fbpx
Connect with us

Mississippi Today

Experts analyze House, Senate Medicaid expansion proposals, offer compromise plan

Published

on

mississippitoday.org – Geoff Pender – 2024-04-16 09:57:55

As Mississippi lawmakers look for compromise between widely differing House and Senate Mississippi Medicaid expansion plans, experts with a research group have projected the costs, savings and efficacy of the plans and offered a third, potential compromise plan.

The analysis shows that under each plan, the state would see net annual savings – ranging from tens of millions to hundreds of millions of dollars – by expanding the state-federal Medicaid program to working, poor and uninsured . The plans, the study says, also vary widely in how many Mississippians would be covered – from around 50,000 to nearly 200,000.

The study was commissioned by the Center for Mississippi Health Policy and conducted by the Hilltop Institute at the University of Maryland, Baltimore County. Hilltop has studied Medicaid expansion nationwide and recently testified before the Mississippi House Medicaid Committee.

Advertisement

“We wanted to get some updated numbers based on publicly available data,” said Morgan Henderson, director of analytics and research for Hilltop. “We really want to make sure folks these discussions have data points they need.”

The study takes the House and Senate plans at face value, even though both contain elements not likely to be approved by the federal Centers for Medicare and Medicaid Services. The Senate plan, for instance, includes a stringent work requirement for coverage that, besides potentially costing millions in administrative fees, isn't likely to be approved by CMS.

Both the House and Senate plans contain another potential poison pill that could prevent expansion from being implemented. They have 12-month moratoriums on people who qualify for the expanded Medicaid coverage from dropping private coverage and applying for Medicaid. CMS is highly unlikely to approve this, and such moratoriums would probably not meet constitutional muster in a court.

The options

Mississippi Senate plan

One striking difference between the Senate plan and the House and compromise plans is the Senate one would turn down about $1 billion a year in federal money to cover more expansion costs. It also would forego nearly $700 million over the first two years in enhanced federal funding that some refer to as a “signing bonus” for states that fully expand Medicaid per the federal Affordable Care Act.

Advertisement

The Senate plan would coverage to people making up to 100% of the federal poverty level – about $15,000 a year for an individual. Hilltop estimates this plan would cover about 54,000 people, although Senate leaders said they estimate about 40,000 people would sign up.

The Senate plan would require participants to work 120 hours a month or be enrolled as a full-time student or in a workforce training program. It would exempt some from this requirement, including of under 6, people mentally or physically unable to work or those who are caregivers to disabled family members.

Cost

The state's upfront cost of the Senate plan would be paid by a 3% tax on Medicaid managed care providers.

Advertisement

Hilltop estimates the Senate plan would cost the state a little over $114 million per year, including $15 million in administrative costs. But when these costs are offset by the tax on providers, the economic stimulus of expansion and other offsets or revenue, Hilltop estimates a net savings to the state of $43.4 million a year.

Mississippi House plan

The House plan would provide Medicaid coverage for people making up to 138% of federal poverty level, a little more than $20,00 a year for an individual. Hilltop estimates this would cover about 134,000 Mississippians (again, factoring in the “moratorium” on leaving private coverage).

The House plan calls for work requirements – 20 hours a or enrollment as a student or in workforce development – but would still go into effect without the requirements if CMS fails to approve them.

Under this plan, Mississippi would draw down about $1 billion a year in increased federal Medicaid payments, and over the first two years, another nearly $700 million in enhanced federal payments.

Advertisement

Cost

The state share of upfront costs for the House plan would be covered by a 4% tax on Medicaid managed care providers.

Hilltop estimates the House plan, with no work requirement approved, would cost a little over $115 million, including $8 million in administrative costs. But when these are offset by the tax on providers, economic stimulus and other offsets or revenue, Hilltop estimates an annual savings for the state of more than $404 million a year for the first two years, then $79.5 million a year for the third year and beyond.

House Speaker Jason White and others have noted that the enhanced federal payments to the state totaling nearly $700 million over the first two years would cover all state costs for the first four years of the House expansion plan. White also noted that the House plan, even if a work requirement is not approved, would require the managed care organizations to track employment and other data from those covered.

Advertisement

Compromise ‘hybrid plan

Hilltop's “Mississippi MarketPlus Hybrid Plan” would offer expanded Medicaid coverage through the state's managed care program for those making under 100% of the federal poverty level. For those making 100% to 138% (up to $20,000 for an individual) of poverty level, the plan would use federal money to provide assistance for them to buy private insurance plans through Mississippi's marketplace exchange.

Hilltop estimates this plan would provide coverage for 197,000 Mississippians.

The plan would require managed care companies to provide employment support and require mandatory referral to workforce training. It would also require those covered to pay marketplace insurance co-pays, but would not include a work requirement or moratorium on people leaving private insurance.

Like the House plan, this plan is expected to qualify the state for enhanced federal Medicaid payments and the two-year “signing bonus” of nearly $700 million.

Advertisement

Cost

The plan, like the Senate's, includes a 3% tax on Medicaid managed care providers to help cover state costs.

Hilltop estimates the upfront cost to the state for this plan would be a little more than $186 million, including $12 million in administrative costs (including work support). But these would be offset by the tax on providers, economic stimulus from expansion and other offsets or revenue. Hilltop estimates a net savings to the state for this plan of more than $356 million a year for the first two years, then $31.3 million a year in savings for years three and up.

The Hilltop study also noted this plan would allow the state to receive a 90% federal match for services currently funded only with state dollars, including hospital services for people and some behavioral health services.

Advertisement
Credit: Chart courtesy of The Hilltop Institute at the University of Maryland, Baltimore County

Other findings

Hilltop's report says that Medicaid work requirements – when they were previously allowed by the feds – have not shown to increase workforce participation. It said, “Moreover, the Arkansas experience demonstrates that the administrative burden in work status can lead to Medicaid coverage loss for the working poor – thus hurting the exact individuals designed to be covered under work requirements.”

A Georgia program similar to the Mississippi Senate's plan in several regards, has shown that stringent work requirements result in low enrollment and high administrative costs, the Hilltop study notes. As of recently, the Georgia program had enrolled only a few thousand people and over 90% of its costs to-date have been administrative costs and consulting fees. Georgia is still battling the federal government in court over its work requirements.

The Hilltop study found the Senate's plan “contains high budget risk” to the state. Since the plan eschews extra federal funding available for expansion, “if enrollment exceeds estimates, there would be proportionally greater budget overruns in the Senate version than the alternative plans.” It noted that to protect state coffers, language could be inserted to the House or hybrid plan that rescinds the expansion should the enhanced federal match drop.

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

Mississippi Today

On Confederate Memorial Day, an honest annotation of the Mississippi Declaration of Secession

Published

on

mississippitoday.org – Michael Guidry – 2024-04-29 12:23:37

Today, Mississippi officially recognizes Memorial Day as the anchor of Gov. Tate Reeves-proclaimed Confederate Heritage Month.

Mississippi is one of just four states to still officially recognize the holiday, which has been granted under gubernatorial proclamations from the past five governors. Notably, one cannot find Reeves' proclamation on his social accounts; instead, you'd have to venture over to the Facebook page of Confederate States president ' home if you want to read it, as first reported by the Mississippi Free Press.

The actual language of the Confederate Heritage Month proclamation appears benign at first glance. It with a reference to the start of the American Civil War in 1861 and follows with an acknowledgment of Confederate Memorial Day in Mississippi (more on that to ).

Advertisement

But the final paragraph, when examined with a critical eye, offers a reason for pause and concern. It reads:

WHEREAS, as we honor all who lost their lives in this war, it is important for all Americans to reflect upon our nation's past, to gain insight from our mistakes and successes, and to come to a full understanding that the lessons learned yesterday and today will carry us through tomorrow if we carefully and earnestly strive to understand and appreciate our heritage and our opportunities which lie before us.”

Gov. Tate Reeves' 2024 Confederate Heritage Month Proclamation

The “if” in that passage is doing a lot of work. We can only learn from the past IF we embrace “our heritage?” That line then begs the question, “Whose heritage, exactly?”

The answer is obvious and makes an earnest reflection of the sins of the Civil War necessary. Despite the lofty verbiage of “insight” and “lessons”, the proclamation is a prop upon which the “heritage” of the Confederacy is elevated — a heritage defined by the institution of slavery.

Advertisement

This Confederate Memorial Day provides us an to take a deep dive into that heritage by carefully dissecting the document that most clearly outlines and defends it.

LISTEN: A Reading of the Mississippi Declaration of Secession


The Declaration of Secession was the result of a convention of the Mississippi Legislature in January of 1861. The convention adopted a formal Ordinance of Secession written by former Congressman Lucius Quintus Cincinnatus Lamar. While the ordinance served an official purpose, the declaration laid out the grievances Mississippi's ruling class held against the federal under the leadership of President-elect Abraham Lincoln.

Below are a few annotated excerpts from the Mississippi Declaration of Secession.

Advertisement
Declaration of Secession, Part 1

The convention really couldn't be any more straightforward with the title and opening graf of their declaration. There is little to no ambiguity about the intent of this document, which is to say, “we are seceeding and this is why.”

If there is any doubt, simply toss the title into the thesaurus machine and see what you get…

An Assertion of the Direct Causes Which Create and Excuse the Secession of the State of Mississippi from the Federal Union

Don't think there is much mystery there.

And there it is.

Despite the “states' rights” rhetoric of the Lost Cause myth, the convention makes it undoubtedly evident that slavery is the prominent reason for secession (just like they promised to do in the previous passage).

Advertisement

It offers a clear and concise answer to the question, “States' rights to do what?”

Read that passage again in your best Ron Burgundy voice. “It's science.”

But in all seriousness, one can't escape the blinding racism of this passage. Nor should one ignore how damaging the perpetuity of this unscientific, unrealistic understanding of the Black race and the Black body has been in the century-and-a-half since.

These lines are in reference to the federal government's attempts to block the expansion of slavery into new territories as the United States grew. 

The Ordinance of 1787 prohibited slavery in the Northwest Territory. The Missouri Compromise of 1820 prohibited slavery in territories formed from the Louisiana Purchase north of the 36°30′ parallel.

The convention doubles down on the notion that secession is not only needed to preserve the institution of slavery, but quelch any attempts to deny its existence in emerging territories

Advertisement

Throughout much of the convention's list of grievances, the word “it” is used as a place-holder for the “hostility to this institution” that is mentioned in the previous excerpt. Or, to put it another way, “it” is the abolitionist movement.

Again, the racism is unavoidably clear. To the convention, advocacy for social and political equality for Black Americans is akin to promoting insurrection.

What after is a line that probably looks all too familiar to anyone who follows the ebbs and flows of grievance politics. The convention paints the press and schools as enlisted agents against them and their cause – the echoes of which are still heard today in regards to policies directed at systemic racism or the preservation of rights for the LGBTQ+ community. It's not a new addition to the playbook, and politicians who invoke this language are merely channeling their secessionist forefathers.

You have to appreciate the tone deaf irony of this bit. It's not the 435,000-plus enslaved Mississippians who are subject to degradation, but rather the wealthy, white ruling class.

This line also helps dispel the myth of the “compassionate slaveowner,” as it clearly indicates how slave-owning viewed the enslaved — as a calculated asset in their ledgers, as a dollar figure, as potential lost property.

To top it off, the convention elevates its cause — the preservation of slavery — to a higher status than the causes for the American Revolution.

Advertisement

There is one thing the Declaration of Secession makes abundantly clear: slavery — the preservation and expansion of — is the prominent reason Mississippi and 10 other states seceded to form the Confederacy.


Reeves could very easily end the practice of recognizing April as Confederate Heritage Month. It's only made possible through a proclamation of the governor. All he has to do is say “no.” 

But even if Reeves remains stubborn, the legislative branch wields enormous power, too. Mississippi's state holidays are codified, and lawmakers have the power to divorce Mississippi from a century-old practice of honoring Confederates and their cause. They can pass legislation ending Confederate Memorial Day on the last Monday in April. They can sever Robert E. Lee from the annual celebration of Martin Luther King Jr. on the third Monday of January. And they can let Memorial Day exist on its own as a federal holiday without doubly venerating Jefferson Davis on the same day.

For those keeping score, that's three Confederate-themed state holidays in Mississippi.

Advertisement

These holidays are rooted in the Jim Crow era. They stand side-by-side with laws and policies meant to deprive Black Mississippians of their economic and civic vitality. Reeves and lawmakers could choose to start down a path of rectification — remedying some of the ills of policies designed to keep certain Mississippians disenfranchised and destitute.

But for now, the holidays — and the reasons for them — remain. Slavery and the subjugation of Black people is the bedrock of Confederate “heritage.”

The origins of Confederate Memorial Day in Mississippi trace back to 1906, a time of Southern Redemption and the reemergence of the Ku Klux Klan.

Ignorance cannot and should no longer be an excuse — certainly not in 2024.

Advertisement

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

Continue Reading

Mississippi Today

On this day in 1945

Published

on

April 29, 1945

Richard Wright wrote his memoir about growing up in Roxie, Miss., called “Black Boy.” Credit: Wikipedia

The memoir by Richard Wright about his upbringing in Roxie, Mississippi, “Black Boy,” became the top-selling book in the U.S.

Wrighyt described Roxie as “swarming with rats, cats, dogs, fortune tellers, cripples, blind , whores, salesmen, rent collectors, and .”

In his home, he looked to his mother: “My mother's suffering grew into a symbol in my mind, gathering to itself all the poverty, the ignorance, the helplessness; the painful, baffling, hunger-ridden days and hours; the restless moving, the futile seeking, the uncertainty, the fear, the dread; the meaningless pain and the endless suffering. Her set the emotional tone of my life.”

When he was alone, he wrote, “I would hurl words into this darkness and wait for an echo, and if an echo sounded, no matter how faintly, I would send other words to tell, to march, to fight, to create a sense of the hunger for life that gnaws in us all.”

Reading became his refuge.

Advertisement

“Whenever my had failed to or nourish me, I had clutched at books,” he wrote. “Reading was like a drug, a dope. The novels created moods in which I lived for days.”

In the end, he discovered that “if you possess enough courage to speak out what you are, you will find you are not alone.” He was the first Black author to see his work sold through the Book-of-a-Month Club.

Wright's novel, “Native Son,” told the story of Bigger , a 20-year-old Black man whose bleak life him to kill. Through the book, he sought to expose the racism he saw: “I was guided by but one criterion: to tell the truth as I saw it and felt it. I swore to myself that if I ever wrote another book, no one would weep over it; that it would be so hard and deep that they would have to face it without the consolation of tears.”

The novel, which sold more than 250,000 copies in its first three weeks, was turned into a play on Broadway, directed by Orson Welles. He became friends with other writers, Ralph Ellison in Harlem and Jean-Paul Sartre and Albert Camus in Paris. His works played a role in changing white Americans' views on race.

Advertisement

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

Continue Reading

Mississippi Today

Podcast: The contentious final days of the 2024 legislative session

Published

on

's Adam Ganucheau, Bobby Harrison and Geoff Pender break down the final negotiations of the 2024 legislative 's three major issues: expansion, education , and retirement system reform.

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

Did you miss our previous article…
https://www.biloxinewsevents.com/?p=353661

Continue Reading

News from the South

Trending