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Legislative committee releases report on UMMC’s LGBTQ+ clinic

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A legislative committee on Friday released a report about an LGBTQ+ clinic at the University of Mississippi Medical Center that came under fire last year after lawmakers were angered to learn it had provided gender-affirming care to trans youth.

UMMC leadership ultimately decided the “Trustworthy, Evidence-based, Affirming, Multidisciplinary,” or TEAM, clinic should stop seeing trans kids last fall even though gender-affirming care for minors was legal at the time, according to emails obtained by .

It wasn't until earlier this year that lawmakers passed House Bill 1125, which banned the provision of gender-affirming care to trans minors in Mississippi. 

READ MORE: ‘Facing political pressure, UMMC cut care to trans kids before the Legislature banned doing so, emails show'

The purpose of Friday's brief published by the Joint Committee on Performance Evaluation and Expenditure , or PEER, was to provide lawmakers with an overview of — and the sources of funding for — gender-affirming care at the TEAM clinic. The report also provides a summary of HB 1125.

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It asks basic questions like “why did UMMC open the TEAM clinic,” “how does the TEAM clinic operate” and “what services are provided by the TEAM clinic?”

The answers paint a picture of a shoestring clinic without its own dedicated physical that operated on private funds and was staffed by the goodwill of 18 employees who had other primary responsibilities at UMMC. The TEAM clinic, founded in 2015, sought to provide a slate of health services in an inclusive environment for LGBTQ+ Mississippians. That included primary care and more specialized services like mental and gender-affirming care. 

Despite conservative lawmakers and blogs claiming that state funding was paying “for mutilation of children,” the TEAM Clinic mainly ran on patient revenue and grant funding from three sources: The Women's Foundation of Mississippi, the LGBTQ Fund of Mississippi and the Manning Family Fund. 

The TEAM clinic did not provide surgery to under the age of 18. For adults, surgical referrals to UMMC's Plastic Surgery Department were provided.

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Most of the patient revenue that supported the clinic over a roughly three-year period beginning in fiscal year 2020 came from Blue Cross Blue Shield of Mississippi ($55,051) and other commercial insurances. The Mississippi Division of Medicaid paid out $24,122 in claims, according to the report, about 17% of the amount billed by UMMC for services at the TEAM clinic.

A very small portion of state funding — an estimated $1,215 in fiscal year 2022 — paid for the few hours that providers spent at the TEAM clinic on the first Friday of every month.

The miniscule amount of state funding is similar to what PEER discovered when it also sent inquiries to Mississippi Medicaid to determine how much the agency paid out in claims associated with gender identity disorder or gender dysphoria.

All told, it took approximately $25,000 a year to support the clinic's operations, the PEER found.

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The clinic saw less than 300 patients in the same three-year period, an estimate that might be “overinflated” due to the way UMMC maintained confidentiality in its patient count, the report found.

Just 221 people in that same period sought “gender transition services” at the TEAM Clinic, which the report appears to have counted as services ranging from “behavioral health” to prescriptions like puberty blockers and hormone therapy.

Over the three-year period, PEER estimated that just 53 patients under the age of 18 received gender transition services.

But the report says that “in FY 2024, the number of minors served in the Clinic should be zero.”

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That number is due to HB 1125 but also to UMMC's decision, made many months before the bill passed, to stop providing gender-affirming care like hormone therapy and puberty blockers to trans youth at the TEAM clinic. The PEER committee's report may have been a factor in that decision.

The first inkling UMMC received of lawmakers' interest in the clinic came on Aug. 31 when UMMC Vice Chancellor and Dean of the School of Medicine Dr. LouAnn Woodward was sent via hand mail a letter from the committee that was then forwarded to the TEAM clinic.

PEER's letter requested “certain information regarding services provided by and payments provided to UMMC regarding gender transition services,” how many services were provided to youth and adults and what amount had been subsidized by taxpayers or billed to Mississippi Medicaid.

Lawmakers had asked about the clinic in the past, but this time, PEER's letter was followed by what Kristy Simms, UMMC's point person with elected at the state and federal level, described as “dozens of inquiries,” according to emails obtained by Mississippi Today.

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After Simms talked with lawmakers, emails show she proposed UMMC consider shutting down the clinic. She characterized her conversations with lawmakers, including Sam Mims, the chair of the House Public Health and Human Services Committee, as “hostile and slightly threatening.”

“It's looking more and more like we have two options,” she wrote on Sept. 12. “Pause or shutter some/all of the work of the Center or be told to do so by the in January.”

Staring in early October, the TEAM clinic began implementing leadership's decision to stop providing gender-affirming care to trans kids, a move that impacted services across the hospital — and left parents and patients scrambling.

“Because it was such a welcoming environment, I couldn't believe that they had just dropped patients like that,” Raymond Walker, a trans teenager who had sought care at the clinic, told Mississippi Today in April. “I was just completely blindsided.”

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The emails also show UMMC leadership pondering if they should begin “dismantling” the TEAM in response to lawmakers' inquiries. 

The PEER report ends with a recommendation for a way UMMC could do that.

“UMMC could consider integrating services provided by the TEAM Clinic back into UMMC's regular care setting, similar to the way it did with services provided to minors, and offer optional LGBTQ training courses to all staff and students,” the report says.

Now , HB 1125 provides that any Mississippian, including doctors, can be held civilly liable for “conduct” that aids and abets the provision of gender-affirming care for trans youth, but advocates and attorneys have noted it's unclear what that looks like.

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UMMC has yet to answer that, but PEER notes the hospital's attorneys are working to understand if its providers “will be to refer patients to providers outside of the state, or if that would be considered aiding or abetting as provided in the law.”

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

Mississippi Today

Legislation to strip key power of PERS Board passes both chambers

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mississippitoday.org – Bobby Harrison – 2024-04-27 15:39:23

Legislation that strips significant power from the board that governs the 's public employee pension program has passed both chambers of the .

Under the legislation set to go to Gov. Tate Reeves during the final days of the 2024 , the Public Employees Retirement System Board would no longer have the authority to increase the contribution rate levied on governments (both on the state and local level) to help pay for the massive retirement system.

The legislation, which passed both chambers in recent days, was a reaction to the by the board to increase by 5% over a three-year period the amount local governments contribute to each employee's paycheck for their retirement. Under the PERS Board plan, the employer contribution rate would have been increased to 22.4% over three years, starting with a 2% increase on July 1.

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The board said the increase was needed to ensure the long-term financial stability of the system that pays retirement benefits for most public employees on the state and local levels, staff of local school districts and universities and community colleges.

City and county officials in particular argued that the 5% increase would force them to cut government services and lay off employees.

Under the bill passed by the Legislature there still would be a 2.5% increase over five years — a .5% increase in the employer contribution rate each year for five years.

In addition, legislative said they plan to put another $100 million or more in state tax dollars into the retirement system in the coming days during the appropriations .

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Under current , the PERS Board can act unilaterally to increase the amount of money governmental entities must contribute to the system. But under the new bill that passed both chambers, the board can only make a recommendation to the Legislature on increasing the employer contribution rate.

The PERS Board also would be required to include an analysis by its actuary and independent actuaries on the reason the increase was needed and the impact the increase would have on governmental entities.

In the 52-member Senate, 14 Democrats voted against the bill. Only one House member voted against the proposal.

Sen. David Blount, D-, said the bill failed to address the financial issues facing the system. He said a permanent funding stream is needed.

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Blount said, “You are moving in the wrong direction and weakening the system” with the bill the Legislature approved. “Is it painful? Is it going to cost more money? Yes, but we need to do it” to fix the system.

The system has assets of about $32 billion, but debt of about $25 billion. But Sen. Daniel Sparks, R-Belmont, and others argued that the debt was “a snapshot” that could be reduced by strong performance from the stock market. The system depends on its investments and contributions from employers and employees as sources of revenue.

The system has about 360,000 members including current public employees and former employees and retirees.

The legislation states that no changes would be made for current members of the system. The legislation does reference looking at possibly changing the system for new employees. But that would be debated in future legislative sessions.

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The bill does not include an earlier House proposal to dissolve the PERS Board, which consists primarily of people elected by the members of the system, and replace them with political appointees.

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

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Mississippi Today

A solution to the Republican impasse on Medicaid expansion

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mississippitoday.org – Adam Ganucheau – 2024-04-27 15:21:27

Kathleen O'Beirne knocked loudly on Sen. Kevin Blackwell's office door in the basement of the Mississippi Capitol on Saturday morning.

O'Beirne, a Ridgeland resident and mother of two boys, has been closely tracking the back-and-forth debate on Medicaid expansion, which Blackwell, as chairman of the Senate Medicaid Committee, is leading for the Senate. She and a group of other concerned citizens simply wanted a word with the Republican leader.

But there was no answer at the door, and there would be no conversation. So O'Beirne and the others took blank sheets of copy paper and began writing letters. When they finished writing, they taped the letters to Blackwell's door.

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“I'm here because of the human cost of not expanding coverage to poor ,” O'Beirne said outside Blackwell's office. “But I'm also here because I'm a taxpayer. And I see that our senators are about to pass up literally billions in federal tax dollars that you and I and most other Mississippians already pay. We have the chance to bring all of that money back to the state of Mississippi, but we're about to walk away from it for no good reason.”

Kathy Knight, left, of Madison, and Kathleen O'Beirne of Ridgeland, hold a sign urging lawmakers to fully fund a Mississippi Medicaid expansion plan, while Jack Reed Jr., a former Tupelo mayor and a long time northeast Mississippi businessman, right, joins a group of small business owners who urged the same during a Tuesday, April 23, 2024, conference at the state Capitol in , Miss. (AP Photo/Rogelio V. Solis)

As O'Beirne and other Mississippians have closely followed, Blackwell has been as dug-in as any lawmaker during the Medicaid expansion fight. This , after agreeing to hold public conference committee meetings to debate Medicaid expansion, he refused to meet a second time with his House counterparts. He has seldom engaged with House Republican leaders in private, either.

He did, however, choose to speak to a gaggle of reporters on Friday after the Senate sent a compromise plan to the House for consideration. In the interview, he drew hard lines against any additional compromise with the House, specifically around a work requirement, and even doubted whether his own plan had the necessary support from his Republican Senate colleagues.

READ MORE: Blackwell says Senate won't budge on Medicaid work requirement

Blackwell and some Republican senators have long maintained that any expansion deal must include a requirement that Medicaid recipients work, which is a conservative policy desire that the federal has struck down in 13 previous expansion states. a stringent work requirement, health care advocates and legal scholars believe, would effectively kill any expansion plan.

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But in the plan the Senate put forward on Friday, they would still mandate the requirement. It would also force the state's attorney general to sue the feds over any rejection and hope that a conservative 5th Circuit Court of Appeals allows the work requirement to go into effect. Unless a work requirement was granted by either the federal Medicaid agency or the federal courts, expansion could not go into effect under the Senate plan.

READ MORE: The unlikely Mississippi politician who could tank Medicaid expansion

However, an earlier House proposal also included a work requirement but would allow expansion to go into effect if the state could not convince the federal government to allow it. House leaders have not yet publicly responded to the Senate plan they received on Friday, but the work requirement piece has been the main topic of deliberations on that side of the building. 

The House and Senate Republican remained at an apparent impasse as of midday Saturday and adjourned for the day without giving any public updates on expansion negotiations. Both chambers were working into the evening Saturday and will work again Sunday to hammer out final agreements on a $7 billion state budget.

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None of that sat right with O'Beirne, inspiring her to come back to the Capitol on Saturday and make the unannounced visit to Blackwell's office. When asked what message she was trying to deliver to Blackwell, she said: “Well, a compromise.”

O'Beirne then summed up what she wrote in her note to Blackwell:

“I'm a recovering lawyer, so I'm used to resolving litigation. I think there's a very obvious compromise that the Senate and the House could come to if they were willing to do the work. 

My suggestion is to keep the Senate's work requirement. Keep the provision that says if CMS kicks back the work requirement, then the AG has to sue the feds. But also, keep the House provision that will allow Medicaid expansion to go into full effect, even if CMS kicks back the work requirement.

So you go on and you start pulling down those billions of federal dollars that help the state and people get health care coverage. Then in the meantime, let the lawyers and government sort out the work requirement business. To me, that's a win-win-win. 

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Now, I'm sure Lt. Gov. Hosemann, Sen. Blackwell and other leaders are mulling that over. Maybe they've already had that thought. To me, it's such an obvious compromise that takes full advantage of our tax dollars. It's not wasting our tax dollars. It's helping communities. It's helping hospitals. It's helping doctors. It's helping needy . It is just an all around win that I sure hope they can get to.”

Kathleen O'Beirne

Such a compromise would require some careful drafting of the legislation, experts say, and whether it checks enough boxes for Blackwell and the hard-line senators is anyone's guess. But O'Beirne, a self-described “pragmatist,” felt led to share it with Blackwell on Saturday.

“I really do think there's a path here,” O'Beirne said. “It seems like a very simple solution right under our noses that Senate leaders are about to pass up. How frustrating would it be to come all this way to get nothing?”

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READ MORE: These Republicans wanted a Medicaid work requirement but couldn't get approval. So they got creative.

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

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Mississippi Today

Lawmakers send MAEP education funding formula rewrite to governor

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mississippitoday.org – Bobby Harrison – 2024-04-27 13:25:23

A new school funding formula has been approved by the that, like the long-standing Mississippi Adequate Education Program, will rely on an objective mechanism to determine how much state funding is needed to operate schools.

The push to replace MAEP has been one of most contentious issues facing legislators in the final days of the 2024 . There have been efforts for years to replace the formula by those who say the state could not afford it.

On Saturday the 52-member Senate with three dissenting votes passed on to the governor a compromise proposal to replace MAEP. The House had unanimously passed it late Friday.

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“The whole point of us doing this is to make certain our school districts are treated as fairly and as best we could,” said House Education Chair Rob Roberson, R-Starkville. He said the new formula will additional money for poor districts and for low-income and special-needs .

Roberson's original bill did not include an objective funding formula, which had been the hallmark of MAEP. Senate Education Chairman Dennis DeBar, R-Leakesville, who was reluctant to rewrite MAEP, finally acquiesced, but was insistent that any rewrite include an objective formula that took out of the hands of politicians – namely legislators – the amount of money needed for the operation of local school districts.

On Saturday, DeBar told senators that if the Senate had not insisted on an objective funding formula, the Legislature could have “willy nilly” decided the level of education funding.

“This formula will allow for predictability over time. Whereas the House bill did not,” DeBar said. “It (the House plan) was a one-year thing where the Legislature could come in and decide to increase or decrease funding for education. This will hold our feet to the fire in the Legislature and ensure our schools are funded.”

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House Education Vice Chairman Kent McCarty, R-Hattiesburg, told House members that the objective funding formula made the original House proposal stronger.

“I think this is a good addition to the bill,” he said. Like MAEP, the formula will be recalculated every four years and in the intervening years there will be an factor added to the funding.

Under the new formula, schools will per student the average teacher salary divided by 14, which represents the average student-teacher statewide ratio. In addition schools will get another 20% of that amount for administrative costs, 30% for ancillary costs and money for operations and maintenance based on the three-year, per-square- average of the school district's operations and maintenance costs.

On top of that, the school districts will receive additional funds for students in certain categories, such as for special-education students, those living in poverty, or living in of high poverty and for students who do not speak English as their primary language. The additional money provided to categories of students was a key component of the original House bill.

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Like MAEP, local school districts will be required to pay a portion of the cost. But wealthier districts will be required to pay more than districts with a smaller local property tax base. No district will be mandated to pay more than 27% of the cost.

Sen. Hob , D-Amory, one of the architects of MAEP in 1997, was one of the three no votes.

While Bryan said there appeared to be good features to the new funding plan, more time was needed to study it.

“It is simply not possible to enact a funding formula for public education in this legislative session where we know what we are doing,” he said. “We don't have enough time for people to look at the new proposal, consider alternatives.”

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Bryan pointed out that if MAEP was unpredictable for school districts it was because of the Legislature's refusal to fully fund it. He said it is possible – even likely – that the same will occur with the new formula.

MAEP had language saying the formula “shall” be fully funded, But the full funding mandate was ignored every year since the program was fully enacted in 2003 except for twice.

Under the first year of the new formula, which goes into effect with the beginning of the new fiscal year on July 1, K-12 education is supposed to receive an additional $230 million.

The additional funding will bring the education budget to $2.94 – about $50 million less than MAEP would have provided if fully funded.

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DeBar said that based on inflation it will take about $50 million more in funds to fully fund the new formula next year.

The new formula will be called simply the Mississippi Student Funding Formula.

Sen. Angela Hill, R-Picayune, voted against the proposal because she feared that like MAEP the new formula would make a commitment over time the state could not afford. Plus, she said she was concerned about the money going to educate students who spoke English as a second language. Hill said she wanted more details on that feature of the bill.

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

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