Mississippi Today
Mississippi moms and babies suffer disproportionately. Medicaid expansion could help.
Mississippi moms and babies suffer disproportionately. Medicaid expansion could help.
Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project.Read more about the project by clicking here.
During her 14 years working as an OB-GYN in Greenville, Dr. Lakeisha Richardson has seen five patients diagnosed with breast cancer during their pregnancies.
Most of them did not have health insurance prior to pregnancy, so going to the doctor for annual checkups was neither affordable nor routine. They missed out on clinical screenings and the chance to learn whether they were at higher risk of breast cancer.
Pregnancy does not cause breast cancer, but it can make it grow and spread more quickly, and breast cancer associated with pregnancy has a lower survival rate. For Richardson’s patients without health insurance, pregnancy brought Medicaid coverage that allowed them to go to the doctor for prenatal visits, and that was when their cancer was diagnosed.
One of Richardson’s patients died from breast cancer a few weeks after giving birth.
“Legislators think, women are healthy, they’re going to have a baby, and they can come off Medicaid,” Richardson said. “They don’t think that other illnesses and disease processes can exist in pregnant women.”
Mississippi doctors like Richardson see thousands of patients every year who have no health insurance, and thus limited access to affordable health care, until they become pregnant and qualify for Medicaid. If the patient has a chronic condition like diabetes or hypertension, getting treatment during pregnancy is critical – but not necessarily sufficient to prevent problems like preterm delivery, low birth weight, birth defects, and even stillbirth.
Access to routine care prior to conception increases the chance a person can have a healthy pregnancy and delivery. But in Mississippi, where one in six women of reproductive age is uninsured, preconception health care is far from universal. Under current Medicaid eligibility policy, adult women can get coverage only when they are pregnant or have kids at home and very low household income.
“If they have a preexisting disease like diabetes or hypertension, if they’re uninsured they’ve probably been off their meds for a while, so they’ll come in with elevated blood pressure, elevated glucose that have been uncontrolled for months or years,” Richardson said. “If it takes them a while to get their Medicaid and they’re already late to prenatal care, they have growth restrictions for the baby.”
It’s no secret that Mississippi is a sick state. More than one in seven Mississippians are living with diabetes, a higher rate than almost any other state. More than 700,000 Mississippians have hypertension, and the state has the country’s highest rate of deaths due to high blood pressure, as well as the country’s highest adult obesity rate, at just under 40%.
But perhaps nowhere are the consequences of sickness – sickness that is largely preventable – more evident than in the unnecessary suffering of Mississippi’s mothers and babies.
The state has the country’s highest percentage of babies born at a low weight. It has the highest percentage of preterm deliveries, which can result in costly NICU stays and long-term health consequences. Mississippi has the country’s highest rate of stillbirth. And more babies here die before their first birthday than anywhere else in the U.S.
Nationally, the leading cause of infant mortality is birth defects. But in Mississippi, the causes are more preventable: premature birth and pregnancy or delivery complications as well as sudden infant death syndrome (SIDS).
Within each of these statistics, Black women and babies suffer much more than their white counterparts.
Expanding Medicaid would not on its own solve Mississippi’s maternal and infant health crisis, which State Health Officer Dr. Daniel P. Edney has identified as a top priority. Health insurance is not the same as access to health care, and access to health care alone is not enough to ensure all Mississippians have healthy food, opportunities to exercise, and safe neighborhoods.
But OB-GYNs interviewed across the state said that lack of access to health care prior to conception is a problem they see every day. They may see a patient get her diabetes or hypertension under control when she has Medicaid coverage during her pregnancy, only to lose coverage and return to self-managing her conditions. They won’t see her again unless she gets pregnant again, and then the process of treating her chronic condition must start all over again.
“We work really hard and optimize their diabetes during pregnancy, and then they’ll be a gap in care between and patients come back for the next pregnancy and it’s like we’re starting from square one again,” said Dr. Sarah Novotny, a maternal-fetal medicine specialist at the University of Mississippi Medical Center.
An analysis by the consulting firm Manatt found that expanded Medicaid eligibility to adults with incomes below 138% of the federal poverty line would likely cut enrollment in pregnancy Medicaid by about half – meaning that it would provide more consistent coverage and access to care for about 10,000 women each year who can currently have health insurance only during and right after their pregnancies.
Dr. Jaleen Sims has worked as an OB-GYN at Jackson-Hinds Comprehensive Health Center since 2019. The federally qualified health center offers services on a sliding scale, so it’s affordable for people without insurance.
“I serve the underserved population that experiences the most suboptimal outcomes , the highest comorbidity rates, the highest mortality rates – those are my patients,” she said.
She estimates that more than half of her patients who are pregnant with their first child have not had health insurance as adults before getting pregnant.
Medicaid offers full coverage for pregnant women with incomes 194% of the federal poverty level, or $4,603 monthly for a family of four. That ensures that low-income and working-class women can get health care during their pregnancies. About 60% of births in Mississippi are covered by Medicaid, the second-highest percentage in the country, after only Louisiana.
Hinds County has both the state’s largest number of Medicaid-covered births, at an average of 2,300 annually from 2016 to 2020, and one of the state’s highest per capita rates of pregnancies covered by Medicaid. Some people with pregnancy Medicaid have another form of insurance, too, but generally the rate of Medicaid coverage during pregnancy gives an indication of how many people lacked insurance before they conceived.
Sims sees patients with hypertension, diabetes, obesity, lupus – “those chronic medical conditions that you really want to have under very, very good control before you get pregnant.”
Diabetes is a good example of a condition that can cause problems during pregnancy– but doesn’t have to.
Sometimes Sims sees patients who got treatment for diabetes during a previous pregnancy, but stopped seeing going to the doctor when that coverage ended. Instead, they’ve tried to manage it on their own.
“Then before you know it, they’re out of the medication, they’re just kind of living,” she said. “They’re like, ‘Well, I don’t check my finger sticks, I don’t have my insulin, I don’t have my medicine. Now I don’t really know where I am at this point.’”
During pregnancy, doctors try to keep blood sugar tightly controlled. That becomes harder to accomplish when the patient’s condition isn’t well managed when they arrive for their first prenatal visit.
If blood sugar is elevated during the first 10 weeks when the fetus’s organs are developing, the risk of birth defects is higher, Novotny said, even if blood sugar is controlled later in the pregnancy.
“A lot of times women haven’t been in care, they find out they’re pregnant, sign up for Medicaid, and by the time they come to us, it’s often the end of the first trimester, when damage may already be done,” she said.
Spina bifida and heart problems are the most common birth defects associated with diabetes. People with diabetes are also at risk for preterm delivery.
Dr. Emily Johnson, an OB-GYN in the Jackson area, said it’s important for people to know that chronic conditions and risk factors during pregnancy can be managed with very good outcomes. Early communication between provider and patient is critical.
“I think them knowing that information helps them have a little autonomy that they can be responsible for their blood pressure and they know what they’re supposed to call me for,” she said. “Communicating about the risk can help them take a little ownership of it and in some way provide some reassurance.”
For many uninsured women in Mississippi, getting signed up for Medicaid is one of the first rituals of pregnancy. But getting approved is a hurdle that for some people can delay their prenatal care by days or weeks.
Providers said they largely see patients get approved within a month or so. A mistake on the paperwork, however, can delay approval.
Matt Westerfield, spokesperson at the Division of Medicaid, told Mississippi Today that according to a recent analysis by the Office of Eligibility, the average approval time for pregnancy Medicaid from Aug. 2021 to Aug. 2022 was about 24 days. That's slightly higher than the average approval time in 2021 for all eligibility categories of 20 days, according to documents Mississippi Today obtained through a records request.
Even a delay of a few weeks can make a difference, given the importance of early prenatal care. Dr. Kushna Damallie, an OB-GYN at The Woman’s Clinic in Clarksdale, said he would like to see a patient as soon as she misses a period. But that often doesn’t happen.
“One of the biggest hurdles we have in our practice is late prenatal care, no prenatal care, or insufficient prenatal care,” Dumallie said.
Westerfield told Mississippi Today that the Division of Medicaid doesn't track when women go to their first prenatal visit or what percentage take place during the first trimester of pregnancy.
Richardson said early prenatal care is particularly important for women with a condition called an incompetent cervix, in which weak cervical tissue can cause very early delivery. Black women are more at risk for this condition. One treatment to help ensure a successful delivery is a cervical cerclage, in which providers stitch the cervix closed, usually around 12 to 14 weeks of pregnancy. If that doesn’t happen in time, the risk of miscarriage is higher.
In August of this year, Richardson had a patient who was in the hospital because her water had broken well before viability. The patient had known she needed to get treatment for her incompetent cervix but had not been able to get an appointment early enough.
“She moved from another state, so she didn’t have her Mississippi Medicaid and so she couldn’t get in anywhere to be seen,” Richardson said.
OB/GYN Dr. Nina Ragunanthan poses for a portrait inside of Delta Health Center in Mound Bayou, Miss., Thursday, July 14, 2022.
While Medicaid expansion is a taboo topic among Republicans in the legislature, extending Medicaid coverage for postpartum women has bipartisan support. A measure to extend coverage from 60 days to 12 months postpartum passed the Senate resoundingly in the last session, before House Speaker Philip Gunn killed it.
Today, Mississippi is one of just two states that has neither expanded Medicaid eligibility nor extended postpartum coverage.
Senate Republicans including Sen. Kevin Blackwell, R-Southaven, who sponsored the measure, have vowed to reintroduce the measure in the next session, though Gunn still opposes it.
Gunn recently said he believed postpartum Medicaid extension would help only a few thousand women in Mississippi, referring to his calculation that only 60% of the 5,000 new births expected annually after the state’s abortion ban would be covered by the program and dismissing the 21,000 people already covered by pregnancy Medicaid each year.
When discussing crisis pregnancy centers, which already get a $3.5 million tax credit from the state and which Gunn wants to expand to $10 million, he offered no information about the number of people they serve and how, probably because that data is not being collected by the state.
Providers largely say they’d welcome any opportunity to lengthen the amount of time their patients have health insurance. Novotny, the maternal-fetal medicine specialist, said 12 months of coverage postpartum would give her patients a chance to control their diabetes for a longer period before becoming pregnant again.
Some providers were not aware of continuous coverage provisions during the pandemic. But those who knew about it said their patients benefited from longer access to care.
“They’ve been able to continue the management of their chronic diseases so that when they’re ready to get pregnant again, they are in a good place,” Sims said.
But postpartum Medicaid does nothing to improve access to health care before conception.
Some advocates are concerned that the conversation about postpartum Medicaid could distract from the need to address Mississippi’s health care crisis more broadly.
Nakeitra Burse, a public health consultant and advocate focused on maternal health, said some of the discussion of postpartum Medicaid seems to reflect a belief that pregnancy can be separated from the rest of a life.
“A person’s already experiencing obesity, diabetes, high blood pressure, and then you add pregnancy on top of that, then pregnancy also becomes a condition,” Burse said. “So you’re trying to treat all these things at one time, when people don’t even just have the opportunity to make the healthy decisions for themselves because they don’t have access to care.”
When patients do get access to care during pregnancy, making it to a doctor’s appointment isn’t as easy as it sounds.
“A lot of that decision making means: Do I miss work to go to the doctor? Do I go to the doctor over my child? It’s a lot of push and pull and give and take for the decision making that shouldn’t have to happen, if we had opportunity or access to quality health care.”
Dr. Nina Ragunanthan, an OB/GYN in Mound Bayou, pointed out that the focus on pregnancy and postpartum coverage, rather than expanding access to health care for everyone, implies that women are more deserving of care if they are giving birth than if they are not.
“I think it's really important not to just pigeonhole a woman as a child bearing vessel,” she said. “Access to care for that woman as an autonomous, independent person, regardless of whether she plans to get pregnant or not, is very important.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Hospitals see danger in Medicaid spending cuts
Mississippi hospitals could lose up to $1 billion over the next decade under the sweeping, multitrillion-dollar tax and policy bill President Donald Trump signed into law last week, according to leaders at the Mississippi Hospital Association.
The leaders say the cuts could force some already-struggling rural hospitals to reduce services or close their doors.
The law includes the largest reduction in federal health and social safety net programs in history. It passed 218-214, with all Democrats voting against the measure and all but five Republicans voting for it.
In the short term, these cuts will make health care less accessible to poor Mississippians by making the eligibility requirements for Medicaid insurance stiffer, likely increasing people’s medical debt.
In the long run, the cuts could lead to worsening chronic health conditions such as diabetes and obesity for which Mississippi already leads the nation, and making private insurance more expensive for many people, experts say.
“We’ve got about a billion dollars that are potentially hanging in the balance over the next 10 years,” Mississippi Hospital Association President Richard Roberson said Wednesday during a panel discussion at his organization’s headquarters.
“If folks were being honest, the entire system depends on those rural hospitals,” he said.
Mississippi’s uninsured population could increase by 160,000 people as a combined result of the new law and the expiration of Biden-era enhanced subsidies that made marketplace insurance affordable – and which Trump is not expected to renew – according to KFF, a health policy research group.
That could make things even worse for those who are left on the marketplace plans.
“Younger, healthier people are going to leave the risk pool, and that’s going to mean it’s more expensive to insure the patients that remain,” said Lucy Dagneau, senior director of state and local campaigns at the American Cancer Society.
Among the biggest changes facing Medicaid-eligible patients are stiffer eligibility requirements, including proof of work. The new law requires able-bodied adults ages 19 to 64 to work, do community service or attend an educational program at least 80 hours a month to qualify for, or keep, Medicaid coverage and federal food aid.
Opponents say qualified recipients could be stripped of benefits if they lose a job or fail to complete paperwork attesting to their time commitment.
Georgia became the case study for work requirements with a program called Pathways to Coverage, which was touted as a conservative alternative to Medicaid expansion.
Ironically, the 54-year-old mechanic chosen by Georgia Gov. Brian Kemp to be the face of the program got so fed up with the work requirements he went from praising the program on television to saying “I’m done with it” after his benefits were allegedly cancelled twice due to red tape.
Roberson sent several letters to Mississippi’s congressional members in weeks leading up to the final vote on the sweeping federal legislation, sounding the alarm on what it would mean for hospitals and patients.
Among Roberson’s chief concerns is a change in the mechanism called state directed payments, which allows states to beef up Medicaid reimbursement rates – typically the lowest among insurance payors. The new law will reduce those enhanced rates to nearly as low as the Medicare rate, costing the state at least $500 million and putting rural hospitals in a bind, Roberson told Mississippi Today.
That change will happen over 10 years starting in 2028. That, in conjunction with the new law’s one-time payment program called the Rural Health Care Fund, means if the next few years look normal, it doesn’t mean Mississippi is safe, stakeholders warn.
“We’re going to have a sort of deceiving situation in Mississippi where we look a little flush with cash with the rural fund and the state directed payments in 2027 and 2028, and then all of a sudden our state directed payments start going down and that fund ends and then we’re going to start dipping,” said Leah Rupp Smith, vice president for policy and advocacy at the Mississippi Hospital Association.
Even with that buffer time, immediate changes are on the horizon for health care in Mississippi because of fear and uncertainty around ever-changing rules.
“Hospitals can’t budget when we have these one-off programs that start and stop and the rules change – and there’s a cost to administering a program like this,” Smith said.
Since hospitals are major employers – and they also provide a sense of safety for incoming businesses – their closure, especially in rural areas, affects not just patients but local economies and communities.
U.S. Rep. Bennie Thompson is the only Democrat in Mississippi’s congressional delegation. He voted against the bill, while the state’s two Republican senators and three Republican House members voted for it. Thompson said in a statement that the new law does not bode well for the Delta, one of the poorest regions in the U.S.
“For my district, this means closed hospitals, nursing homes, families struggling to afford groceries, and educational opportunities deferred,” Thompson said. “Republicans’ priorities are very simple: tax cuts for (the) wealthy and nothing for the people who make this country work.”
While still colloquially referred to as the One Big Beautiful Bill Act, the name was changed by Democrats invoking a maneuver that has been used by lawmakers in both chambers to oppose a bill on principle.
“Democrats are forcing Republicans to delete their farcical bill name,” Senate Democratic Leader Charles Schumer of New York said in a statement. “Nothing about this bill is beautiful — it’s a betrayal to American families and it’s undeserving of such a stupid name.”
The law is expected to add at least $3.3 trillion to the nation’s debt over the next 10 years, according to the most recent estimate from the Congressional Budget Office.
This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The post Hospitals see danger in Medicaid spending cuts 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
This article reports on the negative impacts of a major federal tax and policy bill on Medicaid funding and rural hospitals in Mississippi. While it presents factual details and statements from stakeholders, the tone and framing emphasize the harmful consequences for vulnerable populations and health care access, aligning with concerns typically raised by center-left perspectives. The article highlights opposition by Democrats and critiques the bill’s priorities, particularly its effect on poor and rural communities, suggesting sympathy toward social safety net preservation. However, it maintains mostly factual reporting without overt partisan language, resulting in a moderate center-left bias.
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.
The post Podcast: The Mississippi Sports Hall of Fame Class of '25 appeared first on mississippitoday.org
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.
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