Medicaid

What the experts say about expanding Medicaid

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Here’s what experts say about expanding Medicaid in Mississippi

Note: This article is part of Mississippi Today’s ongoing Mississippi Crisis project. Read more about the project by clicking here.

Perhaps no other federal- policy has been studied and debated more than expansion per the federal Affordable Care Act, including its potential impact on Mississippi — one of just 12 states that has not expanded the program.

A Kaiser Family Foundation report notes there have been more than 400 studies on the topic nationwide. And in Mississippi, the poorest and unhealthiest state in the nation, numerous studies have focused on what expansion would mean. A majority project net positive benefits economically, health-wise or both.

READ MORE: What is Medicaid expansion, really? Answers to common questions.

Expansion would mean someone making $18,754 a year (138% of the poverty level) would be eligible for health care coverage through the federal-state program. The federal government would pay 90% of the costs for those covered, with the state paying 10%.

When Medicaid expansion began Jan. 1, 2014, the federal government paid 100% of the costs, stepped down to 90% over years. Mississippi missed out on the larger matching rates from the federal government.

But under the recent American Rescue Plan, the 12 states that have not expanded Medicaid have been offered a financial incentive to do so. That equates to more than $700 million for Mississippi, and more recent studies have factored in those incentives.

The studies on Medicaid expansion in Mississippi

Mississippi University Research Center/IHL, 2021: This analysis of the fiscal and economic impact of expansion was authored by state Economist Corey Miller and senior Economist Sondra Collins. It found expansion would add about 230,000 adults to Mississippi’s Medicaid rolls between 2022 and 2027. It would produce an average of 11,000 new jobs a year during that time and provide an additional $44 million a year to the state general fund.

The study found that expansion would increase the state’s gross domestic product by more than $700 million a year over five years, increase personal income between $539 million and $812 during the same period and increase the state’s population between 3,300 and 11,500 annually over the same period.

Commonwealth Fund study, 2021: The study estimates expansion would cost the state $956 million over five years, while generating $1.2 billion in savings for a net gain to state coffers of $212 million. The study estimates expansion would provide coverage for about 230,000 adults.

Urban Institute/Robert Wood Johnson Foundation national study, 2020: This was a study of the impact of expansion on the then 15 states that had not expanded Medicaid. The study projected that expansion in Mississippi would bring an increase of 207,000 enrollees and an increase in state Medicaid costs of $177 million a year, but did not attempt to calculate any increased revenues or savings.

Perryman Group study of Mississippi Cares plan, 2019: This was a study of the Mississippi Hospital Association’s “Mississippi Cares” alternative expansion plan. MHA proposed creating a public-private partnership, expanding eligibility to adults earning up to 138% of the poverty level, but imposing a $20 a month premium on enrollees and a $100 copay for non-emergency use of hospital emergency rooms. Hospitals would cover remaining state costs. The Perryman study projected the plan would create an additional 36,000 jobs a year on average for the first 11 years and provide an increase in state tax revenue, a decrease in private insurance premiums and a reduction in uncompensated care costs of $252 million a year. The plan also included a requirement that unemployed beneficiaries enroll in job training or education programs.

University of Alabama Birmingham study for Mississippi Health Advocacy Program, 2013: This study, by UAB’s Department of Health Care Organization and policy, modeled the impact of expansion on enrollment, state and federal costs, employment and state tax revenue from 2014 to 2020. It projected expansion would result in 212,362 more enrollees by 2020, would generate 19,318 additional jobs in 2020, with $200 million in additional state and local tax revenue. It projected an overall state budget savings of $34 million in 2020 and projected expansion would produce $2 billion in economic activity annually.

Kaiser Foundation/Urban Institute national study, 2012: This study projected the effect of expansion on costs and enrollment nationally and by state from 2013 to 2022. The study projected expansion in Mississippi would cost the state about $1 billion for the period, and result in an additional 231,000 enrollees. The study listed the additional costs without estimates of any savings or increases in tax revenues.

Mississippi University Research Center/IHL, 2012: This study projected the impact of expansion on Medicaid costs, enrollment, and net economic impact on the state budget from 2014-2025. The study used three scenarios, high, medium and low participation, predicting that high participation of an additional 310,000 enrollees was most likely. It predicted the state’s cost of expansion would be about $118 million by 2020, but that expansion would create about 9,000 new jobs a year and have a net positive impact on the state budget of nearly $65 million by 2020.

Milliman Inc. study, 2010, 2012: The Mississippi Division of Medicaid contracted this analysis of Mississippi Medicaid’s budget exposure to the ACA from fiscal 2011-2020, and it was updated in 2012 and is still referred to frequently by opponents of expansion. The report modeled three scenarios – low, moderate and high enrollee increases and said moderate or low scenarios were most likely. The report projected under the moderate scenario that 243,000 additional adults and 67,000 more children would enroll and the state share of Medicaid costs would increase by $1.26 billion over the time period, including costs for current and additional enrollees. It estimated that by fiscal 2020, the state would see increased costs of $280 million a year.

The 2012 report modeled enrollment and costs from fiscal 2014-2020 under various scenarios. Under the higher enrollment scenario, it estimated expansion would cost the state $155 million a year by 2020. It focused on the Medicaid budget and did not estimate any cost offsets from other programs or from additional tax revenue.

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

FAQ: Medicaid expansion, what is it, really?

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Q&A: What is Medicaid expansion, really?

Note: This article is part of Mississippi Today’s ongoing Mississippi Crisis project. Read more about the project by clicking here.

The inner workings of , a federal program intended to provide health coverage to low-income Americans, are wonky and incredibly difficult to understand.

You’ve probably heard the term “Medicaid expansion,” words that have become weaponized by opportunistic politicians, used as a smoke screen to avoid talking earnestly about an extension of the existing federal program that provides even more people with basic health care coverage. 

As Mississippi’s health care crisis continues, we’ve compiled answers to some frequently asked questions to show the direct effects of the policy, how it could change lives across the , and what the state could stand to gain by passing it.

Click on questions below to jump to answers, or scroll down to see it all.

Click to jump to a specific question

What is Medicaid? 

Medicaid is a federal program that provides health coverage to millions of people in the U.S., including low-income adults, children, pregnant women, elderly adults and people with disabilities. States administer the program, which is funded by both states and the federal government. Mississippi currently participates in the traditional Medicaid program.

What is Medicaid expansion? 

Medicaid expansion is a special provision created under President Barack Obama’s 2010 Affordable Care Act that aims to allow more low-income Americans to be covered by the program and decrease the number of uninsured people. Mississippi is one of 12 states that has not opted into the expansion program. In states that have chosen to expand, Medicaid eligibility is extended to adults up to age 64 who have incomes up to 138% of the federal poverty level – or about $25,000 for a family of two. 

Currently in Mississippi, non-disabled adults without children generally never qualify for the program, and the income requirements are very stringent for those who are parents ($4,608 in annual earnings for a family of three). 

How many additional people would be insured if Mississippi expanded Medicaid?

Studies have estimated Medicaid expansion in Mississippi would cover over 200,000 additional people. Other states that have expanded have seen a decline in uninsured people – a desired outcome in Mississippi, which ranks 6th in the nation for the percentage of uninsured people. 

What would the economic impact of Medicaid expansion be?

Estimates show Medicaid expansion would bring in more than $1 billion in new revenue each year. Multiple studies have shown Medicaid expansion would save the state money by reducing uncompensated care costs for hospitals, reducing chronic illness through preventive care, and that it would help the by creating thousands of jobs and the “multiplier effect” of the federal dollars. Studies by state economists have shown it would, over time, increase the state’s GDP and population. 

What are the mechanisms that could be used in Mississippi to expand Medicaid? 

Expansion of Medicaid in Mississippi would require action by the state , and approval by the governor.

Who is in favor of Medicaid expansion and why?

Many leaders and physicians in the medical community favor Medicaid expansion because of the financial benefits their institutions would reap. Health care organizations like the Mississippi State Medical Association, Mississippi Hospital Association, American Cancer Society, American Heart Association, and countless others support expansion. And top business leaders and organizations like the Delta Council have publicly supported Medicaid expansion because of the broader economic benefits it would create. 

Democrats in the Legislature, who wield little power and influence over major policymaking decisions, and scores of other Democratic elected officials have publicly supported Medicaid expansion for years. Republican Lt. Gov. Delbert Hosemann, the leader of the state Senate, has repeatedly highlighted the need for health care for working people, though he stops short of advocating for Medicaid expansion. Several other legislative Republicans and even Republican statewide candidates in recent elections have publicly supported expansion, but none have succeeded in starting earnest debate in the Legislature.

Who opposes Medicaid expansion and why? 

Top Republican leaders in the state, led by Gov. Tate Reeves and Speaker of the House Philip Gunn, have long rejected Medicaid expansion. Many of the arguments against expansion have been overtly political and partisan — opposition against expanding “Obamacare,” which many Republicans opposed from the start. Others are more philosophical arguments against increasing any large government program or that health care should be done through the private sector. But two of the main arguments from Mississippi elected leaders against it have been that the state budget cannot afford it and that the federal government will one day stop paying the largest share and leave state taxpayers holding the bag.

What has happened in other states that have expanded Medicaid?

Other states that have expanded Medicaid have seen a large drop in uncompensated care costs – the costs that hospitals must cover themselves to care for uninsured patients. Louisiana, our neighbor that expanded Medicaid in 2016, saw a 55% decrease in uncompensated care costs for rural hospitals after expanding — and a substantial drop in mortality rates.

Why do states have the choice of whether to participate in Medicaid expansion? 

The in 2012 issued a decision in a case that challenged the constitutionality of the Affordable Care Act, the sweeping health care reform law enacted in 2010 that aimed to make health insurance more affordable. One major tenet of the law was to expand Medicaid to cover more people. The high court upheld the law in general, but said that the federal government could not mandate that states expand Medicaid. Based on that portion of the ruling, 12 states, including Mississippi, have not expanded Medicaid. In Mississippi, the few times the issue of Medicaid expansion has been before either full chamber of the Legislature is when Democratic members have offered amendments to other Medicaid-related bills. The Republican majorities have regularly voted down those amendments.

How much do Mississippi hospitals pay to care for people who don’t have insurance or Medicaid? 

The cost of uninsured care for calendar year 2021 is estimated to be $482 million. The cost of total uncompensated care (uninsured plus others who don’t pay the full balance) is $594 million. Hospitals must cover these costs themselves, often leading to budget woes that can close a hospital for good or require drastic cuts in health services offered. The effects of this uncompensated care have only worsened as the pandemic and the accompanying high labor costs have financially strained hospitals. Medicaid expansion would flow millions per year directly to hospitals to help them cover these costs.

Is our current Medicaid program free? Who qualifies for it? 

Medicaid is free for beneficiaries and funded by the federal and state governments. Currently in Mississippi, several categories of people qualify for Medicaid:

  • Infants and children who live in low-income families
  • Uninsured children whose family income does not exceed 209% of the federal poverty level will qualify for Children’s Health Insurance Program
  • Parents and caretakers of minor children who live in the home. The parents must be without the support of one or both parents due to disability, , or continued absence or who are unemployed or have very low income. To qualify, the parent or caretaker must cooperate with child support enforcement requirements for each child whose parent is absent from the home.
  • Pregnant women with income under 194% of the federal poverty level. These women will receive benefits for two months postpartum and are then put on the family planning waiver.
  • Pregnant women under 19 years old automatically qualify for pregnancy Medicaid.
  • Disabled children who require a level of care typically provided in a hospital or long term care facility but are living at home. 
  • Working disabled: Adults whose income is below a certain level and who work at least 40 hours per month. 
  • Aged, blind or disabled people who received Supplemental Security Income (SSI), those who formerly received SSI, and those residing in a nursing facility or participating in a Home and Community Based Services Waiver Program.

How much does it cost the state and taxpayers to provide our current Medicaid program? 

Medicaid expenditures are based on usage. The more Medicaid beneficiaries see health care providers for treatments, the greater the cost. For the current fiscal year, the Legislature has appropriated $902 million in state funds for the Division of Medicaid and expects to receive $5.79 billion in federal funds. Mississippi, as the nation’s poorest state, receives the best matching rate with the federal government currently paying 84.5% of the health care costs. The state pays the rest. If not for the COVID-19 emergency that is slated to remain into effect until early in 2023, the federal government would be providing Mississippi a 77.86% matching rate. But currently, the federal government pays 90% of the health care costs for those covered through Medicaid expansion. In addition, the federal government would provide non-expansion states a two-year incentive to opt into Medicaid expansion. For Mississippi that would result in more than $600 million in federal funds over two years.

What services are covered under the current Medicaid program? 

Full Medicaid benefits cover office visits, family planning services, inpatient and outpatient hospital care, prescription drugs, eyeglasses, long term care services and inpatient psychiatric services. Medicaid will also provide transportation to eligible beneficiaries if they do not have other means of getting to medical appointments. 

What are the differences between traditional Medicaid and expanded Medicaid?

The difference is more people are eligible under expanded Medicaid. Expansion would mean people earning up to 138% of the federal poverty level — or $25,000 for a family of two — would qualify for benefits. This would mostly include low-income, able-bodied parents; low-income adults without children; and many low-income individuals with chronic mental illness or disabilities who struggle to maintain well-paying jobs but do not currently meet disability requirements for Medicaid.

What is postpartum Medicaid and what is the debate about extending it?

Federal law requires states to provide pregnancy-related Medicaid coverage through 60 days postpartum, but many women, particularly in Mississippi and other non-expansion states, lose coverage at that point aside from basic family planning services and birth control. Health professionals and advocates have argued Mississippi needs to extend that coverage to a year postpartum like 34 other states have done. They say this will provide much-needed improvements in health outcome for mothers and babies in the state, where 60% of births are covered by Medicaid.  

Despite bipartisan support for extending coverage for the tens of thousands of moms covered by Medicaid in Mississippi in the Senate, Speaker of the House Philip Gunn killed the bill in the 2022 legislative session and remains opposed. He cites his opposition to Medicaid expansion, but the legislation would not have expanded Medicaid eligibility – it would’ve extended coverage for people who already qualify.

Mississippi and Wyoming are now the only two states with neither extended postpartum coverage nor Medicaid expansion.

What is CHIP and how is it different from Medicaid?

CHIP stands for the Children’s Health Insurance Program and provides health coverage for uninsured children up to 19 years old and whose family income does not exceed 209% of the federal poverty level.   

The coverage, unlike Medicaid for adults, includes dental care as well as medical services. 

The state recently added mental health coverage as a mandatory benefit – including services necessary to prevent, diagnose and treat a broad range of mental health symptoms and disorders.

What is the history of Medicaid?

The U.S. Congress, at the behest of President Lyndon Johnson, approved Medicaid in 1965 to offer a safety net health coverage for poor Americans. Under the landmark legislation, the federal government and the states would share in paying the costs of the program. Mississippi was one of the last states to opt into the traditional Medicaid program during a 1969 special session. Mississippi Gov. John Bell Williams, who called the special session, voted against the Medicaid program as a member of Congress. As governor, Williams said it would benefit Mississippi to opt into the Medicaid program.

How many people in Mississippi are on Medicaid now?

As of July 2021, about 797,000 were enrolled in either full-benefit Medicaid coverage or the Children’s Health Insurance Program.

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

Leaders are ignoring the Mississippi health care crisis. We aren’t.

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Leaders are ignoring the Mississippi health care crisis. We aren’t.

Mississippi’s crisis has reached a grim, catastrophic, inevitable point. 

Hospitals are closing, and many more are on the verge. Already sporadic health services are being slashed. Hundreds of thousands of cannot afford the care they need. Too many people are dying.

Worst of all, our ’s leaders do not appear to be in any hurry to help.

In such bleak moments, it’s difficult not to ponder some “what-ifs.” Today could have been a day celebrated as a victory for Mississippi’s future — one that truly changed the trajectory of the state. An overwhelming majority of Republicans and Democrats alike would be headed to the polls, deciding to do for themselves what their elected officials have refused to do for more than a decade: expand .

Expanding Medicaid, as 38 other states have done and two more are poised to do, would immediately address some of the most urgent aspects of the crisis. It would provide health care for hundreds of thousands of poor, working Mississippians who can’t afford trips to the doctor for basic care or emergencies. It would give an immediate shot in the arm to the dozens of hospitals that are struggling to balance budgets and keep their doors open. It would bring our poorest-in-the-nation state more than $1 billion in new revenue every year. It would create tens of thousands of new jobs, and it would save countless lives and livelihoods.

But there will be no such celebration today.

Last year, the handed down an unprecedented ruling that killed Mississippi’s ballot initiative process, which gave voters the direct power to change laws. That broadly unpopular court decision halted a bipartisan campaign to collect signatures to put Medicaid expansion on the ballot this November. And state legislative leaders — many of the same ones who have rejected Medicaid expansion for more than 10 years — broke their promises to restore that power to voters.

Since we launched in 2016, Mississippi Today has proudly held elected officials accountable and provided Mississippians with the information they need to do the same. For months, our health care and political reporters have closely covered the growing crisis and its effects. But no issue warrants more focused, intensive scrutiny than our leaders’ inaction during this time.

So this week, we are launching a long-term project that focuses on the imminent crisis and potential solutions to it — including Medicaid expansion.

More than a dozen Mississippi Today staffers have been working on this project for several weeks. We will be thorough and independent, tough and fair. But above all else, we will be dogged in our pursuit of truth.

Our project will, first and foremost, thoroughly define the extent of the Mississippi health care crisis. It will show how hundreds of thousands of working Mississippians cannot afford the basic preventative care that keeps the more costly hospital visits and debilitating personal debt at bay. It will show how Mississippi has more rural hospitals at immediate risk of closing than any state in the nation and what that means for so many communities across the state. It will show how the state’s abysmally low investment in public health negatively affects every Mississippian, even those who have private health insurance and can get the care they need.

We will also define what, exactly, Medicaid is. The federal policy is wonky and incredibly difficult to understand. The term “Medicaid expansion” itself has become weaponized by opportunistic politicians, used as a smoke screen to avoid talking earnestly about its merits. We aim to cut through the jargon and political noise to show the direct effects of the policy, how it could change lives across the state, and what the state could stand to gain by passing it.

And perhaps most importantly, we will squarely confront the of the crisis. Even as cries for state intervention have grown on both sides of the political aisle, a handful of elected officials have seemingly decided it is not worthy of focus. They regularly invoke the name of former President Barack Obama, who championed the federal health care program in question, as the chief reason not to expand Medicaid. They disregard nonpartisan economic studies that show the enormous benefits to the state. Too often, they have even seemingly ignored the health care crisis itself.

Many of these elected officials have consistently said they don’t believe the state can afford to expand Medicaid. We will always listen to and share their explanations for that, and we will seek to better understand them. But we cannot ignore appropriate context from state and national experts who have datasets that show otherwise. And we will talk with elected officials in other states — including leaders in dozens of red states that have expanded Medicaid — about how their decision is working out for them.

We hope our journalism will force our state’s leaders to at least acknowledge and reckon with the health care challenges we all face. Beyond that, we will respectfully press them with questions about possible solutions.

Some will question the timing of this project. Lawmakers typically ignore addressing major issues in legislative sessions during major statewide election years, like in 2023. From our perspective, there is no better time to pose these questions than during an election year. 

Others will accuse us of partisanship or advocacy. An important reality we will consider daily as we serve the public: A vast majority of Mississippians, regardless of political leaning, support expanding health care access to poor, working people. A vast majority of Mississippians support accepting federal funding to help keep hospitals open. And no one can question that every Mississippian wants a better future for their children and for themselves.

One year from now, when all 174 legislative seats and eight statewide offices are on the ballot, every voter will have the ability to intimately understand where their leaders stand on the health care crisis and what they have done — or not done — to address it. We’ll make sure of it.

If you have questions, suggestions, or comments about this project, contact editor-in-chief Adam Ganucheau at adam@.org.

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

Mississippi groups want 55% of workforce to have college degree

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MEC, Accelerate Mississippi want 55% of the workforce to have a college degree by 2030

The ’s chamber of commerce and workforce development office are working together on an ambitious goal: Get more than half of Mississippi’s workforce college-educated by 2030.

The Mississippi Economic Council and Accelerate Mississippi are conducting a statewide listening tour, part of the state’s “Ascent to 55%” initiative, to create a strategic plan to increase the number of college graduates among working-aged , considered anyone between 25-64 years old.

Mississippi already seems to be on track to achieve this goal – by 2030, an estimated 59% of the state’s workforce will have a college degree or equivalent certificate, according to a paper commissioned by the Woodward Hines Education Foundation. 

The strategic plan will aim to guide policy and marketing so that Missisippians are getting college degrees that meet the varying needs of employers like Nissan in central Mississippi, to the south and Toyota to the north.

The tour began earlier this week and will continue into December. It is being spearheaded by Jean Massey, a former associate state superintendent who MEC hired with grant funds from the Woodward Hines Education Foundation (WHEF).

Massey’s first stop was at Copiah-Lincoln Community College on Tuesday. She said she wants to learn about the needs of business – what degrees do they want the local workforce to have? – and to generate buy-in from public and private leaders needed to achieve the state’s wide-ranging goal. 

“We want to hear from the business industry what they need, we want to hear from workforce workers, we also want to hear from the educators in the region to hear what they’re offering and aligns with what’s needed, and we also want to hear from the leaders in the community, government officials,” she said. 

Mississippians have long pursued higher education at some of the lowest rates in the country, a fact state leaders have talked about improving for years with little success. 

The initiative comes as Gov. Tate Reeves announced on Monday the largest economic development project in state history. It also takes on new urgency as the pandemic has contributed to a decline in the number of Mississippians going to college, said Courtney Brown, the vice president of impact and planning at the Lumina Foundation, a nonprofit that advocates for postsecondary attainment. 

“If at any point the data were really right in front of our face about the importance of having more education, the pandemic really shows that,” Brown said. “It really showed the inequities in our society between the haves and the have-nots, and we really have to change that.” 

But if Mississippi does increase the number of college degrees in the state, the theory is that it will kick off a positive feedback loop of economic development, leading to bigger business and higher paying jobs. 

“If we raise our attainment level, our workforce becomes more valuable, industry wants to be here, and we can attract more people,” Massey said. 

The goal of increasing college degrees or credentials in Mississippi goes back to 2010 under Gov. Haley Barbour’s administration, when the created the Education Achievement Council (EAC) to measure the progress made by community colleges and universities in terms of degrees awarded, graduation rates and research dollars. 

That same year, the EAC set a postsecondary attainment goal of reaching the national average by 2025. In 2019, Mississippi’s educational attainment rate was 44% – the fourth lowest in the nation, according to Lumina – putting it on track to miss its original goal of 52%.

Two years ago, the EAC revised its attainment goal by committing to the Ascent to 55% initiative. Then WHEF – which is funding the listening tour with a four-year, $1 million grant – put out a request for proposal which it granted to MEC. 

MEC’s strategic plan would mark the first time that Mississippi has created a plan to increase the state’s number of college degrees and certificates, said Jim McHale, the president and CEO of WHEF, which has long advocated for a strong attainment goal. 

“Ascent to 55% is our north star, and everything needs to lead up to that,” McHale said. 

The strategic plan, though, is only for MEC, and it’s unclear if or how it will call on state lawmakers to pass legislation to support educational attainment. Their participation would be needed to achieve such a wide-ranging goal, according to higher education experts. 

“You need everybody at the table,” said Brown from Lumina. “Higher ed can’t solve this alone.” 

A state’s postsecondary education attainment is a reflection of a number of non-education policies, namely social services, said Iris Palmer, an education policy director at New America. Relying on higher education as a pathway to the middle class, Palmer said, isn’t a substitute for social welfare programs.

“If (Temporary Assistance for Needy Families) actually worked, if all the states expanded , if we had a world where there was enough cash assistance for people to be able to live while they’re in school, we wouldn’t have to be pathworking these things through our educational system,” Palmer said.

In Mississippi, the lack of social services is accompanied by few state resources for adult and low-income college students. The rules for Mississippi’s three college financial aid programs by and large exclude adults. Students from low-income families are less likely to complete college than students from wealthier families. As race tracks highly with income in Mississippi, Black students are much less likely to complete college than white students, even though they start college at the same rate. 

While the EAC has committed to this goal, state lawmakers are pursuing policies that either impede educational attainment or hamper the economic benefits

On brightly-colored fliers, MEC and Accelerate Mississippi have touted the benefits of more Mississippians going to college – not just to businesses and the , but to the state government’s bottom line. 

“Every increased percentage point to Mississippi’s attainment rate has the potential to net the state $20 million through reduced social service spending and increased state and local taxes,” one handout says.

The source for that data point, a 2021 paper by research firm ITHAKA-S+R, strikes a slightly different tone. Titled “It’s Complicated: The Relationship between Postsecondary Attainment and State Finances,” the report posited that increased educational attainment would help states spend less money on Medicaid and welfare – as college graduates typically need less social services – and generate more revenue in the form of increased property and income taxes. 

Mississippi, the report found, would see some of the smallest savings in the country on welfare with increased educational attainment. Eliminating the state income tax – which Reeves pledged to do at this year’s Hobnob, where MEC distributed these fliers – would also significantly reduce the potential savings. 

“The revenue coming from income tax is quite significant and definitely the majority of the tax revenue that the state is deriving,” James Ward, who co-authored the paper, told Mississippi Today. “To eliminate that would definitely take a big hit in terms of the potential benefits of increasing attainment because attainment is linked to those higher salaries where you’re getting that additional income tax.

Meanwhile, state lawmakers haven’t expressed interest in policies that research has shown will support more postsecondary attainment, such as increasing need-based financial aid and expanding college financial aid to adult learners. 

Massey anticipates the strategic plan will be finished before the middle of next year and is still sorting out what metrics the plan should measure. She hopes to build a database the public can use to track the state’s progress.

“I think the key is that we all work together, and we understand this is not going to happen overnight, but it’s absolutely vital that we do increase our attainment rate,” she said. 

Editor’s note: Woodward Hines Education Foundation is a financial supporter of Mississippi Today.

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

A look inside- Mississippi Today

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‘Death at your toes’: A look inside a Mississippi maternity care desert

YAZOO CITY — Jamara Johnson knew something was wrong when she went into labor with her third baby early in the morning of Aug. 30. 

She was 38 weeks pregnant and had been in pain the night before. She attributed it to overextending herself while cleaning her apartment in Yazoo City – “nesting,” she said. When her water broke around 5 a.m. – a greenish color she’d never seen with her first two babies – she realized she needed to get to a hospital as quickly as possible. 

Johnson lives in a county defined in a new report as a “maternity care desert” — there have not been any labor and delivery services in Yazoo County since the early 1990s, and there are no practicing OB-GYNs. Many women go to the Federally Qualified Health Center about a half hour away in Canton, while others, like Johnson, see the doctors at an OB-GYN group in Flowood, more than an hour away from her home.

More than half the counties in Mississippi are considered maternity care deserts, according to the new report from the March of Dimes. These counties have no hospitals providing obstetric care, no OB-GYNs and no certified nurse midwives. 

Discontinued labor and delivery services and shuttered neonatal intensive care units have dominated headlines in the in recent months, painting a bleak picture for mothers and babies’ access to care. Greenwood Leflore Hospital closed Leflore County’s only labor and delivery unit on Oct. 15. Over the summer, Ochsner Medical Center in Hancock County did the same. 

The Mississippi Delta’s only neonatal intensive care unit closed in July. A few months ago, the NICU at Merit Health Central in south Jackson also shut down, raising concerns about disruptions in care for high-risk moms and babies.

The trend of reduced access and care for mothers and babies — on the heels of the Dobbs decision that overturned and is expected to result in 5,000 additional babies in Mississippi alone — does not bode well for a state already plagued by high infant and maternal mortality rates and poor health outcomes.

Dr. Rachael Morris, assistant professor of maternal fetal medicine at the , travels the state training emergency responders, nurses and providers in small, rural hospitals in obstetric emergencies and caring for pregnant and recently delivered mothers who may have complications or life-threatening problems. 

The state’s problems did not happen overnight, she said. 

“But it’s really only getting worse. The nature of this problem, it’s additive at this point,” she said. “We have a very complex, medically diverse, underserved population with a lot of high-risk patients, whether it’s diabetes, obesity, hypertension — this is a lot of our mothers in Mississippi. So when you have that baseline complexity, that creates a very high-risk population for pregnancy.”

The unhealthy population in Mississippi, a leader nationally in chronic disease, means women of childbearing age are already behind the starting line. When emergencies come up – as they will do in high-risk pregnancies – access to nearby care is critical.  

“When you’re talking about a baby and a pregnancy and a delivery, minutes matter for that mom’s health and that baby’s health,” said Dr. Anita Henderson, president of the Mississippi chapter of the American Academy of Pediatrics. 

Minutes mattered for another Yazoo City woman with eerily similar circumstances as Johnson: Tamara Stuckey was also pregnant with her third child and was a patient at the same OB/GYN group in Flowood as Johnson. On Aug. 28, 2019, the 32-year-old Stuckey was 35 weeks pregnant and taken by ambulance from her home in Yazoo City to St. Dominic Hospital, according to a filed by her fiance and the father of her other two children. 

She was complaining of constant and sharp abdominal pains, and her medical records indicated Stuckey, who had given birth by cesarean section for both previous babies, was at high risk for postpartum hemorrhage. Her OB-GYN ordered a fetal ultrasound but did not investigate her complaints of “uterine irritability,” or mild contractions, and pain in her right shoulder, according to the complaint. She was discharged that evening and sent back home — an hour away.

That same night, her fiance called emergency medical services again. Stuckey reported a pain level of 10 on a scale of 1 to 10, the complaint states, and was again transported to St. Dominic. She arrived at the hospital around 1:18 a.m. Her baby, a little boy they planned to name Daxton, was already dead. The complaint says medical records indicate the last fetal heart tones detected were at 1:01 and 1:02 a.m. 

Within 30 minutes of arriving at the hospital, Stuckey went into cardiopulmonary arrest. Her baby was delivered stillborn early that morning, and the next day, Stuckey died.

“The maternal autopsy report revealed massive intrapartum hemorrhage, with the abdominal cavity containing four liters of free blood,” the lawsuit complaint states. 

Stuckey’s fiance Damien Sanders and his attorneys declined to be interviewed for this story.

In their response to the complaint, Women’s Health Associates and Dr. David Waddell, Stuckey’s OB-GYN, denied the allegations and agreed only to the basic facts listed in the document. St. Dominic Memorial Hospital and St. Dominic Health Services both said in their responses that the injuries and damages to Stuckey “resulted from medical conditions, events or the acts or omissions of persons or entities other than St. Dominic.” 

Baptist Medical Center – Yazoo in Yazoo City, Mississippi. The hospital offers no obstetric services.

Johnson didn’t want to risk her baby’s life by waiting. 

She called her doctor’s office immediately when her water broke, and a nurse said to get to St. Dominic as quickly as possible. The discoloration meant the baby was at risk for meconium aspiration, which can occur when the baby passes his first stool (meconium) while in the womb. Aspiration can occur when the newborn breathes in a mixture of meconium and amniotic fluid (the liquid that surrounds the baby in the womb). 

The condition can cause difficulty breathing, pneumonia, and at worst,

In the bathroom early that morning, Johnson weighed her options: she could wait for who knows how long for an ambulance to come to her apartment, or she could go to Baptist Memorial Hospital-Yazoo, where she would then be transferred via ambulance to Jackson. 

Or, since she wasn’t having contractions yet, she could get in the car and drive.

She had made this same game-time decision less than a year before when she went into labor with her second child on Sept. 20, 2021. She drove with the child’s father to the Yazoo City hospital but didn’t bother getting out of the car when they saw there was no ambulance there, so they decided to take their chances. 

Less than an hour after leaving the hospital, Johnson called 911 and they pulled over in Sullivan’s Grocery in Flora. Minutes later, Johnson gave birth in the back of an ambulance in the grocery store parking lot at 1:45 a.m. 

“If I was still in Yazoo City, I would’ve had to wait on that same ambulance (that met me in Flora) to come, so I just went on and took my chances,” Johnson said of her decision. 

With her third delivery, she felt even more pressed for time: she needed to get to a hospital capable of treating her baby in case there was something wrong. She called her aunt Summer Brokman, who lived about five minutes away, and asked her to go with her to the hospital. The two started the drive with their hazard flashers on. About 30 minutes into the hour-long drive, Johnson was stopped again — but this time, it was in Pocahontas, and it was for a different reason.

A Highway Patrol car had pulled the two over on Highway 49.  

Brokman told her to try and be calm and not make any sudden movements. But Johnson, who had been driving until that point, was starting to have contractions and was in pain.

The officer asked for Johnson’s license and registration, and Brokman pleaded with the officer.

“I was like, ‘Sir, look, she’s having a baby. She’s in labor, she delivered her last baby on the side of the road … can you follow us to the hospital?’” Brokman recalled. “And he was like, ‘License and registration.’” 

The two were shocked, but Johnson produced her driver’s license, and they sat on the side of the road while the officer ran it through the system. More than 10 minutes later, they said, he came back and issued Johnson two tickets: one for speeding and the other for not having insurance. 

“He’d asked me for insurance and I told him I couldn’t — I was in too much pain to search for it,” Johnson remembered.

Brokman looked for it but couldn’t find it, she said. 

The trooper finally let the two go, and Brokman took over driving. They made it to Jackson, and Johnson’s son was born around 9 a.m. — about two hours after the trooper had written her the ticket.

Criss Turnipseed, director of public affairs at the , said they have no official protocol as to how to handle medical emergencies, and it is “left to the Trooper’s discretion.” 

“Our first preference for those instances is always to call 911 first. There is no ‘official’ protocol for how a Trooper should proceed with someone claiming there is a medical emergency on a traffic stop other than based on his observations and the severity he is authorized to request an ambulance to the scene himself,” Turnipseed said in an emailed statement to Mississippi Today. 

Turnipseed said he had no comment on what happened to Johnson and Brokman. 

Now, more than three months later, Brokman and Johnson can’t help but think of all the things that could have gone wrong that day. They say they commonly hear stories about women in Yazoo City giving birth on the side of the road — like Johnson did in 2021 — and they were glad they made it to a hospital.

“My momma used to always tell me when I was young: ‘When you’re having a baby, you’re closer to death than you’ll ever be in your life,’” Brokman said. “Death is at your toes.”

That statement is especially true in Mississippi, which leads the nation in maternal and infant mortality. And it is even truer for Black women and babies, who are significantly more likely to die in childbirth than their white counterparts. 

The pregnancy-related mortality ratio was 33.2 deaths per 100,000 live births between 2013 and 2016 — nearly double the national average of 17.3 deaths per 100,000 births. 

The same is true for babies: the state has the highest rate of infant mortality in the nation, and the rate of death in Black infants is twice that of white babies. 

For Black women in Mississippi, the rate was about three times the rate of white women at 51.9 deaths. 

The state also has one of the highest rates of uninsured people in the country – a problem the March of Dimes report highlights when discussing the importance of quality care before having a baby, during pregnancy and after.

“Continuous high quality in all three time periods can lead to better health outcomes for both mom and baby,” the report states. “… Stalled progress to improve pregnancy outcomes has, in part, pointed towards inconsistent health interventions before pregnancy.” 

Greenwood Leflore Hospital, which permanently shuttered its labor and delivery unit as the hospital fights to cut costs and stay open, welcomed just over 2,000 babies into the world over the last five years. 

But now, any babies born at the hospital will be born in the emergency room, where interim CEO Gary Marchand said the hospital has relocated labor and delivery equipment. 

The closest hospital with labor and delivery services is in Grenada — a 45-minute drive or more for some in the area.

Providers and community members worry more women in Leflore County will have experiences like Johnson and Stuckey’s. Dr. Terry McMillin, an OB-GYN who has practiced in the Greenwood area for more than 20 years, said the closure of the unit is “devastating.” 

“In the short term, are you going to have potentially some bad outcomes? I can’t predict that, but certainly it only increases that likelihood,” he said.

The hospital now only has “limited obstetrical call available” — or several obstetricians who retained their privileges and can assist ER physicians if the situation warrants and they are available. 

“The March of Dimes report just illustrates that we have to find ways to provide access and health care to moms even in the midst of some of those maternity deserts, and having more and more labor and delivery units closing is just the wrong direction,” said Henderson, the head of the Mississippi pediatrician group.

The March of Dimes report ended with several policy recommendations, including expanding for individuals who make less than 138% of the federal poverty level, or about $30,000 annually for a family of three.  

Mississippi remains one of 12 states not to expand Medicaid under the Affordable Care Act — and one of 21 states not to extend postpartum Medicaid coverage for new moms beyond 60 days to 6 months or a year, another recommendation of the report.

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

Lawmakers pass $247M in incentives for aluminum mill

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Lawmakers pass $247M in incentives for aluminum mill

The Mississippi , in a one-day special session with only a handful of dissenting votes, approved $247 million in taxpayer-funded incentives to help a company build an aluminum mill and other operations near Columbus and create at least 1,000 jobs.

Lt. Gov. Hosemann said Mississippi was in competition with at least two other states for the project. Gov. Tate Reeves said Monday when he called the special session on short notice that the incentive package needed to be approved quickly to help the company with “speed to market” and ensure the mill was built in Mississippi.

officials said they agreed not to name the company until the deal was inked, and referred to the deal as “Project Triple Crown” during Capitol deliberations Wednesday. But numerous sources and industry trade journals said the parent of the deal is Fort Wayne, Indiana-based Steel Dynamics, the third-largest producer of carbon steel products in the U.S.

The company already has a steel plant in Columbus. Over the summer, Steel Dynamics announced plans to build three large facilities — including one in the Southeast — to supply the automotive and packaging industries with flat-rolled recycled aluminum material. An officer for Steel Dynamic recently filed paperwork with the state registering Aluminum Dynamics LLC in Mississippi.

“A $2.5 billion project doesn’t come to Mississippi very often,” Hosemann said, “but it will be happening more often because Mississippi is open for business.”

House Speaker Philip Gunn, R-Clinton, said the project “would be a big economic development opportunity for the Golden Triangle, creating at least a 1,000 jobs and hopefully economic prosperity.”

(Note: Details of deal are itemized below in this article)

While there were few dissenting votes on Wednesday, Democrats and even some Republicans questioned why lawmakers rushed to pass the incentives deal while ignoring other problems pressing the state.

When asked about why lawmakers were not spending or passing policy to tackle water infrastructure woes, hospital closures and other urgent issues, Hosemann noted that only the governor can call lawmakers into special session and set the agenda. He vowed the Legislature will tackle such issues when the regular session starts in January.

“In about eight weeks you’ll see us tackling all the rest of it,” Hosemann said. “This particular Legislature has not been timid in looking at issues and I anticipate those issues will range from water and sewer to hospitals and just about anything else the Legislature thinks should be addressed.”

The bills for the incentives passed the 122-member House with only five “no” votes — all from conservative or Libertarian leaning Republicans who oppose “corporate welfare.” Four House Democrats voted present. In the Senate, the measures passed with no dissent and only Kathy Chism, R-New Albany, present.

Rep. Robert Johnson, D-Natchez, expresses his concerns during a press conference about Gov. Tate Reeves’ plan for an economic development project after the Senate passed it during a special session at the Mississippi Capitol in Jackson, Wednesday, November 2, 2022.

But legislative Democrats held a conference during Wednesday’s session to point out emergency needs facing the state.

“No one here is arguing that economic development isn’t a good thing,” Rep. Robert Johnson of Natchez, the House Democratic leader, said Wednesday on the south steps of the state Capitol. “But while we’re in this building, facing a crisis that affects each and every Mississippian, we should talk about solutions. It would be malpractice to walk out of here, at the height of this crisis, without passing legislation that would begin to address the myriad issues facing our state’s system.”

Given past boondoggles that left Mississippi taxpayers on the hook for millions when companies went belly-up or didn’t deliver jobs for incentives, legislative leaders assured their colleagues Wednesday that this deal includes stringent “clawback” and other measures to protect the state.

“I think these are the strictest clawbacks we’ve ever done,” said Senate Finance Chairman Josh Harkins, R-Flowood. “In large part, it wouldn’t even be clawback — it’s on reimbursement. We’re not just going to cut them a check up front. It will be provided as reimbursement once they’ve done certain things … This is a strong, performance-based contract, if you will. They’ve got to produce to get incentives.”

Tax rebates and abatements would be suspended if the company didn’t meet job and investment benchmarks laid out in phases, lawmakers said, although state Rep. Shanda Yates, I-Jackson, noted during floor debate that the language in the bills said the Mississippi Development Authority “may” enforce clawbacks and suspensions, not “shall.”

House Ways and Means Chairman Trey Lamar said this was to give MDA ability to negotiate with the company to get it back in compliance and he assured colleagues state taxpayers would be protected. He said that all clawback provisions are with the parent company, which is “well-heeled” and not a start-up like some of the companies that burned the state in the past.

Reeves and others called the deal the largest economic development project in state history, and said the company is promising the average salary for the jobs will be $93,000 a year. Hosemann said he was told the lowest salaries for the project would be “$58,000 plus bonuses.”

Lamar said: “This will be life-changing money for families not used to making that much money here in the state of Mississippi.”

Some highlights of the “Triple Crown” deal:

  • Lawmakers authorized state borrowing up to $246.7 million — enough to cover the entire incentives package the company wants, including grants, road work, tax breaks and land. This was to ensure the company all incentives are guaranteed. But lawmakers approved spending $81.1 million in cash up front, and said they hope to not borrow any money for the deal but pay cash as it goes along as long as state finances remain rosy. The first borrowing would not take place for three years, regardless, Hosemann said.
  • The incentives include $155 million in grants for the company. This would include $54 million in a first payment, then other “tranches” as various buildout and hiring goals are met. The state is also loaning $18 million to Lowndes County to purchase the remainder of the 2,100 acres the company plans to use. The grants also include $25.1 million in state road work for the project.
  • The incentives include up to $92 million in tax incentives and rebates, much of this tied to jobs created. Because the state is still considering massive tax cuts or elimination, the state will guarantee up to $45 million in a reserve account if the company keeps adding jobs, even if lawmakers eliminate or cut taxes further. Lowndes County is also providing major local tax breaks for the company.
  • The company is pledging to invest $1.9 billion in a recycled aluminum flat rolled mill and create 700 jobs. It pledges to invest $150 million in a “Renewable biocarbon facility” and create 40 jobs. An MDA official told lawmakers this plant would burn organic material to create ash that would provide feed stock for steel production.
  • The company has pledged $200 million in investment and 160 jobs from other businesses — customers and suppliers — locating at its new aluminum mill campus. Lawmakers said that although this would be other companies, the parent mill company would be on the hook for this as part of the incentives deal. The company has also promised to invest $250 million in a “Future project to be named later” and create at least 100 jobs.

Flanked by the primarily African American Democratic legislative caucus, Johnson dropped to ground bills that would:

  • Expand to provide coverage to primarily the working poor.
  • Provide $40 million to the beleaguered Jackson water system to deal with immediate issues regarding accessible and quality drinking water.
  • Provide grant funds for rural hospitals.

He said those bills were ready to be taken up immediately if the governor would include them in the special session. The governor has indicated those issues can be considered during the regular session.

Johnson pointed out state Health Officer Dr. Dan Edney recently said as many as six hospitals were in danger of closing.

The closure of the hospitals would negatively impact Mississippi’s health care outcomes that already are the worst in the nation. The hospital woes are occurring, Johnson said, as state officials projected an additional 5,000 births per year with the Supreme Court decision giving states the right to ban as Mississippi has done.

In addition to being issues of life and in terms of having quality water and accessible health care, the Democrats said they also were economic development issues.

Derrick Simmons of Greenville, the Senate Democratic leader, said expanding Medicaid, by accepting more than $1 billion annually in federal funds for health care would provide more economic development for the state than the aluminum plant.

The closing of the hospitals in Greenville and Greenwood would result in greater job losses than the aluminum would produce.

“Apparently, only new jobs constitute an emergency meeting of the Legislature,” Simmons said. “The jobs that hardworking continue to lose as hospitals close do not. That logic doesn’t add up.”

On social media, state Rep. Zakiya Summers, D-Jackson, said, “Mississippi needs economic development. Yet we are not having a special session on the water crisis or hospitals closures happening across the state. Mississippi needs those basic services as well.”

Johnson said the economic development package could have been passed in the regular session, beginning in January. Instead, he called the special session “a campaign event — a political pep rally” for the governor.

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

Some leaders ignore health care woes at Hobnob Mississippi

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State’s health care woes ignored by some, but not all at annual Hobnob

“Only positive Mississippi spoken here,” a phrase coined by former Gov. Kirk Fordice, was the theme for the most part of the politicians at the annual Hobnob event sponsored by the ’s Economic Council.

But two politicians – Lt. Gov. Delbert Hosemann and Insurance Commissioner Mike Chaney – devoted much of their speech at the Mississippi Economic Council’s annual Hobnob to the state’s troubled system and the financial difficulties that many of the state’s hospitals are facing.

“Would you locate (a business) in a state that you don’t have health care?” Chaney asked of the crowd of about 1,000 primarily business leaders gathered at the Mississippi Coliseum to hear from the state’s political leadership. “I don’t think you would.”

Hosemann said the Senate would be looking at health care issues during the upcoming session. He also said the legislative leadership should not be scared away from efforts to improve health care by “that X word.”

Hosemann was presumably referring to expansion where, through primarily federal funds, the state could provide health care for about 200,000 poor Mississippians, mostly people who work in jobs that do not offer health insurance. Hospitals have argued that expanding Medicaid like 38 other states have done would help them financially.

At the very least, the lieutenant governor said the state should extend Medicaid coverage for mothers from 60 days after giving birth to one year.

“How can we not be pro-life and pro-child at the same time?” asked Hosemann. “That does not make sense to me.”

While not definitively endorsing Medicaid expansion, Hosemann has said the state should look for the most efficient and inexpensive way to improve health care access in the state. Many argue that expanding Medicaid with the federal government paying most of the costs would be the best way to do that.

Chaney told reporters after the speech he supported Medicaid expansion and that he believes Hosemann does, too. But passing Medicaid expansion will be difficult with both Gov. Tate Reeves and Speaker Philip Gunn in opposition.

Reeves kept his speech positive, not mentioning health care at all.

But after the speech, he reiterated to reporters his opposition to Medicaid expansion.

“I remain opposed to expanding Obamacare in Mississippi …” Reeves said. “No doubt we’ve seen certain health care institutions in our state and across the country struggling, due to leadership decisions that were made in those specific instances. The pandemic certainly didn’t make it any easier.”

Reeves said a solution to Mississippi’s dire health care issues is doing away with the state’s certificate of need (CON) requirements. CON laws regulate approval of major projects or expansions for health care facilities, aiming to control health care costs by reducing duplicative services and restricting where new facilities can be built and operated. Mississippi and 34 other states have varying CON laws.

Reeves said this thwarts competition, and “competition tends to drive down costs.”

“For instance, the doesn’t have to adhere to CON rules, but everyone else does,” Reeves said. “That doesn’t make any sense whatsoever.”

Opponents of removing the CON process say they fear it would result in even fewer hospitals and other health care facilities in poor and underpopulated areas.

On other topics, Reeves said Mississippi is in historically great financial shape and vowed to continue to push to eliminate the state’s personal income tax.

“You have my word that as long as I’m governor I will never stop fighting to fully eliminate the income tax in Mississippi,” Reeves said. He said this will make the state more competitive for economic development with Texas, Florida and Tennessee – states that have no personal income tax.

“Mississippi in virtually every category is climbing the national ladder,” Reeves said. He said the state has seen a record $3.5 billion in capital investment so far this year with “more capital investment in 2022 than we saw in the five years previous to me becoming governor.” He said the state has made great gains in K-12 education, including increasing the graduation rate from 72% to 88.5% during his time in office, now above the national average of 86.5%.

Reeves vowed to push for “good jobs with above-average wages,” and quoted from his first state-of-the-state address: “At the end of my time as governor, we will measure our success in the wages of our workers.”

According to a recent U.S. Census report, Mississippi has the nation’s lowest median household income at $46,511, compared to $67,521 nationally. Mississippi also has the highest poverty rate, with 18.8% of people living at or below the poverty level.

Chaney spent much of his speech criticizing both the University of Mississippi Medical Center and Blue Cross & Blue Shield of Mississippi for their inability to settle their contract dispute, which is impacting tens of thousands of Mississippians. People insured through Blue Cross have been out of network with UMMC since April 1.

“Both parties in this dispute are wrong,” Chaney said. “UMMC is asking for too much, and Blue Cross can give more.”

Chaney later told reporters that he believes the dispute could be settled, though, in the coming days.

Chaney said UMMC is “using (patients) as pawns for a money grab … On the other side Blue Cross is not right, either.”

The Republican insurance commissioner also told the crowd that UMMC has written a letter to a Medicaid managed care company demanding a higher reimbursement rate. If UMMC is not included in the network for the managed care company, this could impact health care for many of the Mississippians covered through Medicaid.

There are three companies – Magnolia, United and Molina – that have managed care contracts with the Mississippi Division of Medicaid. Under the contracts, the companies provide health care services for the Medicaid patients at a set rate paid to them by the state. Under that process, the companies reimburse the health care providers for the services provided to Medicaid recipients.

In response to Chaney’s comments, Dr. Alan Jones, associate vice chancellor for Clinical Affairs told Mississippi Today: “In the course of normal business operations, all health care institutions enter discussions with payor partners about new or current contracts, sometimes several months before the end of a current agreement. These routine engagements are necessary to ensure contracts meet the needs of our patients who are their health plan members.

He added, “Currently, we are in normal contract-related discussions with Magnolia Health Plan on the agreement that covers UMMC care provided to their managed Medicaid health plan members. Our intent is that these standardized discussions will soon yield a new agreement and we will continue our strong partnership with Magnolia and health care relationship with their members.”

Chaney also predicted that efforts to negotiate a lease agreement between the Greenwood LeFlore Hospital and UMMC would be unsuccessful and that the financially troubled hospital would close, negatively impacting health care throughout the Delta.

Chaney said the state’s health care issues must be solved if the state is to prosper.

Also speaking were Auditor Shad White, Secretary of State Michael Watson, Lynn Fitch, House Speaker Philip Gunn, Agriculture and Commerce Commissioner Andy Gipson and Treasurer David McRae.

Gipson, wearing his cowboy hat, sang a portion of the song “A Country Boy Can Survive” before praising the work of Mississippi farmers.

Watson, who has been mentioned as a possible gubernatorial candidate at some point – perhaps even against Reeves in the 2023 Republican primary – said, of next year’s election, “We need leaders who care more about Mississippi than their careers. I hope you help me elect those folks.”

While not being specific, Watson referenced some “tough times” possibly ahead for the state in terms of health care.

White said that as auditor, he gets to “look under the hood of Mississippi government,” and see what works and what doesn’t. He said the state’s workforce is the biggest issue he sees, and he offered four ideas to improve it.

“First, an earned income tax credit,” White said. “If you go from unemployed to employed, you get a tax cut … 29 other states have this … It’s one of the best things to get people off the couch and off the sidelines and working … There are some folks who want to just hand a bunch of money to poor people. That is not going to juice our .”

White said the state should use its federal Temporary Assistance for Needy Families money – the source of a major fraud and misspending case White’s office uncovered – to fund the tax credits, as 20 other states do.

“Second, we’ve got to address brain drain,” White said. “From 2015-2019 we spent $1.5 to $2 billion on higher education, and we only kept 50% of the graduates in Mississippi.”

White said his office has a fellowship program that helps cover tuition for future auditors, provided they stay with his office for two years. He said this could be replicated for other professions statewide.

“Third, fatherlessness,” White said. He said too many children are growing up in broken homes and are not prepared to succeed when they become adults. He said, “There are all sorts of social maladies from not having engaged fathers in the home.” White said the Junior ROTC program in Jackson is an example of a program that helps with this issue – with retired military people mentoring youth. He said the program at JPS has a “100% graduation rate.”

Fourth, White said, “is the city of Jackson.”

“Jackson is our number-one talent magnet in this state,” White said, “with 30% of our graduates coming to work in .”

He said, “Jackson’s magnet is going to turn off unless we learn how to collect the garbage, keep the water clean and not be the per-capita homicide leader in the country.”

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

Medicaid: Advocates say it isn’t doing enough to educate beneficiaries

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Almost no one attends Medicaid’s workshops for beneficiaries. Advocates suspect Medicaid is fine with that.

SOUTHAVEN – Last week, staff from the Division of and three managed care companies that serve Medicaid enrollees assembled at a public library in Southaven. Standing in a large meeting room in front of a dozen empty plastic chairs, they explained who Medicaid recipients can contact for transportation to appointments, how to get benefits like free produce, and how to access additional resources for dental and eye care.

But not a single Mississippi Medicaid enrollee was there to hear the presentation. 

Low attendance has been the rule at this year’s workshops for beneficiaries – and advocates say that’s because Medicaid has done too little to promote the events. They see a pattern of poor communication with enrollees that makes it harder for them to understand their benefits and access

In the coming months, that could have serious consequences for the 867,000 Mississippians now enrolled in Medicaid. When the federal public health emergency ends, potentially as early as January, Medicaid enrollees will lose coverage for the first time since March 2020 if they don’t update their information to prove they are still eligible. 

Mississippi estimates that 14% of enrollees, or more than 121,000 people, will become ineligible. But people who remain eligible will also be kicked off the program if they don’t know they need to update their information. 

Roy Mitchell, executive director of the Mississippi Health Advocacy Program, said the workshops would be a good opportunity to make sure people understand the coming changes and take steps to keep their coverage. 

But almost no one has attended the workshops, which were not promoted through direct mailings despite the use of that tool in the past.

“It’s just presumed that if people know more about the programs, that the programs will work better,” Mitchell said. “And it’s almost as if there’s a deliberate attempt to hide the ball here. And people are frustrated. The beneficiaries are frustrated. The providers are frustrated.”

So far this year, the Division has hosted eight workshops around the , including one in Meridian on Oct. 26. No one attended the workshops in on Sept. 20 and in Starkville on Aug. 25. One person attended the Corinth workshop on Aug. 18, and only a handful attended the events in Vicksburg and Greenwood, according to records obtained by Mississippi Today through a public records request. 

The largest number of attendees recorded at the in-person workshops was in Jackson, with 12. 

Only one person came to the Southaven workshop: A mom who had questions about unexplained recent changes to her daughters’ coverage. She left after speaking with Medicaid staff, so a Mississippi Today reporter was the only person present for the presentation. 

Medicaid said it uses social media to promote the workshops, and it created a flier that was available on its website. But a Mississippi Today review of the agency’s Facebook and Twitter accounts found the agency made only one Facebook post about the workshops before they kicked off. 

The agency’s two tweets were both posted after six of the 10 workshops were already held – and after Mississippi Today sent records requests and questions seeking information about how they were being promoted. 

A tweet and Facebook post about the Southaven workshop were both posted just 90 minutes before it was set to begin.

By contrast, Medicaid posted on Facebook seven times in August, September and early October about workshops for providers to learn about Medicaid’s new billing system. 

Medicaid officials also said they reached out to the Mississippi Head Start Association “and other community groups” to spread the word. The director of that organization told Mississippi Today she had no knowledge of Medicaid working with her group to promote the workshops.

When Mississippi Today followed up to ask about the discrepancy, Medicaid spokesman Matt Westerfield said they had misspoken and did not in fact reach out to the Mississippi Head Start Association this year. He said the managed care organizations shared information about the workshops with “a wide range of groups such as the Health Department, Goodwill and Salvation Army organizations, churches and school districts.”

Managed care staff at the Southaven workshop said that case managers promoted the workshops during conversations with members. The companies also promoted the workshops on their websites, at community events, and through emails to community partners like federally qualified health centers, according to documents Mississippi Today obtained through a records request. 

Staff at the Southaven workshop said they believed the pandemic led people to lose the habit of attending in-person events, and they anticipate attendance will be higher at two virtual workshops in November

The attendance figures are a sharp decline from 2019, the last pre-pandemic round of workshops, when a total of 307 beneficiaries attended 20 workshops across the state – an average of about 15 people per event. (Medicaid held twice as many workshops in 2019 as in other years because there was a new managed care Children’s Health Insurance Plan provider that year.)

And they are an even steeper decline from 2018, when the Division sent a direct mailing to every beneficiary, letting them know when and where they could attend a workshop in their area.

That year, an average of 24 people attended each of the 10 workshops. The year before, average attendance was eight.

Westerfield said the agency did the mailing in 2018 to get the word out about a new managed care organization that had been added. The agency’s “fiscal agent,” a contractor that assists with claims processing and payment, absorbed the cost of the mailing, but Medicaid paid $7,745.59 for postage, according to records Mississippi obtained through a request. 

“Over the years we’ve tried different avenues for reaching beneficiaries, and from what I understand the 2018 mailing wasn’t as effective as we’d hoped,” Westerfield said, though the mailings were associated with a three-fold increase in average attendance.

Westerfield said that the agency has discussed trying mailings again in the future.

Molina , one of the managed care organizations that serves Mississippi Medicaid enrollees, brought this mobile clinic to a workshop for beneficiaries in Southaven on Oct. 19. But only one beneficiary attended, and she did not tour the mobile clinic.

Joan Alker, executive director and co-founder of the Center for Children and Families (CCF) at Georgetown University and an expert on Medicaid, said state Medicaid agencies owe it to taxpayers to make sure enrollees are informed about their benefits. For people enrolled in managed care, the state pays a certain amount of money to the company every month, regardless of the services used. The money is wasted if people aren’t using services because they don’t fully understand their eligibility.

“It’s extremely pennywise and pound foolish, to not be informing beneficiaries of this health insurance that’s being bought for them with taxpayer dollars,” Alker said. 

Medicaid has acknowledged that its communications with beneficiaries during the public health emergency have sometimes been confusing. 

Mississippi Today previously reported that Medicaid told postpartum women they were losing their coverage 60 days after giving birth as usual during the public health emergency, even though that wasn’t true. Medicaid then sent postpartum women a second letter later telling them they still had coverage during the COVID-19 pandemic, but several recipients told Mississippi Today they were confused – if they got the second letter at all – and delayed seeking care because they thought they would have to pay out of pocket. 

Medicaid has now paused the confusing letters, according to documents obtained by Mississippi Today.

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

Greenwood Leflore Hospital faces closure as negotiations with UMMC stall

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‘A death sentence’: Delta hospital faces closure as negotiations with UMMC stall

Greenwood Leflore Hospital could close by the end of November as negotiations between the hospital and the stall, interim CEO Gary Marchand told staff in a memo Tuesday. 

After waves of layoffs and service reductions over the last few months, hospital administrators had hoped to stay afloat until the end of next month and then transition operations to UMMC by early December. They are now looking at further cuts “that might allow certain services to continue into 2023,” Marchand wrote. 

“In the absence of this plan, the closure of the hospital remains a possibility,” the memo said. 

The two parties had been negotiating a lease agreement with an eye toward Nov. 17, the date of the last meeting for the Institutions of Higher Learning, which would need to approve any lease agreement. 

The Greenwood Commonwealth reported that Marchand said UMMC told him Tuesday they had out of time to finalize documents ahead of that meeting. 

Federal and regulations and questions around the hospital’s outstanding debts remain stumbling blocks in the negotiations. The Commonwealth reported that Greenwood Leflore owes Medicare $5.6 million for advance payments it got when the pandemic started. UMMC does not want to take on that debt, and the Delta hospital is hoping its owners – the city of Greenwood and Leflore County – will step in.

Marchand and hospital spokeswoman Christine Hemphill were not available for interviews on Wednesday, but on Wednesday afternoon Hemphill provided written answers to questions sent by Mississippi Today.

Marchand met with the Greenwood city council at 9 a.m. Wednesday to discuss whether the city can help pay the hospital’s debts. Hemphill said the city council “acted to fund a letter of credit to resolve their share of the funding gap,” and that the county will meet Friday to discuss the same topic.

She added that the hospital plans to make decisions next week as to what lines of service to cut.

UMMC and Greenwood Leflore have been working on the agreement since the summer. But State Health Officer Dr. Daniel Edney seemed to allude to the ongoing threat to the hospital’s existence during the state board of health meeting earlier this month, when he described infrastructure in the Delta as “very fragile” and said at least six hospitals in the region are facing dire financial challenges.

“Despite what’s been reported in the media, currently there are no solutions for those hospitals,” he said. “No one’s coming to the rescue.”

Mississippi Today has reported on the financial struggles at Greenwood Leflore, Sharkey Issaquena Community Hospital, and Delta Health System. Liz Sharlot, the health department’s communications director, said she could not name the other hospitals Edney was alluding to because that information came from “private conversations.”

IHL could hold a special meeting later than Nov. 17. But UMMC told Mississippi Today on Wednesday they are not aware of any plans for that. 

The hospital declined to answer other questions about the negotiations. 

Gov. Tate Reeves could call a special session of the to craft a package to keep Greenwood Leflore open, but has given no indication that he will. His office did not respond to a request for comment on Wednesday.

Dr. Roderick Givens, a radiation oncologist at the hospital, attended a meeting for physician staff where Marchand gave updates at 7:30 a.m. on Wednesday. He said Marchand reassured employees that UMMC still intends to pursue the lease agreement.

“That at least satisfied everyone that hey, no one’s walking away from the table,” Givens said.

Givens said the closure of the hospital would further reduce access to health care for Delta communities that are disproportionately low-income.

“It essentially becomes a death sentence to a number of people,” he said. 

The 208-bed hospital is also one of the largest employers in the area, so its closure would hurt the local as well. According to Hemphill, Greenwood Leflore directly employs 589 people full- and part-time, and the food provider Aramark employs an additional 70 people full-time.

Givens said he didn’t understand why state leadership has not stepped in to help hospitals around the state that are struggling to stay open. Mississippi has one of the country’s highest rates of people without insurance, due to the state’s refusal to expand to low-income working adults. 

That means that hospitals face a higher burden of providing care for which they will never get paid. Hemphill said that costs Greenwood Leflore about $550,000 every month, around 6 to 7% of the hospital’s total costs.

Mississippi hospitals are also dealing with supply chain and staffing issues that affect small hospitals around the country. 

“It’s kind of baffling why there’s not at the state level, at least meaningful conversations that say hey, how can we help?” Givens said. “What is it that the government can do with regards to assistance to keep these hospitals open? It’s kind of a deafening silence.”

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

12,000 poor Mississippi kids slated to lose child care

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12,000 poor Mississippi kids slated to lose child care, welfare chief warns lawmakers

The number of spots in child care for poor children in Mississippi will be reduced by 12,470 in September 2024 when the state’s allotment of federal relief funds is exhausted, a special Senate committee was warned on Tuesday.

The Mississippi Department of Human Services is currently using a substantial portion of its federal COVID-19 relief funds to open more spots in child care for poor parents working in low paying jobs, going to school or looking for employment.

But those COVID-19 funds are to be spent by September 2024, meaning the state will have only its normal federal appropriations to direct to the child care block grant, said Bob Anderson, the executive director of the Mississippi Department of Human Services.

The state is using the federal child care funds to provide services to 35,646 children across the state, according to latest statistics. But the COVID-19 funds the Department of Human Services is directing to child care is paying for the services for more than 12,400 of the children.

Anderson’s revelation came at hearings held by a special state Senate panel of lawmakers who have said they aim to pass policies to help women and children following the ’s striking down of .

The nine-member Senate Study Group on Women, Children and Families, chaired by Sen. Nicole Akins Boyd, R-Oxford, was announced by Lt. Gov. Delbert Hosemann after the nation’s high court in June struck down longstanding Roe v. Wade and a dormant Mississippi ban on the books subsequently took effect. Hosemann said it’s now incumbent on lawmakers to come up with policies to help mothers and children as experts predict the state will see an additional 5,000 unplanned births a year.

State Sen. Rod Hickman, a Democrat from Macon, asked Anderson at Tuesday’s hearing whether the state could use a portion of its federal TANF funds, normally called welfare benefits, to pay for the child care spots the state is slated to lose in September 2024.

Anderson said using TANF funds to shore up the child care program is “an option we are exploring.”

“We would be allowed to use up to 30% of the funds,” Anderson said. “But understand, people have a lot of other plans for that money as well. But yes, that’s always an option, assuming we haven’t already committed some of it.”

Mississippi is currently leaving about $18 million in available TANF funds on the table, according to information MDHS provided to Mississippi Today as well as a review of public expenditures. That could provide a year’s worth of vouchers for 4,600 children based on the 2022 reimbursement rate of $3,911 annually. In the most recent available federal report for 2020, Mississippi had an unused balance of roughly $50 million in federal TANF funds.

Anderson said that ultimately he would make the decision whether to convert some of the TANF funds to the Child Care Development Fund program.

Health, education and business experts told the panel Tuesday that lack of affordable child care is a major impediment to Mississippi moving forward economically and socially.

READ MORE: ‘We’re 50th by a mile.’ Experts tell lawmakers where Mississippi stands with health of mothers, children

“The number-one topic that continually comes up is child care, or lack of available child care,” said Ryan Miller, director of Accelerate Mississippi, the state’s workforce development agency. “It is a real issue, and anecdotally, industry has been saying this for years.”

Miller said lawmakers should consider tax or other financial incentives for businesses to create child care programs, consider providing more state funding for programs and eliminate policies that thwart single parents’ access to child care. Miller and others testifying Tuesday said that MDHS’ requirement — per state law — that single mothers identify a child’s father before receiving benefits such as child care appears to keep some from applying.

Boyd said she has heard this brought up repeatedly during committee research.

“I think there are issues about not only feeling like they’re being judged, but probably some protection reasons, safety for the mother,” Boyd said of the requirement.

Other requirements that prevent people from getting child care assistance — and thus from joining the workforce — include a state provision that single mothers turn their child support cases over to the state to participate in the federally funded Child Care Payment Program.

Gov. Tate Reeves’ appointed State Early Childhood Advisory Council has already recommended that the governor instruct MDHS this requirement, but it has not done so.

Anderson also told lawmakers how the so-called HOPE Act, passed in 2017 at the behest of the state’s Republican leadership to crack down on fraud in federal programs administered by the state for poor people, was actually costing the state money. The program looks for fraud by those receiving benefits through , Temporary Aid for Needy Families and other welfare-related programs.

Hickman questioned some experts who testified Tuesday about strict regulations Mississippi has put in place in the name of fraud prevention that instead just prevent people from applying or qualifying for programs.

Mississippi has in recent years been plagued with fraud and embezzlement of government money, but it has mostly been perpetrated by powerful politicians, bureaucrats and business leaders, not the beneficiaries of the programs. Notably, investigations continue into or misspending of tens of millions of TANF dollars, not by the few people who receive the benefits, but by those who were supposed to administer them or provide services.

“I believe in preventing fraud, but we need ideas that make sense and not just provide barriers to poor people receiving help,” Hickman said. “We’ve seen the amount of people applying for benefits dramatically dropped when we made all these requirements … But so much keeps getting fed into this thought that poor people are creating the fraud.”

Anderson said that MDHS is being required to create fraud and abuse systems “that we will never use” because they are redundant or not needed.

“It’s costing the state,” Anderson said.

Hickman asked Anderson if “we are costing the state by over-policing poor people” through the HOPE Act, Anderson said essentially that is true. Anderson, a former prosecutor who worked on governmental fraud cases, said fraud by the poor is “not a big part of the problem.”

He said the last two years prove that as the welfare fraud case has unfolded in Mississippi where numerous private contractors and those close to the contractors have benefitted from the program.

The Mississippi Low-Income Childcare Initiative, led by longtime advocate Carol Burnett, is among numerous groups outlining issues faced by women and children in Mississippi and making policy recommendations to the Senate panel.

In a written statement to the committee, the initiative’s recommendations include:

  • Reducing the mounds of red tape single mothers face in enrolling in and staying in the federally funded Child Care Payment Program.
  • Mississippi using “every dollar it can” on childcare assistance to serve more families. Currently, only about 25% of eligible children are served.
  • Extending postpartum Medicaid for new moms from the current two months to 12 months.

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

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