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Texts: Lawmakers maneuver Mississippi’s Medicaid rolls

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Texts: Lawmakers maneuver Mississippi's Medicaid rolls

Wading through the complexities of Medicaid eligibility in order to secure health insurance for yourself or your family member in Mississippi can be a nightmare. It might even feel impossible.

But if you happen to go to church with a state legislator, you may be in luck.

“Please have someone check on the Medicaid app on (patient),” Rep. Jody Steverson, R-Ripley, wrote to Mississippi Division of Medicaid Director Drew Snyder last summer. “(Patient) has cerebral palsy and I attend church with his grandparents.”

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Snyder forwarded the message to Tracy Buchanan, Medicaid's director of long term services and supports. “Will do,” she responded.

Drew Snyder, Mississippi Division of Medicaid executive director, gives a presentation during a Senate Medicaid hearing at the state Capitol in , Miss., Wednesday, November 9, 2022.

In roughly the last year, Snyder asked Buchanan to follow up on requests from at least eight lawmakers, all white Republican men, according to text messages obtained by Mississippi Today.*

“Being a lawmaker, you can go to the head of the department and start there,” said Rep. Price Wallace, R-Mendenhall, who called and texted Snyder about a Medicaid application in January. “When you can call the top brass and let them know, then the problem seems to get worked out a lot quicker than starting at the bottom and to go up the ladder.”

In the texts, the politicians ask for special attention, sometimes explaining the heartbreaking circumstances and the roadblocks that specific beneficiaries faced in attempting to access Medicaid – the public health insurance program reserved for the poorest and most medically fragile citizens.

READ MORE: ‘You're not in line': Family battles politics, indifference, and suspected fraud in federal health care program

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Medicaid is one of the largest arms of the nation's social safety net, a maze of taxpayer-funded assistance that ideally exists to level the playing field for needy Americans, if not just simply them survive.

Mississippi lawmakers – as well as Gov. Tate Reeves, who reappointed Snyder from the previous Gov. Phil Bryant administration – have resisted expanding Medicaid to cover the poor and uninsured. They've opted instead for punitive policies that target beneficiaries for suspected fraud, such as the HOPE Act, which they refused to repeal even after recent pleas from the Reeves-appointed welfare director.

Yet they can tap into the programs for those they personally deem worthy.

“Thank you for again helping me,” House Appropriations Chairman Rep. John Read, R-Gautier, texted Snyder in early 2022. “The family at this time can not express how great they feel.”

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Looking at it one way, the requests demonstrate the lawmaker's accessibility, their resourcefulness, tangible constituent representation.

But the texts also reflect the potential influence lawmakers have over the agency, not just in relation to its state budget, but in determining who successfully ends up on the Medicaid rolls in the poorest state in the nation.

“Legislators often reach out to the Division with questions or concerns raised by their constituents, and we take those questions and concerns seriously,” Medicaid said in a written response to Mississippi . “However, we strongly disagree with your assertion that these communications demonstrate a pattern of legislative influence on who gets served and how quickly.”

While some of Snyder's inquiries to Buchanan over the last year came from other connected people, the majority originated from lawmakers. Snyder, who came to Medicaid after working as a deputy chief of staff and policy advisor in Bryant's office, has an incentive to make lawmakers happy, since they determine his state budget.

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“I think it does help, you know, when a lawmaker makes the phone call. It puts a little bit hotter fire under their bottom,” Wallace said. “… When I talked back with Drew, he was like, ‘Yeah, we got everything handled.' So it was taken care of.”

“That's what we're here for,” Wallace said. “In all honesty, that's why I ran for this job, to help my constituents. That's where I get the most satisfaction of being a representative for the state of Mississippi District 77 is when one of my constituents calls me with a problem and I'm able to help them resolve that problem.”

Mississippi Today recently published a story about the struggles that a couple in north Mississippi have had navigating a special Medicaid program, called the Medicaid IDD waiver, for their 23-year-old son, who has severe autism.

The couple, Natalie and Jamie Gunnells, sought help from their local lawmaker Sen. Chad McMahan, R-Guntown, which they had supported in his past campaigns. McMahan set up a meeting for the Gunnells with from Medicaid, which eventually acquiesced, adopting a temporary policy that allowed Natalie Gunnells to get paid for care for her son.

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Sen. Chad McMahan, R-Guntown, speaks in favor of legislation to change the Mississippi state flag Sunday, June 28, 2020 at the Capitol in Jackson, Miss. (AP Photo/Rogelio V. Solis)

“I know how to work the system for the people I represent,” McMahan told Mississippi Today. “… I have figured out a way to be very successful in helping my constituents get the medical services or the disability services their family needs. And I'm not gonna reveal how I've learned it. I've learned the system.”

When McMahan found out the Gunnells had expressed support for his upcoming political opponent, a conservative opposed to Medicaid enhancements, the senator called them out, saying it was a “slap in the face” considering all the hours he spent lobbying on their behalf.

Asked if he thinks about helping people access public assistance as a way to secure votes, McMahan said, “That never crosses my mind. There's never a wrong time to do the right thing.”

(Medicaid later chose not to permanently adopt the policy).

Rep. John Hines, D-Greenwood, said when he's reached out to Medicaid about concerns, current agency leadership has always been responsive to him, explaining why one of his constituents may or may not be eligible for the assistance. They say they want to help, Hines said, but that they have to stay within strict eligibility guidelines.

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To Hines, this scenario illuminates a larger point: There wouldn't be such a need for lawmaker intervention on specific beneficiary cases if those lawmakers put in place equitable policies for all.

Rep. John Hines Sr., D-Greenville, asks questions during a TANF hearing at the State Capitol in Jackson, Miss., Thursday, December 15, 2022.

“I think the issue in the whole Medicaid system is the fact that we did not expand,” Hines said. “And a lot of these conversations, a lot of these situations that are here in this state, if we would just expand it, we would not be . There wouldn't even be a need for you to do the story that you're doing.”

Hines continued: “The 's inability to want to expand Medicaid forces representatives and directors of agencies to have to make uncomfortable decisions and conversations around the safety and the health of constituents, which would automatically be eligible for Medicaid if we would expand it, and they wouldn't have to be making all these special phone calls.”

Below are the texts between Snyder and Buchanan referencing lawmaker interactions with Steverson, Read, Wallace, Rep. Tracy Arnold, R-Boonville, Rep. Rob Roberson, R-Starkville, Rep. Joey Hood, R-Ackerman, Rep. Bubba Carpenter, R-Burnsville, Rep. Sam Creekmore, R-New Albany, and former House Ways and Means Chair Jeff Smith, R-Columbus. Most of them either declined to comment or did not return texts or calls to Mississippi Today.

*The text messages referenced in this story were sent between Snyder and Buchanan from Dec. 1, 2021, to February 16, 2023. They do not reflect the entirety of communication between state lawmakers and Snyder, just the correspondence he forwarded to Buchanan that was then shared with Mississippi Today to fulfill its records request.

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Mississippi Division of Medicaid Director Drew Snyder forwarded a text to his employee Tracy Buchanan, director of long term services and supports, from former Rep. Jeff Smith, R-Columbus, in January of 2022. Smith was asking for someone to look into an elderly person's Medicaid application.
Mississippi Division of Medicaid Director Drew Snyder sent his employee Tracy Buchanan, director of long term services and supports, a photo from Rep. Tracy Arnold, R-Booneville, in January of 2022. The next day, he forwarded the screenshot of a text from Rep. John Read, R-Gautier, thanking Snyder for his help.
Mississippi Division of Medicaid Director Drew Snyder sent his employee Tracy Buchanan, director of long term services and supports, a screenshot of a text from Rep. Rob Roberson, R-Starkville, in March of 2022. Roberson explained that one of his constituents was trying to secure Medicaid benefits for their adult son, who had been in a car accident. Buchanan responded that she would see how they could help.
Mississippi Division of Medicaid Director Drew Snyder sent his employee Tracy Buchanan, director of long term services and supports, a screenshot from Rep. Joey Hood, R-Ackerman, in March of 2022. The text described a patient losing her respite care due to a worker shortage. Buchanan responded that they will make a call.
Mississippi Division of Medicaid Director Drew Snyder sent his employee Tracy Buchanan, director of long term services and supports, the contact for a friend of Rep. Bubba Carpenter, R-Burnsville, in March of 2022. Snyder explained that they have questions for Medicaid and Buchanan said they will call.
Mississippi Division of Medicaid Director Drew Snyder forwarded a message to his employee Tracy Buchanan, director of long term services and supports, from Rep. Jody Steverson, R-Ripley, in August of 2022. Steverson asked for someone from Medicaid to look into an application for the grandson of some of his fellow church members. Buchanan responded, “Will do.”
Mississippi Division of Medicaid Director Drew Snyder forwarded a message to his employee Tracy Buchanan, director of long term services and supports, from Rep. Tracy Arnold, R-Booneville, in June of 2022. “They really need help,” Arnold said, referencing a patient in need of Medicaid coverage in order to pay for dialysis. “Will do now,” Buchanan responded.
Mississippi Division of Medicaid Director Drew Snyder sent Tracy Buchanan, director of long term services and supports, a message saying Rep. Bubba Carpenter, R-Burnsville, had called on behalf of a woman who was trying to get Medicaid to pay for brand ADHD medication for her son. “Can y'all get someone in pharmacy to reach out to her tomorrow,” Snyder wrote in the July 2022 text. “Will do,” Buchanan responded.
Mississippi Division of Medicaid Director Drew Snyder forwarded a message to his employee Tracy Buchanan, director of long term services and supports, from Rep. Sam Creekmore, R-New Albany, in August of 2022. Creekmore asked for someone to check on the Medicaid applications of two providers. “Will do,” Buchanan responded.
Mississippi Division of Medicaid Director Drew Snyder sent his employee Tracy Buchanan, director of long term services and supports, a message referencing a call from Rep. Price Wallace, R-Mendenhall, in January of 2023. “Waiting on status of the application,” Snyder wrote. “Got it” Buchanan responded.

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

Mississippi Today

‘This doesn’t need to be a slap on the wrist,’ DA says of Noxubee County case

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mississippitoday.org – Jerry Mitchell and Ilyssa Daly – 2024-05-09 13:45:26

A capital murder investigation helped lead to unrelated federal charges against former Noxubee County Sheriff Terry Grassaree and his deputy that involved the sexual abuse of a jailed woman.

On Tuesday, Grassaree pleaded guilty to lying to the FBI when he denied receiving nude photos and from a woman locked in his jail. He faces up to five years in federal prison when he is Aug. 7.

Ex-Noxubee County Sheriff Terry Grassaree heads into federal court where he will plead guilty, Tuesday, May 7, 2024 in Jackson.

His former deputy, Vance Phillips, pleaded guilty last year to bribery, which experts say could have been the perks the woman received, a contraband cellphone. No date has been set for his sentencing.

District Attorney Scott Colom said Thursday he would like to see serious punishment for Grassaree for such abuse. “This doesn't need to be a slap on the wrist,” he said.

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He said the discovery of this abuse began with a capital murder case. In 2015, Kristopher Haywood died in a convenience store attack in Macon when someone blasted the 28-year-old twice in the head with a shotgun.

A Noxubee County grand jury indicted Jonathan Shumaker, his girlfriend, Elizabeth Layne Reed, and Justin Williams and his brother, Joshua, on capital murder charges. Shumaker was also found in possession of a shotgun and charged with possession of a firearm by a felon. (These charges were dropped last year after an audio recording surfaced that exonerated them.)

But when Colom inherited the case as the new district attorney in 2016, he said he discovered the evidence and some of the witnesses contradicted the description of what happened.

Three years later, as he prepared for trial, he said his office interviewed Reed, who shared that deputies had been sex with her inside the jail, “but you're not going to do anything about it.”

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Colom promised that he would.

He said he reached out to federal authorities in 2019 for assistance out of concern that it might be difficult to investigate law enforcement in such a small county. 

He said his office took the lead. One of his workers messaged Deputy Phillips from Reed's Facebook page a photograph of a positive test for pregnancy.

“That's how we got Vance to corroborate that Reed was telling the truth about the unlawful sex,” Colom said. “We knew we had a serious problem then.”

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Any sex that an officer has with someone behind bars is a felony under Mississippi law and carries up to five years in prison. The maximum penalty under federal law is also five years.

There is no way for those behind bars to give consent, Colom said. “They're in a vulnerable situation. Their liberty and freedom can be used against them.”

Reed told Colom's office that the sex began with Phillips after he began transporting her to doctors' visits. He first took her to his trailer to have sex and then had sex with her while the female correctional were at lunch, Colom said.

The encounters also took place in deputies' offices, the interrogation room and even the evidence shed, he said.

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The deputy continued to demand sex with her on an almost weekly basis between May 2017 and October 2019, according to a she filed against Noxubee County and the sheriff's office. “Reed, under the coercion of Phillips' authority and her incarceration, acquiesced in Phillips' demands.”

Another deputy, Damon Clark, who gave her cigarettes and a touchscreen cell phone, took her up front to a shower, where “he laid me on the floor [and] got on top of me,” she told authorities.

Clark has never been charged. “I never coerced Reed into sex,” he wrote in his response to the lawsuit, but he never answered whether he had sex with her.

Reed told authorities that one other deputy digitally penetrated her and another groped her and “sexted” her.

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Colom said their investigation into sexual abuse corroborated much of what Reed alleged. It was then, he said, “we realized we had a serious problem with the Noxubee County Sheriff's Office under the regime of former Sheriff Terry Grassaree.”

Their investigation showed Grassaree knew about his deputies' activities, but rather than referring the matter to authorities, he sought to “get in on the action himself,” Colom said.

Reed's lawsuit said Grassaree demanded “a continuous stream of explicit videos, photographs and texts” from her in jail. She also alleged in the lawsuit that Grassaree touched her in a “sexual manner.”

The county settled the lawsuit for an undisclosed amount.

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Colom said he decided to turn over his investigation to federal authorities with the agreement they would prosecute since they could pull far more potential jurors. Getting enough people to serve as jurors has long been a problem in Noxubee County, which has a population of less than 10,000, much less finding impartial jurors, he said.

On July 13, 2020, an FBI agent interviewed Grassaree, who denied that he received nude photos and videos from Reed in jail.

Two years later, reporters from the Mississippi Center for Investigative at Mississippi and The New York Times began asking Colom about the case. Colom responded that he was waiting for federal authorities to prosecute as they agreed. Afterward, he contacted federal authorities again and told them reporters had reached out to him, asking questions.

In October 2022, a federal grand jury finally indicted Grassaree and Phillips.

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Colom said federal authorities “never gave me a good reason for why they took so long.”

He said even more troubling in his investigation was the discovery of “illegal activities” by the sheriff's office “that were unrelated to sex.” There have been no indictments in that case.

Noxubee County already have a lot of skepticism toward law enforcement, he said, “so when you actually do have corruption, it has to be aggressively handled. We can't have police forces where the people we are trusting to protect and serve are only concerned about themselves and their own illegal agendas.”

He still hopes federal authorities will prosecute, he said. “It would send a strong message to the citizens in Noxubee County that you care about them.”

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Asked if his office could bring charges now, he said that was impossible because “the statute of limitations has run.”

Federal authorities have a five-year statute of limitations, but the statute of limitations in Mississippi is only two years.

Colom said he didn't move sooner because federal officials “had agreed to prosecute the charges and kept telling me they were going to do something.”

A spokesperson for the U.S. Attorney's office in Jackson responded Thursday, “The Department of Justice follows the facts, law, and principles of federal prosecution when determining how to proceed in an investigation and what charges, if any, can be filed. Federal agents and prosecutors will continue working hard every day to hold public officials in Mississippi, like Sheriff Grassaree, accountable for corrupt use of their office and efforts to mislead investigators.”

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Mike Hurst, U.S. attorney for the Southern District of Mississippi

Former U.S. Attorney Michael Hurst, who served from 2017 to 2021, said prosecuting public corruption was one of his top priorities, especially when it involved law enforcement who “violated their oath and victimized our citizens.”

He said if the U.S. attorney's office had sufficient evidence beyond a reasonable doubt to prosecute, “we prosecuted them, no matter who they were, period. In many instances, federal prosecutors are the last line of defense in our society of ensuring that our citizens are protected, their rights are upheld, and that criminals — especially corrupt public officials — are held accountable.”

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

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Medical residents are increasingly avoiding states with abortion restrictions

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mississippitoday.org – Rachana Pradhan, KFF Health News and Julie Rovner, KFF Health News – 2024-05-09 12:27:53

Isabella Rosario Blum was wrapping up medical school and considering residency programs to become a family practice physician when she got some frank advice: If she wanted to be trained to provide abortions, she shouldn't stay in Arizona.

Blum turned to programs mostly in states where abortion access — and, by extension, abortion training — is likely to remain protected, like California, Colorado, and New Mexico. Arizona has enacted a banning most abortions after 15 weeks.

“I would really like to have all the training possible,” she said, “so of course that would have still been a limitation.”

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In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.

According to new statistics from the Association of American Medical Colleges, for the second year in a row, graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions.

Since the Supreme Court in 2022 overturned the constitutional right to an abortion, fights over abortion access have created plenty of uncertainty for pregnant and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.

Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC — a preliminary copy of which was exclusively reviewed by KFF Health News before its public release — found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.

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Notably, the AAMC's findings illuminate the broader problems abortion bans can create for a state's medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.

“It should be concerning for states with severe restrictions on reproductive rights that so many new physicians — across specialties — are choosing to apply to other states for training instead,” wrote Atul Grover, executive director of the AAMC's Research and Action Institute.

The AAMC analysis found the number of applicants to OB-GYN residency programs in abortion ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal.

In its analysis, the AAMC said an ongoing decline in interest in ban states among new doctors ultimately “may negatively affect access to care in those states.”

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Jack Resneck Jr., immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post- era.

The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions — mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.

Still, Resneck said, “we're extraordinarily worried.” For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies, or potential complications such as infection or hemorrhaging that could stem from pregnancy loss.

Those who work with students and residents say their observations the AAMC's findings. “People don't want to go to a place where evidence-based practice and human rights in general are curtailed,” said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.

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Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth defects later in pregnancy may not be able to receive care there.

Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban “impacts whether we have the best and brightest coming to North Carolina.”

Rohini Kousalya Siva will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York, and Washington, D.C.

“We're physicians,” said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. “We're supposed to be giving the best evidence-based care to our patients, and we can't do that if we haven't been given abortion training.”

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Another consideration: Most graduating medical students are in their 20s, “the age when people are starting to think about putting down roots and starting families,” said Gray, who added that she is noticing many more students ask about politics during their residency interviews.

And because most young doctors make their careers in the state where they do their residencies, “people don't feel safe potentially their own pregnancies living in those states” with severe restrictions, said Debra Stulberg, chair of the Department of Family Medicine at the University of Chicago.

Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved .

“The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” she said. “We don't need people further concentrating in urban areas where there's already good access.”

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After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the nation, Hannah Light-Olson will start her OB-GYN residency at the University of California-San Francisco this summer.

It was not an easy , she said. “I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” she said. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.”

Light-Olson said some of her fellow students applied to programs in abortion ban states “because they think we need pro-choice providers in restrictive states now more than ever.” In fact, she said, she also applied to programs in ban states when she was confident the program had a way to provide abortion training.

“I felt like there was no perfect, 100% guarantee; we've seen how fast things can change,” she said. “I don't feel particularly confident that California and New York aren't going to be under threat, too.”

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As a of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.

“Residents, if they can't get the training in the state, then they're probably less likely to settle down and work in the state as well,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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

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On this day in 1928

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mississippitoday.org – Jerry Mitchell – 2024-05-09 07:00:00

MAY 9, 1928

First NFL with an all-Black officiating crew on Nov. 23, 2020. Burl Toler, pictured far right, was remembered. Credit: NBC

Burl Toler was born in Memphis. The first Black official in any major sport in the U.S., he defeated prejudice at each turn. 

In 1951, Toler starred for the legendary undefeated of San Francisco Dons. Prejudice kept the integrated team from playing in the Gator Bowl, but the team found anyway. Nine players went to the NFL, three of them later inducted into the Professional Football Hall of Fame. Their best player may have been Toler, who was drafted by Cleveland but suffered a severe knee injury in a college all-star game that ended his playing days. 

Toler decided to make his way into professional football through officiating. The NFL hired him in 1965 — a year before Emmett Ashford became the first Black umpire in Major League and three years before Jackie White broke the color barrier in the NBA. 

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He rose above the racism he encountered, working as a head linesman and field judge for a quarter-century. He officiated Super Bowl XIV, where the Pittsburgh Steelers defeated the Los Angeles Rams in 1980. Two years later, he officiated the “Freezer Bowl,” where the Cincinnati Bengals defeated the San Diego Chargers in the AFC Championship Game. The game marked the coldest temperatures of any game in NFL history — minus 59 degrees wind chill — and Toler suffered frostbite. 

In addition to his NFL work, he worked as an educator, becoming the first Black secondary school principal in the San Francisco district. He died in 2009. Two area schools and a hall on the University of San Francisco campus have been renamed in his honor. On Nov. 23, 2020, Toler was remembered again when the NFL had its first all-Black officiating crew.

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

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