississippi, with coffee shops, restaurants, hotels, a regional hospital and several big-box stores. But the downtown has just a few small businesses and a bank, and residents say jobs are hard to find.
Greenville resident April McNair, 45, remembers giving birth 17 years ago, long before Mississippi extended postpartum Medicaid to a full year. She had Medicaid coverage during pregnancy, but was kicked off shortly after giving birth, despite having post-delivery complications.
The result was a trip to the emergency room and a $2,500 bill she couldn’t cover. Right after giving birth, McNair looked for work. She said potential employers often told her that she was overqualified because she had a master’s degree.
“I had to kind of figure out how to make my ends meet,” McNair said. “I ended up with a significant bill, all because I did not have Medicaid.”
McNair feels like Mississippi leaders are making a mistake by continuing to reject full Medicaid expansion.
“That’s a selfish move. To me, they’re selfish,” McNair said, adding that now she’s worried for neighbors in Louisiana who may lose the lifeline she wishes she had.
“God forbid, hypothetically speaking, what if one of them meets their demise because of this bill that [Congress] passed?”
Hard to thrive
Mississippi experienced its first taste of equalized access to medicine in the late 1960s.
Delta Health Center, the first federally funded health center in the nation, opened during the peak of the Civil Rights Movement in the all-Black town of Mound Bayou, about an hour north of Greenville. The center vowed to care for anyone regardless of race or ability to pay in a region plagued with poverty, poor health and discrimination — and continues to do so to this day.
It was a significant opportunity for generations of African Americans who had gone without health care, in a place where people had no access to clean drinking water, running sewage systems or even food, said Robin Boyles, chief program planning and development officer at Delta Health Center.
But it wasn’t easy for the clinic to mobilize support, even though it was clearly needed. Before its opening, it faced pushback from politicians and even doctors. In a 1966 clipping from a local newspaper, the white-owned Bolivar Commercial, the editorial board railed against the new clinic, saying it would “lead further to socialized medicine.”
The situation is certainly better in Mississippi and Louisiana than it was in the 1960s, but critics say the Medicaid cuts could reverse hard-fought progress.
People who live in the Delta are fiercely proud of their communities, but conditions there make it hard to thrive.
Black residents, who are the overwhelming majority, have had a particularly hard time. After the Civil War, many were relegated to sharecropping of cotton and corn for subsistence. Meanwhile, an elite white class of plantation owners and investors amassed enormous amounts of wealth.
A 2001 report from the U.S. Commission on Civil Rights described the area as one with “limited economic resources; inadequate employment opportunities; insufficient decent, affordable housing; and poor quality public schools.”
“We have a lot of patients that are one health issue away from either being out of a job or being bankrupt because of a trip to the emergency room,” said Dr. Brent Smith, a physician at a primary care clinic at Delta Health System in Greenville.
Even some of the most vulnerable people, such as new moms in Mississippi, still struggle to get basic care, in part because the state has left billions of dollars in federal funding for Medicaid expansion on the table, said Dr. Lakeisha Richardson, an OB-GYN at Delta Health System.
“There are a lot of maternal [care] deserts in Mississippi where women have to travel 60 miles or more just to get prenatal care and just to get to the closest hospital for delivery,” Richardson said. “And I don’t see that getting any better in Mississippi and in rural areas.”
Richardson says nearly all her patients are working moms, many of whom would really benefit from having Medicaid expansion.
“America doesn’t realize that there are people out here struggling for no reason of their own,” she said.
That’s why Medicaid expansion in Louisiana in 2016, much like the community health center movement in Mississippi, was a bright spot in the rural South, said Smith.
“Louisiana expanded Medicaid, a surprising move in the South to see any state expand,” Smith said. “They saw it for what it was, which was a very real opportunity to assist this specific group of patients.”
In Mississippi, 20 rural hospitals are at immediate risk of closure, according to a recent report, more than double the number at risk in Louisiana. In many cases, Medicaid is the largest and most reliable payer for rural hospitals. While Louisiana’s overall uninsured rate plummeted to 8.3% by 2023, in Mississippi it was 10.5%.
“Unlike a lot of our Southern peers, we have not had the same level of closures of facilities,” said Courtney Foster, senior policy adviser for Medicaid, with the nonprofit Invest in Louisiana.
“Medicaid was like a real lifeline for people in transition. Oftentimes it was people who had lost their jobs and were just looking to get back on their feet.”
Now, the new work and reporting requirements could put that progress at risk.
In East Carroll Parish, finding a job — let alone a good-paying one with health benefits — is difficult, says Rosie Brown, executive director at the East Carroll Community Action Agency, a nonprofit that helps low-income people with their rent and utility bills. Many of the jobs available in town pay minimum wage, just $7.25 an hour.
Brown loves living in Lake Providence; this is where her family is. She doesn’t want to move but wishes the government would invest more in her community — not take away benefits that help people who are hanging on by a thread.
“We have one bank. We have one supermarket,” she said. “Transportation isn’t easy either.”
Local infrastructure is so limited, she’s even heard of some people charging residents $20 for a ride to Walmart. Some people have to hitch a ride an hour away to go to work, she said.
“There’s nowhere to go,” Brown said.
Dominique Jones works at the local library, where she helps roughly 75 to 85 people per month apply for programs such as Medicaid and food assistance. Many of the residents she helps don’t have access to the internet or even a computer, a real barrier for people who’d be required to report their working hours to state Medicaid officials.
“This town right here is made up of a lot of old people that need Medicaid and Medicare. And without it, they wouldn’t have any kind of health care at all,” Mayor Amacker said.
Even a job in local government in Lake Providence doesn’t offer affordable health insurance.
Nevada Qualls, 25, sits across from Amacker’s office. She earns just $12 an hour as a cashier at city hall. The low pay means she qualifies for Medicaid expansion coverage, which is good because she can’t afford the premiums for private insurance.
“I feel like there should be a higher threshold for people that can get Medicaid, because they’re still struggling,” she said.
At the 99-cent store, school district worker Ervin wonders whether state and federal leaders understand what it’s like to live in her community, urging them to visit and see for themselves.
“They want to do stuff for the rich people that’s already rich,” she said. “What are they doing? It’s almost like there’s no common sense with them.”
‘The tremble factors’
While leaders in the U.S. Senate were working into the night this past weekend debating Trump’s tax and spending bill, Greenville resident Jennifer Morris was praying for the pain to stay away.
Morris, 44, has hemicrania continua, a headache disorder that causes constant pain on one side of her head. There’s no underlying trigger and no cure. Her doctors help her keep the pain to a minimum with regular treatments that include dozens of injections into her head.
“It doesn’t take the pain away,” she said during a late-night gathering in Greenville’s Greater Mount Olivet Missionary Baptist Church in June. “It does reduce the pain so that I’m able to function. But it’s rough.”
Morris is worried about the looming Medicaid cuts. She qualifies for Mississippi Medicaid because her condition counts as a disability, and she depends on the coverage to afford her medications.
Morris’ Medicaid may be safer than that of her Delta neighbors in Lake Providence, as some of the most dramatic Medicaid changes being considered — such as work requirements — target Medicaid expansion states only.
But Mississippi could be hurt by a provision in the Senate bill that would target a strategy states have used to boost the Medicaid dollars they get from the federal government.
Mississippi could see a major hit to its Medicaid funds, which “would be a tremendous decrease in revenue for the state,” harming “services and access to care,” says Mitchell Adcock, executive director at the Center for Mississippi Health Policy.
“It would be just the opposite of expansion. It would be a contraction for the Medicaid program in the state,” he said.
Leonard Favorite, a pastor who was attending the same event at Mount Olivet Church, as Morris, says he grew up on a plantation in Louisiana and worked his way out of poverty by joining the Air Force. This type of journey is hard, he said, when you’re already starting from so far behind. He thinks the “big, beautiful bill” will create more roadblocks for poor people.
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“You have people who are already living below the poverty line and they will certainly be submerged into poverty at unspeakable levels,” said Favorite, 70.“ That seems to be the trend of this administration from the point of view of looking from the outside.
“Poor people are beginning to feel the tremble factors of an administration that caters toward the rich.”
National researchers estimate that up to 132,000 Louisianans who gained health insurance under expansion could lose it under work rules.
But national reports that rely on census data likely underestimate the potential Medicaid losses. For example, while 2023 census data show 47% of East Carroll Parish was on Medicaid, state health data reviewed by Stateline and Public Health Watch suggests the number is more like 64%. Similarly statewide, census data showed about a third of Louisianans were on Medicaid. State data shows that percentage is closer to 46.5%.
Experts such as Joan Alker at the Georgetown Center for Children and Families say the undercounts nationally are a well-known issue among researchers, but it’s difficult to correct because the quality of state reporting can be so uneven.
State Medicaid funding is also at risk. For years, both Mississippi and Louisiana have relied on revenue generated through a financing tool — known as a provider tax — to draw down more federal dollars and boost Medicaid reimbursements to providers. But congressional Republicans hope to limit states’ ability to collect those taxes.
Depending on how Congress restricts provider taxes, Mississippi could lose hundreds of millions in federal Medicaid funding, crucial in a state with such a high uninsured rate, said Richard Roberson, president and CEO of the Mississippi Hospital Association.
“It’s unavoidable that when you’re taking that much money out of the system, that there’s not going to be some repercussions felt even in non-Medicaid expansion states like Mississippi,” Roberson said.
Last week, the Louisiana Hospital Association signed a statement calling the package of Medicaid cuts before Congress “historic in their devastation.”
From her small, sunny office in East Carroll Parish, nurse Jennifer Newton can’t understand the attacks on Medicaid.
Newton, who grew up one parish over in West Carroll, is executive director of the Family Medical Clinic, a community health center in Lake Providence and one of the few health providers in town. She says 50% of the clinic’s patients have Medicaid insurance.
Newton has worked in health care in the area for decades and watched as Medicaid expansion made it possible for more patients to access and afford health care they desperately needed, including preventive services. “It’s absolutely helped,” she said. “Absolutely.”
In 2015, the year before Louisiana expanded Medicaid, the uninsured rate among working-age adults in East Carroll Parish was nearly 35%. By 2021, that number was 12.7%.
“Why are we going back?” Newton asked. “We’ve made so much progress.”
Republican supporters of work requirements, including Louisiana representative and U.S. House Speaker Mike Johnson, argue they will encourage people to find jobs and ensure Medicaid goes to people who need it most. But according to KFF, a majority of Louisiana adults with Medicaid — 69% — already work.
Brian Blase, president of the Paragon Health Institute, a conservative policy group that is working with Republicans to formulate Medicaid cuts, is not concerned about eligible people losing coverage, as has happened under previous work requirement efforts. He says the bill has built in exceptions for certain people and requirements “can be met by not just work,” so “concerns seem pretty overstated.”
Medicaid recipients also can meet the requirement by volunteering or attending school for 80 hours per month.
“It’s hard for me to understand that there are areas in the country where there’s not jobs. There’s always work to be done,” Blase told Stateline. Blase said he believes Medicaid is “the government conditioning welfare for able-bodied working-age adults.”
But advocates and experts predict East Carroll, where internet access is notoriously bad, would experience results similar to when Arkansas instituted Medicaid work requirements in 2018: People disenrolled because of lack of awareness and confusion over the policy, as well as paperwork errors — not because they weren’t working enough.
“Unless the beneficiary can navigate that red tape, they’re going to lose coverage and become uninsured,” said Benjamin Sommers, a health economist at Harvard T.H. Chan School of Public Health.
Data shows Arkansas’ experiment did not increase employment, Sommers said, and instead led to more people reporting medical debt and delaying care because of cost.
‘Take a step back’
People in the Delta — where the legacy of government neglect and discrimination are all around — want politicians to visit their towns and see the barriers people face trying to improve their lives and stay healthy.
“People spent their lives uninsured,” said Amy Hale, a nurse practitioner at East Carroll Medical clinic. “Medicaid expansion allowed them to get in here and be treated.”
Lake Providence residents are scared they may find themselves in a similar situation as McNair and other people across the river in Greenville: working, uninsured, and too poor to access health care.
Recent estimates show up to 317,000 Louisianans could lose Medicaid health insurance under Trump’s tax bill. Nearly 33,000 in Mississippi.
“People are actually trying,” McNair said. “I really wish [lawmakers] would look at it from a different lens. What if it was their kid? Or they didn’t have the salaries they have now and your baby is ill. … Like really take a step back and think about what it is that you’re doing.”
This story is part of “Uninsured in America,” a project led by Public Health Watch that focuses on life in America’s health coverage gap and the 10 states that haven’t expanded Medicaid under the Affordable Care Act.
Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org. Public Health Watch reporter Kim Krisberg can be reached at kkrisberg@publichealthwatch.org.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The post Medicaid cuts could be devastating for the Delta and the rest of rural America 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: Center-Left
The article presents a clear perspective sympathetic to low-income and rural communities affected by Medicaid cuts. It highlights the hardships faced by residents in Louisiana’s and Mississippi’s Delta regions, emphasizing poverty, limited job opportunities, and the critical role Medicaid plays in health access. While it reports Republicans’ arguments for work requirements and cost control, the language and framing focus more on the negative consequences of cuts and the struggles of vulnerable populations. This tone and focus suggest a center-left bias, favoring expanded social safety nets and critical of policies perceived to harm the poor.
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