medicaidexpansion

Hosemann announces Senate plan to help Mississippi hospital crisis

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Hosemann announces Senate plan to help Mississippi hospital crisis

Lt. Gov. Delbert Hosemann said measures he’s pushing in the Senate will help with Mississippi’s hospital crisis “not just next year, but for the next generation.”

The Senate plan would provide immediate help to hospitals with grants, legal barriers to consolidation of small hospitals and try to incentivize nurses and doctors to stay in Mississippi.

Hosemann said he is also working with Mississippi and Gov. Tate Reeves to see if Medicaid can increase reimbursement to hospitals for some services. But Hosemann, one of few GOP leaders open to Medicaid expansion through the federal Affordable Care Act, said he doesn’t foresee full expansion as a starter this year.

READ MORE: Poll: 80% of Mississippians favor Medicaid expansion

Senate leaders have drafted four bills, with a cost of about $111 million as part of the plan Hosemann announced. Hosemann said he worked extensively with the Mississippi Hospital Association and other hospital and leaders to come up with this plan. It would:

  • Provide $80 million in grants, to help shore hospitals’ flagging revenue and increased costs, which threaten closure of 38 rural hospitals across the . SB 2372 would distribute money to hospitals based on the number of licensed beds and type of care. Hosemann said it would also require hospitals to provide data that lawmakers could use to overhaul the state’s health delivery system. He said adjustments are needed to meet demographic and other changes.
  • Change “anti-trust” laws or other state legal barriers to “collaboration and consolidation” of hospitals. Hosemann said SB2323, which has a mirror bill in the House, would not change the state’s certificate of need laws that limit where certain hospital beds and specialties can go, but that “our CON laws are due for a review” and will likely also be examined this year. For the long , Hosemann said the state’s health care infrastructure needs to be reorganized and modernized to make facilities more financially viable.
  • Provide $6 million for a nurse loan repayment program. Hosemann said SB 2373 is a do-over of a bill passed last year that did not work to address the states drastic shortage, estimated at about 3,000 nurses. He said changes the House made last year and other issues derailed the program, but those issues are being worked out. The plan, using federal pandemic relief money, would provide $6,000 a year, for up to three years, for nurses who agree to work at Mississippi hospitals.
  • Provide $20 million for a nursing/allied health community college grant program. SB2371 would use federal pandemic funds, initially, for grants to help community colleges’ nursing and health programs. Hosemann said many of the programs have long waiting lists and shortage of faculty, equipment and infrastructure needed to train nurses. Hosemann noted the pandemic showed the importance of nurses and “our community colleges are leading the way in providing nurses throughout the state.”
  • Provide $5 million to help with hospital residency and fellowship programs. Also in SB2371, this proposal, funded by federal pandemic money, would help create new programs, or add capacity to existing residency and fellowship programs in medical or surgical specialty areas at Mississippi hospitals. Hosemann said the federal government provides reimbursement for some residents or fellowships at hospitals, but the initial startup costs are prohibitive, and this new plan would help. He said that hospitals report that a majority of doctors stay in areas where they do their residencies.

READ MORE: Democrats finalize hospital crisis plan, blast Republicans for inaction

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

Hosemann on Wednesday also reiterated his support for extending postpartum Medicaid coverage for new mothers from 60 days to a year. The Senate passed such measures last year, but they were killed in the House.

“We won the pro-life case, and now we’re unwilling to take care of our moms?” Hosemann said. “I don’t understand how you can make that argument.”

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

Fact check: Feds not slated to end Medicaid expansion funding

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Fact check: Feds not slated to end Medicaid expansion funding

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

Mississippi Insurance Commissioner Mike Chaney recently told members of the media he supports the expansion of , but that the program most likely will end in 2025.

That statement is inaccurate. Robin Rudowitz, vice president and head of the Medicaid team for the Kaiser Family Foundation, said the program is not slated to end and there is nothing pending federally that would result in the demise of Medicaid expansion in 2025.

The Medicaid expansion program will continue “unless Congress changes the law,” said Rudowitz. Kaiser is a health care advocacy nonprofit and keeps close tabs on federal legislation.

Medicaid expansion is part of the Patient Protection and Affordable Care Act, commonly called Obamacare, which was passed in 2010. Under the expansion program, states can provide health care coverage through Medicaid for people — primarily the working poor — earning up the 138% of the federal poverty level, or about $18,500 annually for an individual.

Q&A: What is Medicaid expansion, really?

Mississippi is one of 11 states that has opted not to expand Medicaid to ensure health care coverage for the working poor. Many in the Republican leadership in Mississippi, specifically Gov. Tate Reeves and House Speaker Philip Gunn, have maintained the cannot afford to expand Medicaid and that they do not want to add to the welfare rolls by providing health insurance for the working poor.

Chaney is the only Mississippi statewide official to take a firm position in favor of expansion, though in doing so he has echoed another talking point of those who oppose expansion — that it will not last.

During the annual Hobnob in October, where the state’s political leaders speak to members of the Mississippi Economic Council, Chaney said of Medicaid expansion: “I’m not sure it would work today because it’s only got a three-year life left on the expansion part. In 2025, all the people that have been put on under expansion will be taken off and you’ve got to find a new (health care coverage) home for them unless the feds change the program. It depends on who controls the election, who controls the administration. I don’t know.”

During additional conversations in recent days, Chaney referenced programs other than the Medicaid expansion program that will end. It is true that the state’s “traditional” Medicaid rolls could be shrinking in the coming months.

READ MORE: Mississippi leaving more than $1 billion per year on table by rejecting Medicaid expansion

As part of federal relief legislation, the federal contribution to each state’s Medicaid program was increased by 6.2% during the pandemic public health emergency. The increase means that this fiscal year the federal government would pay 84.06% of the cost of providing health care services for Mississippi Medicaid recipients with the state paying the rest.

As part of receiving the additional federal funds through the higher matching rate, the state has had to agree not to anyone from the Medicaid rolls. In Mississippi, Medicaid provides coverage for poor pregnant women, poor children, the disabled, some categories of the elderly and some caretakers of Medicaid recipients living in extreme poverty.

Medicaid expansion would provide coverage for healthy people who otherwise would not be eligible for Medicaid.

The increased matching rate has resulted in a boon in revenue for the state. According to a Kaiser study, between 2020-2022, the enhanced matching rate for the state’s current program and increased Medicaid enrollment have resulted in additional costs of $173 million in state funds. But during the same time period, the federal government has provided an additional $1.1 billion in federal funds for Mississippi Medicaid recipients.

Mississippi, as the poorest state in the nation, receives the largest matching rate from the federal government for its existing Medicaid program.

Chaney is correct that the enhanced matching rate will end and people most likely will be from the rolls, most likely long before 2025. But Rudowitz said the administration of has said it will provide states a 60-day notice before ending the state of emergency.

At that time, as Chaney said, Mississippi and other states will have to determine if there are ways to provide health care coverage for those who are removed from Medicaid. In Mississippi, many of those who might be removed could obtain coverage by expanding Medicaid or by providing one year of Medicaid coverage for mothers of newborns.

READ MORE: Extending postpartum coverage to Mississippi mothers ‘a no brainer,’ key lawmaker says

Many of the people in Mississippi who have remained on the rolls during the public health emergency are mothers of newborns. Under Mississippi law, outside of the federal public health emergency, postpartum coverage lasts for only 60 days.

Under Medicaid expansion, the federal government pays 90% of the costs.

Rudowitz said the 90% rate “remains in perpetuity unless Congress changes the law.”

She also said there has been no talk in recent years of Republicans in Congress trying to repeal Obamacare or more specifically the Medicaid expansion program.

In fact, as part of COVID-19 relief legislation, the states that have not expanded Medicaid have been offered a financial incentive to do so. In Mississippi, it is estimated that the financial incentive would provide more than $600 million in federal funds over two years.

Rudowitz said the federal legislation does not put a time limit on how long the states have to expand Medicaid and claim the financial incentive. But the financial incentive only lasts for two years once it begins.

South Dakota citizens voted in early November to adopt Medicaid expansion. Mississippi and 10 other states, most in the Southeast, have not adopted Medicaid expansion.

READ MORE: Here’s what experts say about expanding Medicaid in Mississippi

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

Louisianans on Medicaid expansion can get care across river at Natchez hospital

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Louisianans on Medicaid expansion can get care across river at Natchez hospital

Just across the Mississippi River bridge from Natchez are the Louisiana towns of Vidalia, Ferriday and other communities where there are people who have coverage through the expansion of .

Those Louisianans, if they are in the correct Medicaid health care network, can obtain medical services across the bridge in Mississippi at Merit Natchez hospital. People in Mississippi, of course, also can receive health care at Merit, one of the largest health care providers in southwest Mississippi.

But those cannot take advantage of Medicaid expansion to help pay their medical bills because Mississippi, unlike Louisiana, does not have Medicaid expansion.

“Expanding Medicaid was Gov. (John Bell) Edwards’ first official act when he took office in 2016,” Laura Leist, a spokeswoman for the Democratic governor, told Mississippi Today via email. “He often says it’s the easiest big decision he’s made as governor.”

Kay Ketchings, a spokesperson for the Natchez hospital, said Merit will work with Louisianans who are not in network to provide them medical care as it will with Mississippians who have no access to Medicaid expansion. But Merit Natchez, like other Mississippi hospitals, have a difficult time collecting payment from many poor people who are not covered by Medicaid expansion. They often do not have the money to pay, leaving hospitals to eat those costs or pass the costs on to other patients.

“Medicaid covers the most vulnerable residents in Mississippi …,” Ketchings said. “It is an important step toward advancing the overall health of Mississippians because it provides sustainable coverage for continued access to preventive care and physician assistance with chronic conditions. Like others in , we are supportive of efforts to expand coverage for vulnerable Mississippians.”

Louisiana is one of the few Southern states to expand Medicaid. Medicaid provides health care coverage for primarily the working poor who earn up to 138% of the federal poverty level or about $18,750 for an individual. The federal government pays 90% of the cost plus substantial incentives for the states that have not expanded Medicaid to do so.

South Dakota voters earlier this month voted to expand Medicaid. Now 11 states, mostly in the Southeast, have not taken advantage of the expansion as is offered as part of the Patient Protection and Affordable Care Act, also known as Obamacare.

A map of the states that have not expanded Medicaid looks much the same as a footprint of the NCAA’s Southeastern Conference with four notable exceptions – Arkansas, Louisiana, Kentucky and Missouri. Those four states, including two contiguous to Mississippi, have expanded Medicaid.

Of the 11 states that have not expanded Medicaid, seven have schools in the Southeastern Conference, and all seven have higher percentages of their population uninsured or lacking health care coverage than does the nation at a whole.

The four SEC states that have expanded Medicaid have higher percentages of their population with health insurance coverage than those that have not expanded Medicaid.

“Today, more than 747,000 of Louisiana’s working poor have access to health care, including mammograms and other preventive heath screenings, mental health resources and substance abuse services,” said Leist. “Louisiana’s uninsured rate has dropped from 22.7% in 2015 prior to expansion to just 9.4%, and rural hospitals that were on the verge of closing before expansion have been able to stay open and continue serving their communities.”

In Mississippi, the Hospital Association, with many of its member medical centers in financial straits, is one of the most vocal supporters of Medicaid expansion. Mississippi's Health Officer Daniel Edney has said that 38, or 54%, of the state’ rural hospitals are in danger of closing. Hospital Association officials say Medicaid expansion would provide a boost to those struggling hospitals by decreasing the amount of uncompensated care they deliver.

But Mississippi political leaders have blocked efforts to expand Medicaid. They have provided a litany of reasons for opposing the expansion, ranging from the state cannot afford it to not wanting to expand welfare programs in the state.

Susan Dunlap, a spokesperson for Kentucky Gov. Andy Beshear, a Democrat, said Medicaid expansion has been a positive in the Bluegrass state.

“Costs to the state have what was anticipated,” she said. “Expansion of this program resulted in economic growth through increased state and local tax revenue, the creation of new jobs and additional (health care) provider revenue.”

She said the expansion has resulted in people being able to get medical care, including important but non-life threatening procedures, such as knee replacements, shoulder surgeries and tonsillectomies.

In three Southern states, Louisiana, Arkansas and Kentucky, Medicaid was expanded under Democratic governors. But in those states, the expansion has been largely supported by Republican-controlled legislatures that have not tried to repeal the program. And in Arkansas, it has been continued under a Republican governor. And Arkansas-Gov. elect Sarah Huckabee Sanders, former spokesperson for , has not advocated for the repeal of that state’s version of Medicaid expansion. In Arkansas, the state uses the federal Medicaid expansion matching funds to purchase private insurance for those who otherwise would be eligible for the Medicaid expansion program.

“Out of the 38 (states that have expanded Medicaid), none have stopped,” Tim Moore, chief executive with the Mississippi Hospital Association, recently told the Senate Public Health Committee during a hearing on the financial difficulties facing Mississippi hospitals.

“They continue to use it. They continue to take down federal dollars. It has been a good thing for everybody, including the state, the patients and the providers.”

The states with the highest uninsured rates in the nation are primarily Southern states that have not expanded Medicaid. Texas is the highest at 18.4%, while Georgia and Florida are at 13.2% followed by Mississippi at 13%, according to a recent report by the Health Foundation.

The national uninsured rate is 9.2%, according to the same study. The Southern states that have expanded Medicaid all have uninsured rates near or below the national average. Kentucky's uninsured rate is 6.4%.

Uninsured rates across the national have declined significantly since the 2010 passage of the Affordable Care Act that also includes the health care exchange that allows people to buy insurance coverage in most cases with the help of a government subsidy.

But there are people who do not qualify for health insurance policies through the health care exchange because their income is below a certain level. The architects of the Affordable Care Act envisioned they would be covered through Medicaid expansion, not contemplating there would be states like Mississippi that opted not to participate in the program.

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

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