Medicaid

Medicaid: Proposed pay increase could help in-home nurses

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Proposed Medicaid pay increase could help in-home nurses amid shortage

After three months and nearly losing her job, Shavondra Smalley of Natchez is hopeful her 8-year-old daughter can now get the medical care she needs so the mother can get back to work.

Smalley, who struggled to find nurses to care for her bed-bound daughter, is hopeful the situation will improve thanks to a proposed increase in pay from for private duty nurses and rewritten doctor’s orders that specifically allow for the use of licensed practical nurses when registered nurses aren’t available.

The nursing shortage, exacerbated by high-paying travel and contract nursing jobs, meant very few nurses were interested in working for the meager hourly reimbursement rate approved by Medicaid for private duty nurses, who work one-on-one with patients in their homes. And confusion over some of the care Smalley’s daughter Layla was receiving prompted a months-long period where the licensed practical nurses (LPNs) who had been taking care of Layla for years were no longer allowed by Medicaid.

This left Smalley, a single mother, with no choice but to take an unpaid leave from her job to take care of Layla, who is bed bound. Her daughter requires 20 hours of nursing care a day because of complex medical conditions including a rare brain malformation called lissencephaly. 

On average, each week for the last three months, they had a nurse for about 40 of the 140 hours Layla needed, Smalley estimated.

“The main issue was my child needed care and me being a single mother, I needed to work,” said Smalley. 

READ MORE: Nursing shortage, low reimbursement rates mean this 8-year-old can’t find care

Layla also suffers from scoliosis, chronic respiratory failure and pyruvate dehydrogenase complex deficiency, among other conditions. She is on a ventilator around the clock. 

She is enrolled in Medicaid’s Disabled Child Living at Home program, which allows certain disabled children with long-term disabilities or complex medical needs who live at home with their families to qualify for Medicaid. 

The state Division of Medicaid on Sept. 30 submitted an emergency amendment to the federal Centers for Medicare and Medicaid Services for a 15% increase in reimbursement rates for private duty nurses for as long as the federal Public Health Emergency lasts. The proposal is still pending before the federal government, but if approved, the increase will retroactively take effect as of Oct. 1. The amendment says the rate increase would be “to ensure that sufficient items and services are available to meet the needs of individuals enrolled in the respective programs… .” 

The Public Health Emergency could end as soon as mid-January, so the rate increase would expire at that point.

“We’re still evaluating private duty nursing rates post-Public Health Emergency, but doing the emergency amendment to the state plan is allowing us to be a little faster than what normally submitting things for federal approval is,” said Matt Westerfield, communications officer at the Division of Medicaid. “We’re attempting to provide as quick of a relief as we possibly can.” 

Currently private duty nurses are paid ranging from $17/hour for certified nursing assistants to $34/hour for registered nurses, or RNs. RNs who take care of patients on ventilators in the home – like Layla – are paid $51/hour. A 15% increase would mean the rates would rise to nearly $20/hour and $39/hour, and up to $58.65/hour for registered nurses taking care of patients on ventilators. 

Layla’s physician in September also rewrote a plan of care that calls for RNs but allows for LPNs when RNs are unavailable. The revised plan of care was originally denied by Medicaid, Smalley said, but she did what she’s been doing the past three months and picked up the phone, prepared to file an appeal. 

“I’d been speaking with a lawyer and she told me if I’m not happy with the services, I can file for an appeal,” Smalley said.

When she got the the plan of care had been denied, she called Medicaid to initiate the process and left a message with the person who handles appeals.

“About 20 to 30 minutes later, I got a call from somebody completely different with Medicaid … who wanted to hear my side of the story. I explained to her what was going on and told her the doctor approved for there to be RNs and LPNs and (there has been clarification) that we’re not doing deep suctioning, and you all are still denying these services.”

There had also been confusion over whether nurses were performing a task called “deep stem suctioning” on Layla. Smalley and Layla’s caregivers also had to get clarity from the Board of Nursing that the tracheostomy care Layla receives is not deep right main stem suctioning that extends beyond the carina, a section at the bottom of the trachea, but is instead routine tracheostomy care. LPNs are not allowed to perform deep suctioning.

The next day, the employee called Smalley back and told her the care had been approved by Medicaid – days before Smalley’s employer told her if she wasn’t able to return to work the following week at the end of her leave, the job would have to be posted.

Smalley returned to work Monday – the same day her 12-week leave ended – and has the next several weeks of care lined up, she said. 

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

Sensing long-term challenges, Singing River seeks buyer

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Singing River hospital is not on the brink of financial collapse. So why is it seeking a buyer?

Editor’s note: This story was reported and published in a collaboration between Mississippi Today and the Sun Herald. Isabelle Taft reported for Mississippi Today and Gautama Mehta reported for the Sun Herald.

– Unlike other Mississippi hospitals, Health System is not facing an immediate financial crisis – and that’s exactly why its leaders say they need to find a buyer. 

The roughly 700-bed system, based in Jackson County on the Coast, came through the pandemic in decent shape, with revenue up in 2021. But the long-term forces buffeting Singing River and small hospitals around the country mean the future is still dark. 

Costs are rising, especially for nursing staff. The hospital system needs to make improvements to facilities and equipment after years of underspending. Singing River has almost no leverage to increase payments from the state’s dominant commercial insurer, Blue Cross and Blue Shield of Mississippi. And in part because Mississippi has refused to expand Medicaid, a significant number of the system’s patients have no insurance, meaning Singing River doesn’t get paid for their care. 

Hospital leaders say they need a bigger chain to take over so they can benefit from economies of scale and greater negotiating power with suppliers and insurers. If they wait until a crisis point, they’ll have less leverage and possibly fewer interested buyers. 

“We’re coming at it now at a place of strength,” CEO Tiffany Murdock told a community group in the town of Hurley in August. “And in five years, I can’t promise you the same thing.”

It’s the latest demonstration of a trend with potentially troubling consequences for patients: In the world of American hospitals, only the huge survive. 

From 2005 to 2017, the share of hospitals around the country that are part of a larger system rose from 53% to 66%

In Mississippi, a 2017 merger made Baptist Memorial the largest hospital system in the state. The has expanded its footprint to Grenada, Holmes County, and the Gulf Coast and is bidding to lease hospitals in the Mississippi Delta. Rush Health Systems, which owns seven hospitals in east Mississippi and west Alabama, this year merged with Ochsner, the Louisiana-based system Singing River leaders see as their likely buyer. In 2019, Franciscan Missionaries of Our Lady, also based in Louisiana, acquired St. Dominic Memorial Hospital in Jackson.

State and locally owned hospitals like Singing River are a fading model. The American Hospital Association reports that, of the country’s 6,100 hospitals, about 950 are owned by local governments, down from 1,130 in 2008

The potential downside of spending years trying to fight massive economic forces – and ending up in a much weaker negotiating position with a potential buyer – is clear enough in Mississippi. Hospitals like Greenwood Leflore are struggling to stay afloat long enough to find a savior or be forced to close their doors. 

A growing body of research shows hospital consolidation usually increases costs for consumers by reducing competition. And despite hospital leaders’ claims about the resource benefits of joining a larger chain, research also suggests it doesn’t improve outcomes for patients. 

“We know that consolidation is going to increase prices and potentially decrease access to care,” said Christopher Whaley, a health economist at RAND Corporation. “But if the alternative is that the hospital or physician group goes out of business and exits the market entirely, then maybe that’s a tradeoff we have to make.”

Tiffany Murdock, CEO of Singing River Health System, speaks during a public hearing over the potential sale of Singing River Health System during a Jackson County Board of Supervisors meeting in on Wednesday, Aug. 17, 2022.

While small hospitals like Singing River look for buyers, bigger players like Ochsner – one of the biggest hospital systems in the Gulf South – have been looking for new acquisitions. 

In 2020, Ochsner and Singing River announced a strategic partnership, and Singing River acquired Garden Park Medical Center in , rebranding it as Singing River . During Hurricane Ida, the partnership allowed Ochsner patients in hard-hit southeast Louisiana to move to the Gulfport hospital. 

Corwin Harper, Ochsner CEO for Northshore and the Mississippi Gulf Coast, said expanding into Mississippi makes sense in part because so many Mississippians already use Louisiana health care facilities, and the states face similar issues with workforce recruitment. 

“With Ochsner being the largest health system in Louisiana, it’s almost a natural migration for people to access the resources that Ochsner has,” he said. 

Murdock, a registered nurse whose career in hospital administration has included stops in California and Oregon, was named the administrator of Singing River Gulfport. When former CEO Lee Bond stepped down earlier this year, Murdock was named interim CEO of the health system and then CEO. She is the first woman to hold the position.

In June, the hospital trustees voted to pursue a sale to a “like-minded hospital organization,” though Ochsner is generally the only name that comes up in Jackson County. 

A report by the firm Raymond James found that while the hospital’s revenue had rebounded in 2021, rising expenses had cut margins. The hospital sees a high rate of uninsured patients, and federal payments to care for them are dropping. And as a small system, it has little opportunity to access loans or to increase cash flow by negotiating with insurers, since most of its patients are on Medicaid or Medicare and the commercial market is dominated by Blue Cross. 

“It’s a nationwide issue,” Ryan , executive director of the Mississippi Rural Health Association, said of hospitals’ financial struggles. “But it is especially important here because we are a more poor state. Our hospitals are in the red, like on the verge of closure in a critical state, and it’s not because our hospitals are doing anything wrong or there’s anything wrong with Mississippi. It’s just because we’re a poor state and we have less money to go around.”

The pandemic also highlighted the benefits of scale. 

“We were spending, you know, a nickel on a surgical mask five years ago when during the height of COVID, we’re spending $5 a mask and buying thousands of masks,” Murdock said at the community meeting in Hurley.

Ochsner, by contrast, built its own plant to make personal protective equipment in Lafayette. 

But scale can come with a loss of local autonomy.

Ochsner also has a lease agreement with Hancock Medical Center on the Coast. In May, Ochsner closed the labor and delivery unit at the hospital, citing the low number of deliveries that made it hard to operate the unit safely. That left the county without a single labor and delivery unit and frustrated some Hancock County residents and leaders. 

Over the summer, a Singing River retiree named Irby Tillman appeared poised to derail hospital executives’ plans. 

Under Mississippi law, anyone can force a referendum on a public hospital sale by obtaining a petition with at least 1,500 signatures. Tillman, who worked as a carpenter at the hospital, was at one of the board of supervisors meetings where the sale was discussed. He heard an attorney say that the supervisors would make the decision – unless someone forced a referendum.

“I happened to be standing there and I said, ‘Well, I’ll take that challenge,’” he said. “I don’t think five men should have that big decision.”

But even if Tillman had never launched his petition drive, pursuing the sale would have required Singing River executives to embark on a kind of political campaign to persuade not only supervisors but also their constituents to support the sale. 

The hospital is the second-largest employer in Jackson County with more than 3,500 employees. People all over the county remember births and deaths, emergencies and routine check-ups, first jobs and decades-long careers at Singing River. 

Many of them also remember a profound betrayal: For years, the hospital secretly stopped paying into retirees’ pension fund before it collapsed in 2014. A settlement in a federal class-action lawsuit resulted in lower payments than retirees had been promised. 

Murdock embarked on a county-wide speaking tour late this summer. She spoke at school district convocations and rotary club meetings, the chamber of commerce and churches, trying to convince people to support the sale. 

At a special meeting for pensioners, Murdock assured them the sale would not affect the pension settlement

Meanwhile, Tillman traveled the county, too. In late August, he and his cousin Paul Wise, also 73 and a Singing River retiree, spent several hours outside Ixtapa, a Mexican restaurant in Vancleave. They both grew up in Pascagoula, two of their grandmother’s 75 grandchildren. Wise was leaning toward supporting the sale, while Tillman was leaning against it. 

Paul Wise and Irby Tillman, Singing River retirees, collect signatures in support of a referendum on selling the hospital outside a restaurant in Vancleave, Mississippi.

Tillman prided himself on never saying a word about how he thought anyone should vote, only emphasizing the importance of having a say in the process. The men carried a handmade poster that said “Let your voice be heard” and was decorated with small American flags. Everyone they talked to wanted to see a referendum. 

All five supervisors and even Murdock signed the petition.

“If I didn’t sign, I didn’t want (that) to get in the way of the goal, which is to move this forward,” she said. “And so I didn’t want that to be the headline. I wanted the headline to be like, ‘This is the right thing to do, whether there’s a petition or not.’”

But she was wary of what a referendum could mean.

Mississippi Today could locate only one such referendum in state history. Oktibbeha County voters roundly rejected a proposal to sell OCH Regional Medical Center in 2017. If that happened in Jackson County, Singing River leaders said the county would have to raise taxes and still be unable to cover rising costs. 

In the end, Tillman did not gather enough signatures to require a referendum. It rained heavily in the weeks before the deadline to turn in the petition, and Tillman relied on old fashioned methods to obtain signatures.

“Water and ink don’t go together too good,” he said. 

And after months of discussion, showing up to board of supervisors meetings and public hearings, he was leaning toward supporting the sale anyway, he said. 

Irby Tillman addresses Randy Bosarge during a Board of Supervisors meeting on the possible sale of the Singing River Health System in Pascagoula on Wednesday, Aug. 17, 2022. Tillman started a petition to bring the sale to a public vote.

The Jackson County Board of Supervisors doesn’t yet have a specific timeline for when the request for proposals will be finalized and buyers can begin submitting bids. 

The potential buyer frequently mentioned by name in Jackson County is Ochsner. But other hospital chains could make a move, too. 

The Franciscan Missionaries of Our Lady Health System (FMOLHS), which operates St. Dominic Memorial Hospital in Jackson and hospitals in Louisiana, said in a statement that it is “aware” that an RFP has been issued. 

“FMOLHS regularly evaluates opportunities to expand access to care by partnering with quality health systems to bring together outstanding clinicians, the most advanced technology and leading research to ensure that our patients receive the highest quality and safest care possible,” said Kevin Cook, chief operating officer.

The sale will leave Mississippi with one less locally owned hospital, and it may be an indication of the future facing every small hospital in the state. 

Richard Roberson, general counsel and vice president of policy at the Mississippi Hospital Association, said Singing River’s situation highlights the structural forces working against Mississippi hospitals. 

“I think that is what’s scary about it – you do see a hospital that is a strong hospital, a strong health system, and as good as they do things, they’re still struggling,” Roberson said. 

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

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

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

A panel of lawmakers trying to come up with policies to help women and children post- ban heard a familiar refrain from experts Tuesday: Mississippi ranks worst or near-worst in infant and maternal mortality, poverty, hunger, access to and child care and many other pertinent statistics.

“… This means 39% of children in Mississippi belong to households with no full-time working parent,” said Heather Hanna, assistant research professor at the Mississippi State University Social Science Research Center. “… 43% of Black children in Mississippi live in poverty … Women in Mississippi have higher rates of educational attainment than men, yet earn less.”

The disheartening stats from various experts continued for much of the day — 46% of Mississippi children are in single-parent homes. One in five children experienced hunger in the last year. Nine out of 1,000 babies in Mississippi die. In the rural Delta, there are 4,000 children for every one pediatrician — statewide that number drops only to 2,000 per — and many counties have no OB/GYN. Many mothers do not receive proper prenatal or postpartum care. Mississippi has alarming rates of premature, low-weight babies being born.

Young women have problems obtaining or affording long-acting, reversible contraception. The state Health Department is estimating Mississippi will see an additional 5,000 unplanned pregnancies a year now that abortions are banned here.

The Senate Study Group on Women, Children and Families opened the first of four planned hearings with an examination of the extent of the problem. The committee was announced by Lt. Gov. Delbert Hosemann after the in June struck down longstanding Roe v. Wade and a dormant Mississippi abortion 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. House Speaker Philip Gunn has also created a commission with a similar charge.

“As a state we are in the wrong place on a lot of lists,” Dr. LouAnn Woodward, vice chancellor at the , told the nine-member, bipartisan committee on Tuesday.

Dr. Daniel Edney, director of the state Department of Health, showed lawmakers a chart with a national report card that ranks states on numerous health issues.

“We’re not just 50th,” Edney said. “We’re 50th by a mile. I think if we had 60 states we’d be 60th … The Department of Health is absolutely committed to work with you and do whatever it takes to get us off the bottom.”

Tuesday’s hearing was open to the public and the committee is asking for written testimony from the public, which can be emailed to WCFStudyGroup@senate.ms.gov. The comments will be presented to the full committee.

A large part of the hearing’s audience — many of those who were not lobbyists or government staffers — walked out of the hearing, holding hand-made signs, briefly mid-morning Tuesday to hold a press conference organized by leaders of organizations representing Black women. Black women and babies experience a disproportionate share of the state’s highest-in-the-nation rates of stillbirth, low birth weight, and infant mortality. They said the statistics about the state’s problems are old , and the title of the press conference was “We are the Data.” They complained about a lack of Black women on the Senate committee — only one of the nine members — and among Tuesday’s presenters.

They want to see some action from lawmakers, and many had come to call on lawmakers to extend postpartum coverage for mothers — a subject of much debate in Mississippi over the last year.

“What we’re asking for here is just a right to life,” said Angela Grayson, lead organizer for Black Women Vote Coalition and advocacy and outreach coordinator for The . “The data is here. The data shows that this is good legislation and that that is what we need here in Mississippi for Black women to be able to go through the childbirth experience and not have the unnecessary burdens of inadequate health care.”

In Mississippi, about 60% of births are to women on Medicaid. The Senate in this year’s legislative session attempted to extend standard postpartum Medicaid coverage from 60 days to 12 months, an effort to help combat high maternal mortality rates and other health problems for mothers and children. The House shot down the proposal, with House Speaker Philip Gunn linking extension of postpartum coverage to general Medicaid expansion under the Affordable Care Act. Gunn and other Mississippi Republicans have fought Medicaid expansion under “Obamacare” for years, and Mississippi remains one of 12 states that has not expanded coverage.

On Tuesday, Woodward, Edney and other presenters voiced support for extending postpartum Medicaid coverage.

Mississippi Medicaid Director Drew Snyder, when asked his opinion on extending postpartum Medicaid coverage, appeared to sidestep the question with a lengthy word salad. But he noted that extending postpartum coverage is “a different” discussion from general Medicaid expansion under the ACA and said, “I don’t think it poses long-term sustainability questions like ACA expansion does.”

Snyder advised lawmakers considering postpartum extension: “if you do it, do it because you believe it will help mothers and children, don’t do it because others say you’re being cruel and heartless.”

Sen. Nicole Akins Boyd, R-Oxford, is chair of the new Study Group on Women, Children and Families, which will continue hearings on Wednesday, then on Oct. 25 and 26.

Boyd said part of Woodward’s presentation stood out to her.

“She said that a 20% decrease in low-birth-weight babies at UMMC’s (Newborn Intensive Care Unit) would save about $8 million a year,” Boyd said. “Extending postpartum Medicaid coverage would cost about $7 million, so that would pay for it.”

Mississippi Today staff writer Isabelle Taft contributed to this report.

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

Elderly care providers struggle to stay afloat

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Hit hard by pandemic, providers of care for the elderly struggle to stay afloat

PHILADELPHIA – Tanya Cook climbs into the gray van and starts her day as she always does: picking up the elderly to bring them to daycare. 

Cook, the transportation manager at New Beginnings Adult Day Care in Philadelphia, has a list that’s shorter today than she planned. Two participants canceled at the last minute, but they’ll have over 50 seniors at the center that day. 

Many adult daycare service providers in Mississippi are struggling or have closed in recent years due to low reimbursement rates from and years of legislative gridlock. The centers provide crucial services to elderly and disabled people and allow their caregivers to work and have lives outside of caretaking.

Before , New Beginnings averaged around 70 participants per day but now only sees 45 to 60 – still a marked improvement from the 30 or so they saw each day after a multi-month shutdown in 2020.

“They keep saying they’re going to wait until this is over,” Cook said. “I don’t know if this will ever be over. But some of them are slowly coming back.”

Adult daycare is a nearly invisible facet of the care system for elderly and disabled people. The centers provide transportation and meals, in addition to administering medication. Attendees participate in exercise and socialization activities. Often, they serve as participants’ only opportunity for social interaction outside of the home. 

Cook had never heard of adult daycare until she started working in one in Oct. 2017. In that time, she’s driven every route in the center’s service area. It covers eight counties total, stretching as far as Morton, more than an hour’s drive away. 

Cook remembers getting calls from participants one month into the COVID-19 shutdown where they asked: ‘Are you going to come get us?’

 “They’re stuck at home all day, so this is their way out of the house,” Cook said. 

That was the case for Jean Anderson, an 85-year-old Philadelphia native who has been coming to New Beginnings for over four years. After her husband passed away, her case worker asked if she’d like to start attending an adult daycare, and she agreed to try it out. 

“I was getting lonely at the house by myself,” Anderson said. “This keeps you from sitting there and doing nothing all day.” 

There were at least 126 adult daycare service providers across Mississippi pre-pandemic, but around 30% of them have closed permanently over the last few years, according to Benton Thompson, president of the Mississippi Association of Adult Day Services.

 “Their volume dropped due to COVID, and they couldn’t continue operations with the same overhead costs and limited revenue,” Thompson said. 

The bulk of those overhead costs come from staffing, which includes a family nurse practitioner and social worker, along with seven other required positions. Under quality assurance standards set by the Mississippi Division of Medicaid, each facility must maintain a minimum staff-to-participant ratio of one to six, or one to four in a facility that serves a high percentage of people who are severely impaired. 

The vast majority of those who use adult daycare services are enrolled in Medicaid’s Elderly & Disabled Waiver program. The waiver provides home and community-based services for Mississippians who would require nursing home level care if not for the alternative forms of care the waiver provides, like adult day care. At New Beginnings, 98% of its clients are on the waiver. As of June 2022, there were 17,022 waiver recipients across the state, according to the Mississippi Division of Medicaid.

The problem with this system, workers and advocates say, is that reimbursement rates have stagnated while costs have continued to rise, meaning only those who bring in a high number of participants can break even.

Currently, adult daycares receive a maximum reimbursement of $60 per person each day from Medicaid. They can only bill for up to four hours of care, though they’re required to be open for eight.

“We’re at the mercy of (Medicaid) case workers,” said Michelle McCool, administrator at New Beginnings. “It’s all based on numbers, and if they don’t refer clients to us, or if there’s a backlog of people waiting to get into the waiver program, we can’t survive.”

Some legislators have attempted to increase the reimbursement rate for adult daycare services every year since 2015. Each time, it has either died in committee or passed in both chambers, with each side unable to agree on a final version. 

If passed, the bills would have more than doubled the level of reimbursement that adult daycares like New Beginnings currently receive. Their per-person reimbursement would increase to $125 and the centers could also be reimbursed for transportation costs separately. Thompson believes the lack of awareness about adult day services is what has caused this repeated failure to act from lawmakers.

“I think it’s due to a lack of knowledge,” Thompson said. “I think most of them sitting up there in Jackson on these bills have never been to an adult day service and don’t understand the benefits.”

Thompson believes that expanded utilization of adult daycares would save the government money in the long run by preventing costly hospital stays and delaying costlier institutionalized care in a nursing home setting. He also pointed to the benefits for the primary caregivers of participants who have them, which sometimes provide the only way for them to run errands, work or just simply have a break.

“If you don’t give that caregiver a break, then they’re going to become a participant (person who needs adult daycare),” Thompson said. 

On Friday, Jeanette Carter is one of the few participants at New Beginnings dressed up for that day’s theme: Remembering 9/11. The 68-year-old is wearing a red, starry tank top and American baseball cap. She walks around the room, talking to her friends and looking for places to help out before the scavenger hunt.

Carter has been coming to New Beginnings nearly five days a week for over a year and a half. The only days she’s missed were due to catching COVID-19 in Oct. of last year. 

“If this place was open seven days a week, believe me, Jeanette would be here,” Carter said.

She only started coming to New Beginnings after the previous center she went to closed during the pandemic. In that brief period, she was scared of being stuck at home. 

“I get out of hand at times,” Carter said. “I can’t be nobody else but me and they understand me. I don’t know what I’d do without this place.”

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

‘Termination notice’: Letters from Medicaid confuse new moms

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Postpartum women never lost Medicaid coverage during the pandemic. But the state told them they did.

Thanks to misleading letters sent by the Mississippi Division of in recent years, tens of thousands of new moms may have chosen to forgo after giving birth – even as the federal government was sending Mississippi extra money to help pay for their care during the pandemic. 

Mississippians whose pregnancies were covered by Medicaid retained full benefits during the pandemic under federal law, instead of getting kicked off 60 days after giving birth as they ordinarily would under state policy. That should have allowed them to keep seeing their doctors and get treatment for conditions like postpartum depression, high blood pressure and anything else they needed to stay healthy after their baby’s birth. 

But many women thought they didn’t have coverage because of letters sent to every recipient of pregnancy Medicaid telling them they were no longer eligible. While healthy adults under 65 generally don’t qualify for Medicaid, pregnant women are covered as long as they meet income requirements, and about 60% of births in Mississippi are covered by Medicaid. An untold number of pregnancy Medicaid recipients may have stopped going to the doctor after receiving the letters, believing they would be charged as if they had no health insurance. 

Several recipients of the letters told Mississippi Today they only found out they had coverage after going to the doctor, in some cases so desperate for care that they were willing to pay whatever they had to out of pocket. 

“Your Medicaid eligibility has ended,” the sparse letter from the Division of Medicaid said. The heading read “TERMINATION NOTICE – Loss of Medicaid Eligibility.”

A second letter delivered later, titled “NOTICE OF MEDICAID REINSTATEMENT DURING COVID-19 PUBLIC HEALTH EMERGENCY,” explained that those covered as of March 18, 2020 would have their coverage reinstated. But it did not make reference to the first letter or explain what kind of coverage recipients now had. 

Some women told Mississippi Today they never got the second letter. 

Dr. Anita Henderson, a Hattiesburg pediatrician and president of the Mississippi Chapter of the American Academy of Pediatrics, said she screens moms for postpartum depression during their newborns’ early checkups. During the public health emergency, she and colleagues expected new moms to retain Medicaid coverage indefinitely. 

“We found that some of those moms were coming back and saying, ‘We don’t have Medicaid, or we don’t know that we have Medicaid.’ Or they were saying, ‘No, I have gotten this termination letter,’” Henderson said. “Once we offered clarification and discovered they still qualified, they would go to that appointment, or we would help set up the appointment and they would go. But if they did not know they had coverage, they may not have utilized it.”

The new moms’ confusion and reluctance to seek care almost certainly saved the Division of Medicaid money – and one expert believes the confusing communication may have been intentional.

The first letter notified the recipients that they had been kicked off of the managed care plan, a program through which the state pays a set amount of money to a “coordinated care organization” each month, which then pays for recipients’ care. 

The reinstatement described in the second letter shifted them to another type of Medicaid in which the state pays directly for each visit and treatment. The fewer services new moms sought, the less money the Division of Medicaid had to spend. 

Joan Alker, executive director and co-founder of the Center for Children and Families (CCF) at Georgetown University and an expert on Medicaid, said she had not heard of other states moving people from managed care to fee-for-service coverage during the pandemic. 

“I fear this is an intentional strategy to cut costs on the backs of these postpartum women,” Alker said. 

Matt Westerfield, communications director for Medicaid, said the department could not provide a “validated analysis” of postpartum spending during the public health emergency by publication time. 

“Generally, it appears that monthly medical costs have exceeded $200 per beneficiary per month in months 3 to 12 of the postpartum period,” he wrote.

The state pays managed care companies between $1,076 and $1,186 monthly per pregnant woman, depending on the beneficiary’s location.  

In a statement to Mississippi Today last week, the Division of Medicaid acknowledged the letters were a mistake. 

“An automated form letter related to disenrollment from a managed care plan should have been updated to mention the continuing availability of full Medicaid benefits,” said Westerfield. “We have directed that the form letter be updated, and staff is currently reviewing other beneficiary communications to make improvements where needed.”

Trista Carlton gave birth to her daughter in June 2021. The 28-year-old Laurel resident had Medicaid as her secondary insurance, and about 60 days postpartum, she got the letter informing her that her coverage had been terminated.

Carlton started rationing her visits to the doctor because she was worried about the cost. 

“Not only do you have your copay, you have what your insurance doesn’t cover afterwards, so it definitely makes you second-guess making a visit to go to the doctor and see what’s going on,” she said. “Having a new baby, that comes with added costs that you’re thinking about. You kind of put yourself on the back burner, not knowing what’s going on.”

She never got the second letter telling her the coverage had been reinstated, but she eventually decided she needed to see her doctor for anxiety and depression. Only then did she learn she still had coverage.

Trista Carlton, a 28-year-old new mom in Laurel, thought she no longer had Medicaid coverage after she got a letter telling her she had been terminated. When she finally went to the doctor, she learned she was still covered, as federal law requires during the COVID-19 Public Health Emergency.

Carlton then called local Medicaid offices in Laurel and Brandon to ask what was going on. She said staff there told her she only had family planning Medicaid coverage, which pays for up to four annual visits related to birth control. Before the Public Health Emergency, women who gave birth on Medicaid were rolled onto family planning coverage for one year after they lost full coverage. 

“I’ve never really been able to get a direct answer,” she said. “But all of my primary care visits have gone through. And as far as I know, I’m still covered under Medicaid.”

Several other women told Mississippi Today they had similar experiences after receiving the letters. 

Chelsea Brooks, a new mom in Florence, canceled a doctor’s appointment because she got the letter telling her she had lost coverage. More than two months later, she got the reinstatement letter and contacted her doctor. The experience was “very confusing,” she said.

Kristen Elliott, a mom in Brandon, got the first letter a few months ago and thought she had lost coverage. But when she went to the doctor a few weeks ago, she found out she was still covered. 

“I’m not even sure what was going on with it,” she said. 

In March 2020, Congress passed a law requiring “continuous coverage” for Medicaid recipients to ensure no one lost access to health care during the COVID-19 pandemic. That forced states to do something they had never done before: change their systems to stop kicking people off of Medicaid even if they lost eligibility, said Jennifer H. Wagner, director of Medicaid Eligibility and Enrollment at the Center on Budget and Policy Priorities.

Nearly 150,000 more Mississippians are on Medicaid than before the pandemic, said Westerfield, the state Medicaid communications officer. 

In Mississippi, the termination notice at 60 days postpartum was already programmed to be sent to recipients. Creating a totally new notice to explain instead that recipients still had coverage is “more complicated than it sounds,” Wagner said. Instead, the state just added a second letter telling recipients their coverage was reinstated. 

Wagner said that though she understood why the state sent the letters, they were confusing. 

“Coverage is only good if you know you have it,” she said. 

The continuous coverage requirement also came with extra federal funding for states. That funding exceeded the extra costs of covering more people in every state. But no state got a better deal from the feds than Mississippi, where the extra federal funding was six times higher than the expanded coverage costs, according to an analysis by KFF, a nonprofit research organization. (The state already had the highest federal matching rate in the country before the pandemic.)

By moving women from managed care to fee for service, and then paying for fewer services, the state saved money.

Mississippi has the second-highest share of births covered by Medicaid in the country, at 60%. 

More than 21,000 Mississippi women gave birth while covered by Medicaid in 2020. Nearly all of them should have been able to continue seeing their doctors until the public health emergency ended. The Biden Administration has not yet said when that will happen, but is expected to extend it until at least January 2023. 

Mississippi has a high maternal mortality rate relative to the national average. Black women in Mississippi are three times likelier than white women to die of pregnancy-related complications. 

Doctors and public health advocates argue that extending postpartum Medicaid would save lives and improve infant and maternal health by ensuring women have access to health care for the first year of their baby’s life. After passing the Senate with broad bipartisan support this year, a proposal to extend coverage to a year postpartum died in the House thanks to opposition from Speaker Philip Gunn, R-Clinton. 

Sen. Kevin Blackwell, R-Southaven and chair of the Medicaid Committee, has vowed to reintroduce the legislation. With now banned in Mississippi, lawmakers are under pressure to help families and babies who suffer the nation’s highest rate of infant mortality. 

Drew Snyder, the director of the Division of Medicaid, has so far declined to take a stance on whether postpartum Medicaid coverage should be extended. But he recently told the talk radio host Paul Gallo that data from the pandemic, when pregnant women didn’t lose coverage after giving birth, could be used to inform the conversation. 

“Maybe one of the benefits of deferring a decision on this is that Mississippi and every other state is going to have 2021 data to show … Did anything happen with maternal health outcomes?” Snyder said. “Particularly late maternal …  That may be a good argument for advocates of the 12-month [extension] to say, ‘Hey, we need to do this.’”

Mississippi doctors and national experts say that idea ignores the effects of COVID-19 on pregnant women. The virus has been linked to higher rates of stillbirth and maternal death

And now, it appears that many women may not have known they still had health insurance throughout the pandemic. 

Henderson saw the coverage help moms – if they knew they had it.

“I have moms who are at two months, four months, six months, 12 months and are on antidepressants and now have those medications covered,” she said. “They are getting therapy. They are getting their asthma and hypertension treated. So, I do know from a parent (and) patient standpoint, that my patients have been positively impacted if their mothers have been able to continue with access and continue with coverage in those instances.”

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

Cops came to take him to the hospital. They killed him instead.

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Deputies were supposed to take him to the hospital. They killed him instead.

If Corey Maurice McCarty Hughes stopped taking his medication, his family knew what to do. When he started to become paranoid or barricaded himself in a room, a family member would go down to the Forrest County chancery clerk’s office and file an affidavit stating that Hughes needed to be hospitalized. Then, sheriff’s deputies would pick him up and take him to get treatment. 

The series of events had unfolded about 16 times before, and there was little reason to think it would be different when it happened again in mid-July of this year. 

When family members sought to have him committed, they expected he would spend a few weeks or months at the state hospital in Purvis and then come home to Palmers Crossing in Hattiesburg, where he lived in a trailer a few hundred feet from his parents’ house.  

On July 14, Forrest County deputies arrived at Hughes’ sister’s house to take him to the hospital. They killed him instead. 

According to the incident report released to Mississippi Today by the sheriff’s office, Hughes struck a deputy with a “blunt object” before the deputy shot him in the torso. 

Exactly what happened is still unclear: The Mississippi Bureau of Investigation is investigating, as it does every time law enforcement officers kill someone in the state. The Bureau refused to turn over records except for an incident report until the investigation is over. 

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The four deputies at the scene were not wearing body cameras; their department had begun buying the cameras only in June after receiving a federal grant. Forrest County Sheriff’s Office officials said they would not provide further information until MBI’s investigation is closed.

But to Hughes’ loved ones, the case is already a clear indictment of the state’s mental health and criminal justice systems, which are uniquely intertwined in a process called civil, or involuntary, commitment. 

Every year, thousands of Mississippians and hundreds of thousands of Americans go through the civil commitment process. For some Mississippi families navigating a patchwork system of mental health services and care, having relatives forced into treatment is not just the option of last resort, but the only option. 

Some Mississippians, like Hughes, go through the process more than a dozen times, cycling in and out of state hospitals without connecting to effective long-term treatment back home.

“Civil commitment is forcing someone to get mental health treatment,” said Sitaniel Wimbley, executive director of National Alliance on Mental Illness Mississippi. “Had that individual had someone to talk to … or they had been in a treatment plan, civil commitment may not be something that they ever have to see, because they would be aware of their mental health and what’s going on in the process to be able to get help for themselves.” 

The state is the subject of a years-running federal lawsuit over its failure to provide adequate mental health services in communities, historically forcing people to spend years institutionalized in mental hospitals. 

As in many states, Mississippi law specifically requires sheriff’s deputies to transport the person being committed, effectively forcing law enforcement to get involved in the care of people suffering from serious mental illness. The justification for this is that only law enforcement is equipped to physically force someone to get treatment against his or her will. But mental health advocates say the mere presence of a officer – especially if they are not trained in helping people in a mental health crisis – can increase a person’s distress and agitation. 

Hughes’ father, James Hughes, doesn’t understand why medical professionals were not on the scene – at the least to talk with his son before police pulled out a weapon. On other occasions when he didn’t want to go to the hospital, officers sometimes used their taser, but never a gun, he said.

“I’m under the impression, well, I’ll be going to Purvis to visit my son,” he said. “And then I have to bury him.”

A baby photo of Corey Maurice Hughes. Hughes was shot and killed by Forrest County Sheriff’s deputy after attempting to take him to a mental facility.

‘That was my son’

When his son was at the hospital in Purvis, James and his wife visited every chance they could. He usually stayed there for a few months, once close to a year. The family would pick up food – Hughes loved chicken and pork chops – and eat together at a park before taking him back to the hospital. 

“That was my son,” James said. “If we don’t support him, who is?”

Hughes, born Corey Maurice Hughes, spent his childhood fishing and hunting. The youngest boy in a family of seven siblings and half-siblings, he was a joker who liked to make people laugh. 

When he was a kid, his dad bought him toy dump trucks, tractors, and Tonka trucks. After high school, he got a job driving 18-wheelers for a local trucking company. He drove as far as California and New York. 

James said his son’s health problems began in the late 1990s, when he was diagnosed with paranoid schizophrenia and bipolar disorder.

“He had desires to go back to school, and he wanted to get back into trucking, but with his health issues, that wasn’t fixing to happen,” James said. 

After he got sick, Hughes spent most of his time around his family. He lived independently in a white trailer just steps away from the house where he spent most of his childhood. From a chair on the concrete porch, he could see when someone stopped by his parents’ home, which happened often because James is a notary public. Hughes would walk over to check up on them. 

“He was sick, but he wasn’t just crazy, crazy,” James said. “He was sick. Paranoid schizophrenia is a sickness.”

Hughes would tell his father about the voices he heard: usually women, sometimes cursing him out. He had insurance thanks to disability and got treatment at Pine Belt Mental Health Services in Hattiesburg and from other doctors, but his father doesn’t think the medication did him much good. 

That’s part of why he sometimes stopped taking it, James said. When he was killed, it had been about three months since he had taken the medication.

James E. Hughes talks about the shooting of his son, Corey Maurice Hughes, at his home in the Palmers Crossing community in Hattiesburg, Miss., Tuesday, August 16, 2022. Corey was shot and killed by a Forrest County Sheriff’s deputy as deputies attempted to transport him to a mental health facility.

Civil commitment, a controversial process, expanding around the country

Among mental health experts and providers, involuntary commitment is controversial. The legal process takes away someone’s freedoms of movement and bodily autonomy without ever charging them with a

Because of patient privacy concerns, inconsistent recordkeeping and different processes across jurisdictions, the number of people who are forced into mental health treatment against their will every year in the United States is unclear. 

Research suggests the rates vary widely across states, and that the number of involuntary commitments  each year is on the rise. One study found that from 2011 to 2018, the rate of involuntary commitments grew three times faster than population growth across 25 states. (Mississippi was not included in the study.)

In Mississippi, chancery clerks handle the paperwork around civil commitment, and chancery judges determine whether someone will be forced into treatment. But the process historically has varied from county to county. Wimbley said some counties have charged different amounts of money for initiating the commitment process. Some judges are known for committing people based on limited medical evidence, said Melody Worsham, a long-time advocate for Mississippians with mental illness and a certified peer support specialist at the Mental Health Association of

“Some judges will commit somebody just based on the word of a distant relative that says, ‘Hey, this guy is nuts. You need to lock up my relative,’” she said. “Then others are like, ‘No, you better present some serious evidence that this person needs to have his life taken from him.’”

As part of the federal against the state, Mississippi is under pressure to reduce civil commitments. The Department of Mental Health is aiming to divert people from the state hospitals by trying to connect family members to resources so they don’t see commitment as the only option.

The lawsuit settlement agreement requires the state to bring consistency to the civil commitment process by establishing uniform guidelines and training chancery staff. 

Roughly 5,000 Mississippians were committed in Fiscal Year 2021, according to data collected by the Office of the Coordinator of Mental Health Accessibility – a position created by the Legislature to oversee mental health programs in the state.

The number of commitments per capita varied widely around the state, from one per 290 people in Region 1 – Coahoma, Quitman, Tunica and Tallahatchie Counties – to one per 1,011 in Region 15 – Warren and Yazoo Counties. 

Region 14, which includes 13 counties in south Mississippi, sits in the middle, at one per 554. In Forrest County, the rate was one per 422, with 177 commitments and 86 admissions to the state hospital. 

Forrest County Chancery Clerk Lance Reid said families are often reluctant to turn to commitment. But sometimes, commitment is the only option they have. 

He tells them: “You’re faced with putting your loved one in a facility, but the way you have to look at it is, that’s the best that we can offer in this state right now to try to get them some help, to try to get them some medications that can get them better, get them some treatment.”

The state hospitals are supposed to improve discharge planning, so that when someone’s civil commitment ends, the patient is immediately connected to resources and care in the community. But the first report produced by the special monitor charged with evaluating how well the state is complying with the federal settlement agreement found that that wasn’t happening at every state hospital

That could be contributing to the high number of readmissions for people who are civilly committed – like Hughes.

“There’s a pretty big revolving door, for lack of a better word,” Reid said. “Yes, we see a lot of return patients … The fact of the matter is, they get out, even if they follow up with their local community mental health provider, they have that tendency to get back off their medicine and come back through the system again.”

James said he had no problems with the hospital at Purvis, where the staff were always respectful and professional. But his son wound up having to go back more years than not after his diagnosis. 

In 2014, Hughes legally changed his name from Corey Maurice Hughes to Maurice McCarty Hughes. Sometimes he had to remind his parents to call him Maurice, not Corey. The most recent time he stopped taking his medication, he told his father it was because an employee at his doctor’s office in had called him the wrong name.

“But you know, I don’t know if they have to have an excuse,” he said. “You don’t know what nobody’s mind is telling them.”

Corey Maurice Hughes’ funeral program. Hughes was shot and killed by Forrest County Sheriff’s deputy after attempting to take him to a mental health facility.

Unclear how many Mississippians have been killed by law enforcement during civil commitment 

Sheriff’s deputies have killed at least two other Mississippians during a civil commitment in the last 12 years, according to records Mississippi Today requested from MBI. 

But the true figure of people who have been killed when law enforcement was supposed to take them to mental health evaluation and treatment is not known: MBI’s records cover only those cases the agency investigated. Prior to last year, law enforcement agencies in Mississippi were not required to bring in MBI to conduct an independent investigation when their officers killed someone. That means any records of such events could be spread across the state’s 82 counties. 

Jesse Jones, a 53-year-old Black man, was killed by deputies on April 27, 2010, when they arrived at his home in Carthage “to serve a lunacy warrant.”

“Victim pulled a weapon on deputies and was shot in yard by 1 deputy,” the sparse MBI report says. “Subject taken to Leake Memorial Hospital by ambulance and pronounced dead.”

The report contains no other details about Jones’ life or death. 

At around 10 p.m. on May 14, 2020, Choctaw County deputies arrived at the home of John Beam, a 65-year-old white man, to serve both an arrest warrant for simple assault, stalking and trespassing and a writ to take custody for a mental health examination. Beam had been diagnosed with schizophrenia and, according to the MBI report, “complained about his medication not working and stopped taking said medication.” His daughter had begun the involuntary commitment process by filing an affidavit that he could harm himself or others. 

Around midnight, Beam pointed a pistol at the deputies and then began firing. The deputies fired back. Four hours later, they entered the house and found him lying dead on the floor. 

Law enforcement often steps into the mental health services gap because they’re the only service people can or know how to call. So Mississippi has expanded crisis intervention team (CIT) training across the state, designed to teach officers how to respond to people experiencing a mental health crisis and connect them to treatment instead of taking them to jail. 

The training requires 40 hours, a substantial commitment of time and resources for a law enforcement agency. Mississippi officers learn about mental illness and local resources and laws. They practice verbal de-escalation strategies and learn the procedures for connecting people to nearby mental health facilities. They speak with people who have firsthand experience with mental illness, and they spend hours role-playing with their classmates and trainers. 

Nearly 700 law enforcement officers in Mississippi have participated in the training since mid-2018, according to the Department of Mental Health.

The Pine Belt region has been a leader in the training, thanks to a federal grant to the local community mental health center. Thirty-two Forrest County deputies have completed the training since 2017. 

Mississippi law enforcement, mental health leaders and advocates agree the training is a powerful tool. 

Wade Johnson, a retired police captain who has spent about a decade expanding CIT training around the state and now serves as the East Mississippi Training Coordinator, said sheriffs and police chiefs recognize the need to change the way law enforcement interacts with people in mental health crises. 

“They don’t want their department to be front page on how they had to deal with this particularly mentally ill subject that led to something very unfortunate,” he said. “They want their officers and deputies to get that training, that they can do a proper response to the mentally ill and get them help, keep them out of the jails, if that’s not the place for them.”

But nationally, there are questions about how effective the training is at reducing use of force against people experiencing mental health crises. 

One 2016 analysis of studies on the program found that none of them found CIT significantly reduced the chances that an officer used force against a mentally ill person. One study found that it was actually associated with a significant increase in use of force. 

The Forrest County Sheriff’s Office said all four officers who responded to Hughes’ home had gone through the training. 

“That makes me sick to think about,” Worsham said. 

Of their 25 current patrol personnel, 17 had completed the training as of late July, and the remaining will do so when there are classroom seats available, the department said.

Johnson said that nothing in the training teaches officers to disregard their departments’ use of force policies, which generally permit officers to use deadly force against someone they believe could kill or seriously injure the officer or another person. 

“You go to a scene involving a mental health issue,” he said. “You get there, it explodes all over you. I don’t have time to deploy CIT. You gotta take care of the business as it’s unfolding in front of you.”

Corey Maurice Hughes was in the process of repairing these vehicles, shown here outside of his home in the Palmers Crossing community in Hattiesburg, Miss., Tuesday, August 16, 2022. One of Corey’s hobbies was repairing cars for racing. Corey was shot and killed by a Forrest County Sheriff’s deputy, as deputies attempted to transport him to a mental health facility.

‘Nobody can love me how you did’ 

Mississippi Today obtained incident reports from MBI and the sheriff’s office. The agencies said they will withhold all other documents – including witness and officer interviews, forensic analysis, and photos – during the investigation.

When MBI finishes its investigation, it will turn over the files to the ’s office, who will present the evidence to the grand jury thanks to a law that took effect two weeks before Hughes was killed. It could take months for this process to play out.

According to the Forrest County incident report, deputies got to Hughes’ sister’s house just after 6 p.m. 

“Shortly after deputies arrived at the residence a male subject approached one of the deputies and an altercation ensued,” the summary says. “The deputy received an injury to the head from a blunt object and the subject received a gunshot wound to the torso.”

The deputy was taken to the hospital. 

James said his son was carrying a hammer, a screwdriver and a pellet gun with no pellets. He doesn’t understand why the officers – who knew they were picking up a mentally ill person to force him to go to the hospital – got so close to his son that he could hit one of them with a hammer. 

Hughes’ 14-year-old daughter was in the house when he was killed. She had come from Louisiana to be with her dad and his family for the summer. They had gone on a trip to Disney World and spent time cooking together. Now, her dad lay dead in front of his sister’s home. 

James said his son’s body was left outside for nearly five hours after the shooting. 

He believes a staff member from Pine Belt or another person with expertise in mental health should go on commitment calls, with deputies present for backup. A person with different training and tools could have handled the situation differently, he feels. 

“If you ain’t got no gun, you can’t use no gun,” he said. 

Hughes was buried on July 23. His funeral program included a note from his daughter, who remembered him teaching her how to cook eggs in the kitchen of his trailer.

“Nobody can love me how you did,” she wrote. “Just wish you were with me now chilling and listening to music as the days go by.”

Now, James remembers his son during quiet moments at home, cooking or folding laundry. 

“I just think, if he’d have been here, he would be folding my clothes for me,” James said. “And I just think, gee, so many things he did to help me. And you know, I used to think, well, Corey will miss us when we’re gone. Then I’m missing him.”

Before he died, Hughes was working on fixing up two cars: a Ford Fairmont and a Chevrolet S-10. He wanted to turn them into race cars, his dad said. He’d ordered parts from a local mechanic but never got to use them. Soon, James will go by the shop to pick up the parts. 

The cars, sagging a bit on their wheels, ready for a fresh coat of paint, still sit in the driveway outside the trailer where his son lived.

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

In student loan argument, Gov. Reeves ignores Mississippi’s federal dependence

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In student loan argument, Gov. Reeves ignores Mississippi’s federal dependence

Gov. Tate Reeves took to social media recently to ask “why does the Democratic Party hate working people so much” after announced his limited student loan forgiveness program.

The first term governor surmised that the tax dollars of working Mississippians would be used to pay off the student loans taken out by “Harvard doctorate degree gender studies majors living in California.”

Individuals earning less than $125,000 or $250,000 for a family can have $10,000 of their student loan forgiven under the Biden plan. People who receive Pell grants (which provides financial help for the needy for undergraduate studies, not Harvard doctorate degrees) can get up to $20,000 forgiven.

People who attended college, but dropped out, perhaps due to financial hardships, can take advantage of the loan forgiveness. Those people certainly are not Harvard elites and are probably the working people the governor cited as being treated unfairly by the loan forgiveness.

Still, the governor makes a good point.

Under our system of government on the local, state and federal levels, people pay taxes for what is considered the greater good of the government and of society.

People who don’t have children in pay taxes because it is a benefit to society to have a good educational system. People pay taxes for restaurant inspections whether they eat out or not.

The list could go on of services that taxpayers pay for whether they use them or not.

Working Mississippians also are paying their taxes for expansion. But since the governor steadfastly refuses to allow the state to expand Medicaid, the Mississippi tax dollars are going to the other 38 states that have expanded Medicaid to provide insurance to primarily the working poor.

The tax dollars of working Mississippians also are going to help pay for rental assistance in other states since the governor is ending the state’s participation in an emergency rental assistance program designed to help the poor and those impacted by the pandemic. The governor will be sending more than $100 million in rental assistance funds back to the federal government.

But Reeves nor anyone else should be too concerned about Mississippi taxpayers subsidizing people in other states – those Harvard elites or anyone else. By multiple measurements, Mississippi is the beneficiary of federal tax dollars, not the subsidizer.

Mississippi ranks sixth nationwide in terms of federal spending per resident at $6,880, according to a 2022 study. Virginia, home to a large percentage of the federal work force, ranks first at $10,301 per resident, followed by Kentucky, New Mexico, West Virginia and Alaska.

New Jersey is last in federal spending per resident at a minus $2,368, followed by Massachusetts at minus-$2,343. California, the state where Reeves was afraid Mississippi tax dollars would go for the Harvard elites, garners minus-$12 in federal spending for each resident.

Using a different measurement — return on tax dollars — Mississippi gets $3.40 for each tax dollar sent to the federal government, according to a 2020 report. In that study, Mississippi trails only New Mexico, which gets $4.33 for each dollar it sends to the federal government, and West Virginia, which garners $3.74 for each dollar it directs to the federal government.

New Jersey gets 78 cents for each dollar its residents provide in federal taxes. The other states that get less than a dollar for each dollar sent to D.C. are Nebraska, Washington, Minnesota and Illinois.

Mississippi gets more federal spending than most states in part because it has the highest percentage of people living in poverty who qualify for various federal programs. Mississippi also has multiple federal military bases. Many, but not all, of the state’s farmers also are big winners in terms of federal subsidies.

The taxing system is set up to send funding to programs that political leaders believe are good for the betterment of the nation, state or local government. A big part of the nation’s political discourse centers around what those programs should and should not do.

But regardless of that discourse, Mississippi has and will continue to be a winner in terms of the federal government providing tax dollars to the state despite the Biden student loan forgiveness program.

If Reeves really wants to stick to those other states and those elites by taking more of their tax dollars, all he has to do is expand Medicaid.

That decision would provide Mississippi about $1 billion per year in additional federal taxes.

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

Leaders have been obsessed with preventing welfare fraud among poor; not so much among wealthy

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Leaders have been obsessed with preventing welfare fraud among poor; not so much among wealthy

State legislative leaders spent an inordinate amount of time in 2017 passing the and Human Services Transparency and Fraud Prevention Act to put in place additional reporting requirements and other safeguards to ensure poor Mississippians were not getting benefits some feared they did not deserve.

“We (Mississippians) have the second-lowest work participation rate in the country,” Jameson Taylor, then vice president for policy research with the Mississippi Center for Public Policy, told the Heartland Institute at the time. “Welfare is a trap. We want to help move people from dependency to dignity, and from poverty to prosperity. That’s what these reforms do. They will also save the state money by kicking fraudsters off our rolls.”

Around the same time that legislators and others were concerned about fraud related to poor Mississippians who were receiving government assistance, $1.3 million in welfare funds were diverted to then-Lt. Gov. Tate Reeves’ fitness trainer, Paul Lacoste, who used $300,000 of those funds to pay himself a salary and another $70,000 to purchase a truck, according to the state auditor.

Additionally, $5 million was spent to build a volleyball court at the University of Southern Mississippi, and $1 million went to pay NFL and USM standout quarterback Brett Favre for speaking engagements that he did not make. Other welfare funds went to invest in drug research at the behest of Favre — with the blessings of former Gov. Phil Bryant. The list goes on and on and on. As much as $92 million in welfare funds could have been misspent, according to a 2020 state audit.

But legislators have yet to devote even a tiny fraction of the time addressing those misspent funds as the time they spent on the Medicaid and Human Services Transparency and Fraud Prevention Act, which was signed into law by then-Gov. Bryant and supported by Reeves, who then was lieutenant governor and is now governor.

In fairness to the Legislature, it should be pointed out that finally in the 2021 session, the welfare benefit for poor families was increased from $170 to $260 per month for a family of four. Those funds are earmarked for children and their caregivers.

Based on research done by Mississippi Today, less than 3,000 poor state residents normally receive cash benefits through the program. A study by Mississippi Today found only 5% of Mississippi’s federal block grant welfare funds went for monthly cash assistance. And until the legislation was passed in 2021, those monthly benefits for the poorest of the poor — paid entirely with federal welfare funds — were the lowest in the nation.

These are the same welfare benefits that were used to pay for the volleyball court, the fitness program and multiple other programs designed to help the supporters of Bryant, Reeves and others.

When the Medicaid and Human Services Transparency and Fraud Prevention Act was passed in 2017, one of the concerns cited was that there were dead people on the Medicaid rolls.

During debate in the Senate, then-Sen. Bill Stone, a Democrat from Holly Springs, asked of Medicaid Chair Brice Wiggins, R-, “Are you talking about dead people on the rolls for Medicaid?”

Wiggins responded, “I am talking about everybody, yes. It doesn’t matter if it is dead people. It doesn’t matter if it is people double dipping. They need to be following the law.”

The benefit a Medicaid recipient receives is . The state Division of Medicaid pays the providers — such as doctors, hospitals and nursing homes — for providing care. Medicaid recipients do not receive any cash payments, just health care.

It is difficult to envision a person assuming the identity of a dead person on Medicaid and then going to the doctor to receive health care. Perhaps it has happened.

No doubt, Wiggins, then the chair of the Senate Medicaid Committee, knew it would be unlikely for dead people to be receiving Medicaid benefits, but just got twisted up in his explanation since the bill dealt with making sure poor people were not cheating both the Medicaid program and the Department of Human Services. And as cited earlier, some poor Mississippians do receive cash benefits through Human Services — just not very many and not very much.

Medicaid, on the other hand, is a state-federal program that provides health care for the disabled, poor pregnant women, poor children and the elderly. Most adults are not eligible for Medicaid in Mississippi.

There is a small percentage of adult caregivers of Medicaid recipients, earning less than $578 monthly for a family of four, who are eligible for Medicaid.

If Mississippi expanded Medicaid, like 38 states have, other adults, primarily the working poor, would be eligible.

But dead people need not apply. In Mississippi, it is difficult enough for living poor people to garner help.

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

Natchez: Woman can’t find in-home medical care for daughter

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Nursing shortage, low reimbursement rates mean this 8-year-old can’t find care

NATCHEZ – Shavondra Smalley wakes up on her living room couch and looks at her 8-year-old daughter Layla stretched out on a hospital bed beside her, BiPAP machine humming. The two start their day as they always do. 

Smalley pulls out a stethoscope and listens to Layla’s labored breathing, checking to see how much mucus has built up in her trachea in the four hours since she last performed this sacred task. She grabs a chest percussion therapy cup, shaped like the bottom of a toilet plunger, and taps her daughter’s chest with it for around five minutes. Having broken up any secretions that could obstruct Layla’s airflow, she then inserts a suction catheter into her tracheostomy tube and removes the debris. 

It’s a Wednesday, but Smalley can’t go to her job of seven years. Layla, who is bedridden, requires the care of a registered nurse when her mother is away. For over a month, the nursing staffing agency she uses has been unable to find enough nurses willing to take a job that only pays up to $35 per hour.

The current reimbursement levels from were set in 2009, amidst a recession, and have not changed since, according to Kate Taylor, the owner of Faith and Friends Healthcare Staffing. Smalley uses her agency to find Layla’s nurses.

The hourly wages travel nurses can earn has decreased dramatically since their pandemic-fueled peak, when they could make up to $10,000 per week in New York. But they’re still much higher than the wages private-duty nurses can make serving patients like Layla who are on Medicaid. 

Smalley said she’s called the Mississippi Division of Medicaid multiple times to plead for help, but hasn’t received any response. Officials with the Division did not respond to emails or calls from Mississippi Today about reimbursement levels for private-duty nursing. When a reporter went to the Division building to try and speak with someone, he was told he must make an appointment. 

Taylor has also been reaching out to Medicaid.

“We have asked them (Medicaid) for reimbursement increases, and they say it’s in the works, but in the meantime, we can’t compete,” Taylor said.

Layla requires 20 hours of nursing care a day due to a litany of complex medical conditions. She was born with lissencephaly, which literally means “smooth brain,” a rare brain malformation characterized by the absence of normal folds in the cerebral cortex. She also suffers from scoliosis, chronic respiratory failure and pyruvate dehydrogenase complex deficiency, among other conditions. 

Over the past three weeks alone, Layla has only received 180 of the 420 hours of nursing care she needs, Smalley said. As a result, Smalley has missed work and is becoming increasingly exhausted.

“If they’re (Medicaid) not willing to try to increase the pay, then we’re still going to be going without the care that she needs,” she said. 

Smalley, a single mother of three children, is currently on unpaid family leave from her job. She gets up to 12 weeks of leave each year and is quickly running out. She’s worried about paying her bills and putting food on the table for her three children. She wants to work and loathes the idea of taking “handouts” from others or getting on welfare.

“I work so hard to take care of my kids and to take care of my responsibilities,” Smalley said. “Anybody that knows me knows that I don’t like to owe anybody.”

She does not want to institutionalize Layla, believing she would receive lower quality care. She takes pride in the care she provides Layla at home, noting she has never had a bed sore.

“I took on the battle to fight for my child since day one, and I’m not stopping,” Smalley said

Though their life has never been “normal,” Smalley is proud of the life she has built for herself and her children. Not having the nursing care Layla needs not only keeps her from working, but also prevents her from doing simple things like going to church or attending her 13-year-old son, Jonathan’s, sports games. 

Jonathan helps out with Layla’s care when she can, though Smalley tries to prevent this as much as possible.

“I try not to put responsibility on my children, because they’re just kids,” Smalley said.

Federal dollars from coronavirus relief packages  subsidized increased nurse wages for hospitals, but not for private nursing staffing agencies like Taylor’s.

Taylor said in addition to Smalley, she has clients in Vicksburg, Collins and Greenwood who can’t get the level of nursing care they need. 

“Any place that’s a little bit more rural, it’s hard to staff,” Taylor said. “Even if I offer a little bit more pay, that doesn’t seem to help.”

Data from the management consulting firm Kaufman Hall & Associates showed the dramatic increase in the national average for contract nurse labor costs. Before the coronavirus pandemic, wage rates for contract nurses were almost double those for employed nurses. By March 2022, contract nurses were making $132 per hour while nurses employed by hospitals were making $39. 

Hospitals are competing with each other to hire nurses. Mississippi has lost more than 2,000 nurses over the course of the pandemic due to burnout or higher paying jobs in other states. This strain is being felt all across the country, and the national shortage is likely to get worse over time.

Smalley was told when she was five months pregnant with Layla that her child would have  lissencephaly and was given the option to terminate the pregnancy. She is against , so she declined. 

After giving birth, Smalley received two weeks of tracheostomy and gastrostomy training at the hospital before being sent home with Layla. Through Medicaid’s Disabled Child Living At Home program, she was able to get a rotating group of nurses, each working 10-hour shifts, to take care of Layla. 

That has not been the case for over a month now. 

Medicaid is also experiencing a shortage of certain medical supplies, including tracheostomy tubes. Smalley has been forced to boil Layla’s tube in water to sanitize and reuse it, instead of replacing it each week as she should. 

The staffing problem Smalley is experiencing has been made worse by restrictions placed on who can provide Layla’s care. The nasopharyngeal suctioning Smalley performs on Layla every four hours is considered a “specialized skill” outside of the scope of practice of other health care workers like licensed practical nurses (LPNs) and vocational nurses. This restriction frustrates Smalley, as she’s able to perform it herself even though she’s not a medical professional.

Dr. Phyllis Johnson, executive director of the Mississippi Board of Nursing, said that while she understands Smalley’s frustration, nurses without the educational background of registered nurses do not have the skills needed to perform the kinds of emergency interventions that might be needed in a case as medically complex as Layla’s. 

“Our job is to make sure that the nurses perform safe, efficient and competent care the way they’ve been trained to, because when they don’t do that or step outside the scope of practice, that’s where the patients’ lives become endangered,” Johnson said. 

Smalley is doing the best she can in an exhausting and unsustainable situation. Her kids can’t help but notice the strain caring for Layla puts on their mom. Her 5-year-old daughter  Katelyn just started kindergarten and will often come and sleep next to Shavondra on the couch next to Layla’s hospital bed. 

Smalley has called multiple other staffing agencies across the state, none of which had the staffing available to help her.

“My daughter doesn’t have a voice so I have to be her voice and advocate for her … I just don’t know how long we can go on like this,” Smalley said. 

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

5 reasons lawmakers might not want to restore the ballot initiative

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5 reasons lawmakers might not want to restore the ballot initiative

Mississippi is the only state in the modern era to rescind its initiative process that allowed voters to bypass the Legislature and place issues directly on the ballot.

In 2021 the ruled unconstitutional the signature-gathering process as spelled out in the Constitution to place issues on the ballot. The ruling resulted in a initiative approved by voters in November 2020 and the entire initiative process being found to be invalid.

The Legislature could not agree during the 2022 session on language to revive the initiative process.

If the Legislature did restore the initiative, there would be at least five issues that could be the subject of initiative efforts. Those five issues, all opposed by many of the state’s political leaders, might be the reason legislators are reluctant to revive the initiative.

Those five initiatives would:

  • Expand .
  • Allow early voting.
  • Approve recreational marijuana.
  • Restore rights.
  • Allow people convicted of felonies to regain their voting rights at some point after they complete their sentence.

No doubt, there are other issues that most likely would be the subject of initiative efforts if the process was restored. Generally, initiatives are undertaken when legislators refuse to act on issues, such as on medical marijuana recently and on voter identification in 2011.

Medical marijuana was being rejected by the Legislature as a whole. In 2011, one chamber of the Legislature – the Democratic-controlled House – was blocking the enactment of a voter ID requirement.

Just like with medical marijuana and voter ID, the five issues cited above are currently being blocked by key legislators.

Medicaid expansion

Mississippi is one of 12 states that have not expanded Medicaid to provide health insurance for primarily the working poor. The two biggest obstacles to Medicaid expansion have been House Speaker Philip Gunn and Gov. Tate Reeves, who argue the state cannot afford to cover Mississippi’s share of the costs. Various studies have concluded that the expansion would actually be a boon to state coffers since the federal government would pay the bulk of the costs.

Various diverse groups ranging from the Mississippi Hospital Association to the Delta Council have endorsed expansion.

Early voting

Despite the rhetoric of former and many of his supporters bemoaning the evils of early voting, 46 states allow no excuse early voting and 27 permit voting by mail. And most states were allowing the various forms of early voting long before the 2020 election and the pandemic.

And truth be known, early voting has long been popular. Still, Reeves and other Mississippi politicians proudly proclaim they will block any effort to place Mississippi within the mainstream of states by enacting no excuse early voting.

Recreational marijuana

Like with early voting and Medicaid expansion, there was a recreational marijuana initiative being considered when the Mississippi Supreme Court shut down the initiative process.

And granted, it might be a long shot that Mississippi voters would approve recreational marijuana. But marijuana supporters in Arkansas garnered significantly more signatures than needed to place the issue on the November ballot.

If Arkansans approve or come close to approving recreational marijuana in November, that could be a sign that Mississippians also are willing to consider the issue.

Felony suffrage

Mississippi is one of a few states (less than 10) that do not restore voting rights to people convicted of felonies at some point after they complete their sentence. The felony suffrage provision was incorporated into the 1890 Constitution by those attempting to prevent African Americans from voting.

Voters in Florida recently voted via ballot initiative to restore voting rights to people convicted of felonies.

Abortion rights

Granted, it has long been perceived that Mississippians as a whole are staunchly anti-abortion. But after the June ruling by the in the Mississippi decision – Dobbs v. – overturning and rescinding a national right to an abortion, there has been a hue and cry by some to let Mississippians vote on the issue. After all, people who support abortion rights figure they have nothing to lose since existing Mississippi laws ban most abortions.

And there are a few reasons to give abortion rights supporters hope. For instance, in Kansas, a conservative state like Mississippi, voters recently rejected an anti-abortion proposal at the ballot box.

In addition, when Mississippians voted on abortion in 2011, they overwhelmingly defeated the “Personhood” initiative that defined life as beginning at conception. Plus, recent polling indicates that a vote on abortion in Mississippi might be close.

But unless the Legislature restores the initiative, we may never know how Mississippians feel about these issues and others.

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

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