Mississippi Today
Medicaid expansion: What are its chances in 2025?
Arguably the biggest issue of the 2024 legislative session, Medicaid expansion is likely to come up again next year. But did the historic 2024 session create the momentum needed for it to cross the finish line in 2025, or was it merely a one-off?
The two most influential lawmakers for this issue in the Senate, Lt. Gov. Delbert Hosemann, who oversees the Senate, and Senate Medicaid Chair Kevin Blackwell, both told Mississippi Today they would not consider an expansion plan that didn’t include a work requirement.
Hosemann, who said he was disappointed with the way expansion died last year, confirmed in an emailed statement that he would push for an expansion bill next session as long as it had a work requirement in it. Blackwell declined to comment whether he would push the issue next year.
A work requirement is more likely to be approved by the federal government this year than last, since President-elect Donald Trump will be in office and approved work requirements in his last term.
Still, the Trump administration only ever approved work requirements in states that had expansion – as a means of limiting it – and never in states seeking to expand Medicaid for the first time. That means the Senate is banking on the president making an unprecedented move for Mississippi.
Including a work requirement is a political tactic meant to make expansion more palatable to a Republican majority Legislature led by a governor who has been vehemently opposed to expansion for years, derisively calling it “Obamacare” and “welfare” on social media.
The bureaucracy of requiring monthly or semi-annual proof of employment ends up being another stressor on low-income people already facing a slew of socioeconomic barriers – as well as a stressor on the state Medicaid system, some experts say.
Currently, Georgia is the only expanded state with a work requirement, and it remains in litigation with the federal government over the issue. The plan has only covered 4,300 people – despite lawmakers predicting 345,000 people would be eligible – and cost taxpayers $26 million as of last March. More than 90% of that went toward administrative costs.
“Georgia’s plan has proven to be very profitable for large companies like Deloitte (the primary consultant for Georgia’s project) but has provided health care to almost no one who needs it,” said Joan Alker, Medicaid expert and executive director of Georgetown University’s Center for Children and Families. “It’s been a terrible waste of taxpayer dollars so far.”
Meanwhile, Hosemann and Blackwell’s counterparts in the House chose not to speak to Mississippi Today on the details of the issue ahead of the session, despite being the main drivers of last year’s expansion bill – the first expansion bill authored by Republicans in the history of the Mississippi Legislature, and which garnered more support than any other expansion bill in the last decade.
Speaker of the House Jason White did not respond to Mississippi Today’s questions about his plans for the session.
White told business leaders at the Mississippi Economic Council’s annual Hobnob event that he would make Medicaid expansion a 2025 legislative priority.
“We trust our elected officials and state agencies to use federal dollars responsibly to invest in critical infrastructure, promote education and workforce training and maintain a balanced regulatory framework that all promote economic development,” White said. “Let’s give our hospitals and health care experts the same opportunity, so that hardworking, low-income Mississippians will benefit.”
House Medicaid Chairwoman Missy McGee told Mississippi Today that it will be a priority for the House Medicaid Committee.
The 2024 House expansion bill included a provision that if federal authorities did not approve the waiver necessary to allow a Mississippi work requirement by a certain deadline, Medicaid would still be fully expanded to people up to 138% of the federal poverty level – about $20,000 for an individual or $43,000 for a family of four. Ultimately, the Senate scratched that provision in conference, and also lowered the income threshold to 99% of the federal poverty level – about $15,000 for an individual or $31,000 for a family of four. The Senate’s plan isn’t considered traditional expansion and wouldn’t qualify for the increased federal match that makes expansion a prudent economic policy for states.
Since the Affordable Care Act made it possible in 2014, states have had the option to expand Medicaid to cover the working poor. Mississippi is one of only 10 states not to do so.
Tens of thousands of working Mississippians go without health coverage each year, making too little to afford the high deductibles on the cheapest marketplace insurance plan but too much to qualify for Medicaid under the current stipulations.
Medicaid eligibility varies from state to state, and Mississippi has one of the strictest income requirements in the nation. Childless adults don’t qualify, and parents must make less than 28% of the federal poverty level, a mere $7,000 annually for a family of three, to qualify. More times than not, that means that working a full-time job counts against an individual – despite anti-expansion critics arguing that Medicaid should only apply to those who work.
Expanding Medicaid would cover adults – including those without children – who make up to 138% of the federal poverty level.
But it would also alleviate an enormous burden that Mississippi hospitals currently shoulder: uncompensated care costs.
Without health insurance, many Mississippians are forced to let their health conditions deteriorate. That, in conjunction with the fact that the emergency room is the only place health care providers can’t turn patients away for not having money, means that some Mississippians use the emergency room as their only source of primary care.
The emergency room is also the most expensive place to receive care. When patients can’t pay, hospitals pick up the slack covering their care, and the practice – called uncompensated care – costs hospitals millions.
That’s why Mississippi Hospital Association’s CEO, Richard Roberson, is again asking the Legislature to consider expansion.
“The upside for hospitals could be several hundred million dollars,” he said. “Right now, the hospitals continue to see the patients that don’t have any form of insurance, which is financially harmful for hospitals because they’re having to provide that care for which they’re not being paid. But probably the bigger and most important part of that is you’re having people that are showing up in the hospitals for what really amounts to primary care services – and that’s not what hospitals are for.”
Without expansion, he said, it’s “very possible” more rural hospitals will be forced to shut down in the coming years.
Right now, they’re being kept afloat by enhanced Medicaid payments Gov. Tate Reeves passed in the eleventh-hour of his heated 2023 reelection campaign. But Roberson said there’s no guarantee those payments will continue, which makes it hard for hospitals to plan services and staff.
“We don’t want to rely on a program that’s a one-year program, because that enhanced payment, we’ve got to ask for it every single year,” he said. “And so, as hospitals try to plan for the services they’re going to provide, or as they’re trying to recruit physicians and other staff members, you know you’ve got this for one year … but there are no guarantees.”
Roberson says he’s hopeful going into 2025, given how far expansion got last session.
“I’m more hopeful than I have been, because we now know what a starting place is – for both the Senate and the House. We now know from that conference report what a meeting of the minds was seven months ago. So, that makes me hopeful that whatever concerns still remain, it’s a shorter path to get to those. We’re not starting from scratch.”
But because many Republicans still oppose expansion, any expansion bill in 2025 will likely need the help of the minority party to achieve a veto-proof majority. Last year, Democrats came under fire for blocking a Medicaid expansion compromise in the final days of the session – despite pushing expansion bills for years to no avail – because they felt that the compromise Republican leaders reached wasn’t expansion at all.
Getting both chambers and both parties to agree could prove difficult again this year.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Will new state-appointed Jackson court have city-based jurists? Yes, chief justice decides
In 2023 as lawmakers were passing the bill that would establish a state-appointed court within Jackson, there was talk about appointing “the best and the brightest” judges from around the state to serve – a comment some Black legislators said implied they couldn’t be found within a majority Black Hinds County.
Over a year later, the Capitol Complex Improvement District Court is set to open next week, and three judges with roots in Jackson and live in the capital have been appointed to serve.
The judges who were sworn in during a Friday ceremony said they were interested in the positions because they wanted to serve the community where many of them grew up and live.
“This is a very serious undertaking to citizens who live in this city,” said Judge Christopher Collins, who will serve on a part-time basis. He moved to Jackson for the role.
Judge Stanley Alexander and James Holland will be the full-time judges.
Alexander is a former assistant district attorney in multiple judicial districts and he worked in the attorney general’s office, including as director of the Division of Public Integrity. Holland has practiced law for over 40 years and has trial experience, including defense in state and federal courts. He ran an unsuccessful race for Hinds County district attorney in 2015.
Collins has been a prosecutor and public defender. His judicial experience includes work as a circuit and municipal judge, intervention court judge and a judge for the Mississippi Band of Choctaw Indians.
Bryana Smith McDougal was appointed as the court’s clerk. She previously was judicial assistant to former Supreme Court Justice Jim Kitchens and an assistant deputy clerk for the Supreme Court. She grew up in Jackson and lives in Madison.
Supreme Court Chief Justice Mike Randolph, who appointed the judges and clerk, said he considered many from across the state and took recommendations. It was through letters of recommendation and conversations with the three judges that showed that they were the best for the position.
“These judges have proven themselves,” Randolph said.
House Bill 1020, passed in 2023, created the court. The CCID court was supposed to be operating last year, but it waited on a building to operate. Now business will begin operation Monday at 8 a.m. at its renovated facility at 201 S. Jefferson St., a former bus terminal in downtown.
The CCID court will hear misdemeanor cases and initial appearances for felonies investigated by Capitol Police. Those cases have been handled in the existing Hinds County court system during the interim.
“We want to stay current (with cases.) Our goal is to support and supplement the current court system,” Holland said.
At the Friday ceremony, Gov. Tate Reeves said the court and the ongoing work of Capitol Police will help make Jackson safer.
“Make no mistake. Jackson’s best days are ahead of us,” he said.
Reeves stood alongside various government officials, law enforcement and lawmakers, including House Ways and Means Chairman Trey Lamar, who authored HB 1020, and Public Safety Commissioner Sean Tindell, whose agency includes Capitol Police.
Lamar said the court will be for the regular people of Jackson who want to have their kids play safely in their yards, people who want an efficient and blind justice system and families who will be supported by future jobs that come to the city.
HB 1020 also expanded the jurisdiction of the Capitol Police from within the district to Jackson. The district covers downtown, the area around Jackson State University, Belhaven, the hospitals, Fondren and up to Northside Drive. A bill has been proposed this session to expand the district even further.
In recent years, Capitol Police has been built up from a former security force for government buildings into a law enforcement agency.
The court and police expansion were touted as solutions to crime and a backlogged Hinds County court system. Pushback came from Jackson lawmakers, advocacy groups and community members and two lawsuits were filed, but they have since been resolved.
Prosecutors from the attorney general office’s Public Integrity Unit were also appointed to work in the CCID court, but they were not announced Friday. A spokesperson said their identities will be known once the court opens.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
UMMC refuses to answer questions about shuttered diversity office
Until a few years ago, the University of Mississippi Medical Center’s press releases and social media posts regularly touted the accomplishments of faculty and staff who worked to promote diversity, equity and inclusion at the public hospital.
In one example from 2021, the vice chancellor for health affairs, LouAnn Woodward, affirmed the hospitals’ commitment to a range of administrative efforts, centered around the Office of Diversity and Inclusion, to comply with civil rights law and increase minority enrollment.
“Diversity among our workforce and student populations and an inclusive environment are, and must always be, core considerations at the Medical Center,” Woodward said.
Then sometime before the start of this fiscal year, UMMC closed its diversity office.
The public hospital is now refusing to answer questions about when or why that decision was made, if any employees were let go as a result, or what happened to the more than $1 million in funding that once supported the office.
It is unclear if UMMC announced the decision internally; the hospital did not say if it had. Partially redacted faculty senate meeting minutes from 2024, obtained through a public records request, contain no mention of the move, even though the faculty have a committee dedicated to diversity and inclusion.
A March 2024 announcement lists the now-defunct office’s chief diversity officer among new hires at the School of Population Health, indicating UMMC may have shuttered the office around that time.
That’s also when UMMC appears to have scrubbed the office from its website, according to the Internet Archive. The URL for the office now redirects to a web page titled “Diversity and Inclusion at UMMC” which states “throughout UMMC’s three mission areas – education, research and health care – a climate of diversity and inclusion is present.”
Missing from the webpage are the many initiatives the diversity office oversaw, including a professional development certificate.
While UMMC is not the only institution of higher learning in Mississippi to shutter or reimagine its efforts to foster DEI on campus, the public hospital appears unique in its reticence about the decision.
Other institutions in Mississippi have made their plans to revamp DEI offices more accessible. Last fall, the University of Mississippi announced its decision to reinvent its diversity division in a campus-wide email from the chancellor. Earlier in the year, Mississippi State University’s vice president for access, opportunity and success appeared before faculty to discuss the reasons behind the diversity division’s new focus.
In response to questions from Mississippi Today, UMMC’s director of communications provided a written statement with the preface that the hospital would have no further comments.
“While we no longer have that office, our commitment to access and opportunity for all students, faculty and staff remains,” Patrice Guilfoyle wrote in an email. “If we are to effectively address Mississippi’s persistent and daunting health challenges, it will take everyone working together to fulfill our tripartite mission of education, research and patient care.”
Though funding fluctuated, the office was allocated $1,029,143 during the 2023-2024 fiscal year, according to budget documents obtained through a public records request. About a third of the office’s funding came from state appropriations.
Until its closure, it appears the office was led by a member of Woodward’s executive cabinet, a role Woodward created shortly after she was appointed in 2015, according to a press release announcing the hire. The chief diversity officer was charged with creating a strategic diversity and inclusion plan for the hospital.
“Not only did I want this work to be represented and visible at the highest level of leadership, this new institutional role would cover all three of our missions as well as coordinate diversity and inclusion efforts between them,” Woodward said.
The chief diversity officer also oversaw three employees as of fiscal year 2023, according to information UMMC reported to the state auditor that year, including a cultural competency and education manager who ran workshops on topics like health disparities and a program coordinator who worked on the office’s annual award ceremony.
Beyond that, the office also hosted a professional development program and held monthly conversations to foster “dialogue among members of the UMMC community on stimulating topics in pursuit of sharing and understanding experiences, emotions, and different perspectives,” according to a newsletter.
This legislative session, lawmakers have filed multiple bills to ban DEI at state-supported institutions of higher learning, as well as one directed at public and charter schools. Mississippi has not passed such a ban, but lawmakers may be primed to do so on the heels of President Donald Trump’s executive orders targeting DEI in the federal government.
UMMC has in the past curtailed programs after receiving pushback from lawmakers.
In 2023, the hospital shuttered an LGBTQ+ focused clinic months after cutting gender-affirming care for trans minors because lawmakers complained.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
What would Dr. Naismith think if he watched Ole Miss and Mississippi State?
So, as I watched the last 90 seconds of Mississippi State’s overtime victory over Ole Miss last Saturday night at Starkville, I got to thinking: What would Dr. James Naismith, the inventor of basketball, think?
I had plenty of time to think. Because of video reviews, timeouts, fouls, free throws and more replay reviews, the last 90 seconds of playing time lasted 17 minutes of real time. The game itself took two hours, 41 minutes. That’s 161 minutes if you are keeping score, which is roughly four times the length of time the ball actually was in play.
I think I know what Naismith would think. I believe he would think: You know, this is not really what I had in mind.
Some historic perspective is necessary here. Dr. Naismith was not yet a doctor when he conjured up the game we call basketball. Later to become a doctor of both divinity and of medicine, Naismith was a recently hired YMCA training school instructor at Springfield (Mass.) College in December of 1891, 134 years and change ago. His boss, Dean Luther Gillick charged Naismith with the task of developing a new indoor sport to fill the void between football and baseball seasons. Seems the Springfield students were terribly bored with gymnastics.
Gillick told Naismith he wanted a sport that required skill and sportsmanship. He wanted a game that provided exercise for the whole body, yet a game played without extreme roughness causing damage to players and equipment. Had they watched the Rebels and Bulldogs last Saturday night, Gllick and Naismith might have covered their eyes. Extreme roughness and physicality ruled the night.
But all in all, Naismith did fairly well. Take last Saturday night, for example: Certainly none of players, nor the more than 9,000 fans at The Hump, were the least bit bored, except for during the numerous replay reviews.
Given his advanced degree in divinity, Naismith probably would admit he was fortunate in some ways. For instance, after sketching out his idea for the sport, Naismith sent a janitor in search of two 15-inch by 15-inch boxes to hang at either end of the gymnasium. Basketball was almost boxball. Hoops was almost squares. The janitor couldn’t find the appropriate boxes and returned to Naismith carrying two peach baskets. And, yes, the baskets had bottoms. Initially a ladder was needed to retrieve the ball after made baskets.
Naismith’s class had 18 students. So it was the first game of basketball matched nine against nine. Tacking, pushing, holding and tripping were prohibited, but, then, so was dribbling. Clearly, as Bob Cousy, Pete Maravich, Juju Murray and Josh Hubbard have illustrated, the game would evolve. The first game, played with a soccer ball, ended with the score one to nothing. Accuracy has evolved, too.
Naismith’s game quickly grew in popularity, especially In the northeast. Naismith became something of a hero. In fact, some folks suggested the new sport be called Naismith-ball. To his everlasting credit, Naismith flatly rejected the idea.
You, as I, may wonder how some of the terms we use in basketball today came about. For instance, the player who patrols the area closest to the goal is often called the post-man even though there is no mail involved. Sometimes, he plays the low post. Sometimes, he moves farther away from the basketball and plays the high post. Why post? Glad you asked. Back in Naismith’s day, most gyms, including the one in Springfield, had posts in the middle of the courts to hold up the ceilings. The players had to maneuver around the posts. The player who played near the posts closest to the baskets was called the post-man.
Back then, many of the courts were elevated and doubled as stages (think Memorial Coliseum at Vanderbilt). There was an inherent danger of players falling off the stages and breaking legs, arms and noggins. Netting was often put up around the courts to protect the players from such danger, giving the playing floor the visual effect of a cage. And that’s why basketball players are often still referred to a cagers. Now you know.
Women took to the sport from almost the very beginning. The first women’s game was played in 1892 at Northampton, Mass. Men were not allowed to attend because the women played the game in bloomers. Uniforms, too, have evolved.
“Basketball,” Naismith wrote, “is a game to play. You don’t coach it.” Chris Jans and Chris Beard, two guys who make millions, surely would disagree. But maybe Naismith had the right idea. All that coaching – which happens mostly during TV timeouts – is part of what makes the last 90 seconds of a close game last more than 10 times that long.
In his book about basketball, Naismith wrote, “Let us all be able to lose gracefully and to win courteously; to accept criticism as well as praise; and, last of all, to appreciate the attitude of the other fellow at all times.”
Dr. Naismith, we can reasonably surmise, would not have appreciated the numerous refrains of “Go to hell Ole Miss” and “ref, you suck” last Saturday night.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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