Mississippi Today

‘The life and breath of communities’: Hospital leaders say Medicaid expansion still needed

Published

3 months ago

February 1, 2024

Gov. Tate Reeves' Medicaid payment changes, pitched during the eleventh-hour of a heated reelection campaign and his only major health plan during his first four years as governor, delivered $658.2 million to hospitals in January.

Hospital leaders say the influx of federal money is a lifeline, but it's not enough to forgo Medicaid expansion – a long-term solution that would insure hundreds of thousands of working poor people in one of the country's sickest states.

Quentin Whitwell owns four hospitals in rural Mississippi. He knows intimately the struggles they face. While the extra federal money Reeves secured is helpful, he said, expansion would go further.

“There is no reason to leave funding on the table to assist rural hospitals that are the life and breath of communities,” he said.

As Mississippi hospitals continue to struggle, expanding Medicaid to cover the working poor has been hotly contested over the last decade, most openly during the last two gubernatorial elections. Reeves, as did two of his GOP predecessors, has remained steadfastly opposed, saying it would make Mississippians more reliant on “welfare.”

Medicaid expansion would increase the income threshold needed to qualify for Medicaid to 138% of the federal poverty level, meaning many more Mississippians would qualify for coverage. For a family of four, that would be an annual income of $43,056.

As it stands, low-income, working-class Mississippians who make just above the poverty level don't qualify for Medicaid but also can't afford insurance. Nearly one in five Mississippians is uninsured, contributing to the state's abysmal public health metrics – such as the lowest life expectancy in the country.

Extensive research underlines the policy's financial and health benefits, and a majority of Mississippians say they want Medicaid eligibility expanded, as it has been in 40 other states. Researchers estimate the policy would insure between 200,000 and 300,000 Mississippians, generate thousands of jobs, help struggling hospitals and bring billions of dollars into the state.

The money's needed — one report estimates nearly half of the state's rural hospitals are at risk of closure, largely due to losses related to caring for uninsured patients.

However, the governor and some other Republican leaders have remained staunchly against the policy.

Weeks before the November election, in which Reeves narrowly defeated Democrat Brandon Presley, the governor announced that the state had requested federal approval of changes to its Medicaid payment policies. The changes, Reeves claimed, would bring in nearly $700 million in total to the state's hospitals.

Reeves' plan relies on increased extra payments hospitals get for treating patients on Medicaid. It increases a “bed tax” on Mississippi hospitals, in exchange for them drawing down more in federal Medicaid payments. Hospitals and GOP leaders in the Legislature had pitched roughly the same plan the year before, but Reeves' own Medicaid administration had told them it wouldn't work.

At the September press conference announcing his plan, Reeves touted the reforms as an alternative to Medicaid expansion, which he referred to as increasing the state's “welfare rolls.” He was flanked by various hospital leaders from across the state. Most were from hospitals that had recently left the state hospital association under political pressure after the association's political action committee made a largee donation to Reeves' pro-expansion opponent Presley.

Months after his announcement, half of Reeves' plan has been approved and the bulk of the money has gone out.

And while hospital executives say the money will allow Mississippi hospitals that have been struggling for years to stay above water, the program does nothing to address the egregiously high number of uninsured, working-class Mississippians.

Lee McCall, chief executive officer of Neshoba General Hospital in Philadelphia, said his hospital loses more than $4 million a year on uncompensated care.

“These proceeds are going to help offset that … but it hasn't done anything to expand access to coverage for Mississippians that are uninsured,” he said. “So yes, we're still proponents of expansion, in whatever form it could come in, really to help out Mississippians, so that they can seek the care that they need.”

McCall said while he was thankful for the extra money, he acknowledged the governor's plan gave more money to the state's larger hospitals, rather than the ones struggling the most in rural parts of the state.

While the reimbursement plan helps hospitals recoup losses they face when caring for uninsured people, Baptist Memorial Health Care's vice president of government affairs Keith Norman said it doesn't replace the need for Medicaid expansion, which would insure more people.

“We have never seen the (payment increases) and Medicaid expansion as being exclusive of one another,” Norman said. “We've always seen the both-and approach, not either-or. Because when we start talking about Medicaid expansion, we're talking about covering working Mississippians … and we're looking to adopt both.”

From a strictly financial perspective, the reimbursement plan is seen by some hospital executives as comparable to the benefits of expansion.

“It is injecting close to $40 million in additional funding for Singing River Health System, which we really needed after the lingering effects of COVID,” said Singing River chief financial officer Jason McNeil. “From our perspective, it's really doing about the same as if Medicaid were expanded.”

But in order for the two programs to have comparable financial benefits, the reimbursement plan would need to recur annually. And while hospital executives are expecting that to be the case the plan doesn't automatically renew. The current payment arrangement applies through June 30, 2024.

“If we lose access to the program, it's going to destabilize our operations,” said Greenwood Leflore Hospital's interim chief executive officer Gary Marchand.

Greenwood Leflore's financial struggles have been well-documented — the hospital, once poised to close, has managed to hold on until through the end of its fiscal year.

McCall said that while the expectation is that the money from the reforms will continue to arrive annually, “we won't know until it's submitted.”

Even assuming it is a permanent change, the plan only benefits hospitals, explained Marchand, and not other forms of care – such as outpatient care and preventative care patients receive at clinics. One of the consequences of the current system of coverage is that the indigent population does not have access to preventative care – leading to tragedies such as widespread amputations among diabetics whose condition went unchecked and untreated.

In addition to the devastating consequences a lack of coverage has for patients, it's also not cost effective for hospitals. The population not currently covered by Medicaid tends to only have access to health care in the context of an emergency room, which can't turn anyone away – regardless of insurance coverage. But it's also the most expensive place to receive health care.

The hospital reimbursement plan helps offset some of the money hospitals lose when caring for uninsured patients. But it's throwing money at a problem that wouldn't exist under Medicaid expansion.

“I haven't spoken to anyone in health care or hospital administration that says we're no longer interested in expansion,” McCall said.

Hospital leaders from Merit Health System, Delta Health System in Greenville, North Mississippi Health System in Tupelo and Forrest General Hospital in Hattiesburg declined interviews.

Leaders from the University of Mississippi Medical Center and Gulfport's Memorial Hospital System also refused an interview. South Central Regional Medical Center's chief executive officer Greg Gibbes did not respond to multiple requests for comment. Representatives from all three were part of a cohort of medical leaders that flanked the governor at his September election-time press conference.

A second, smaller part of Reeves' plan is still pending approval from the federal government. Medicaid expansion will likely be a major policy discussion during the Legislature's 2024 session, and several Republican legislative leaders have said they'll devote attention to the topic.

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

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Mississippi Today

Lawmakers may have to return to Capitol May 14 to override Gov. Tate Reeves’ potential vetoes

Published

15 hours ago

May 10, 2024

Staff Editor

mississippitoday.org – Bobby Harrison – 2024-05-10 12:50:25

Legislators might not have much notice on whether they will be called back to the Mississippi Capitol for one final day of the 2024 session.

Speaker Jason White, who presides over the House, and Lt. Gov. Delbert Hosemann, who presides over the Senate, must decide in the coming days whether to reconvene the Legislature for one final day in the 2024 session on Tuesday at 1 p.m.

Lawmakers left Jackson on May 4. But under the joint resolution passed during the final days of the session, legislators gave themselves the option to return on May 14 unless Hosemann and White “jointly determine that it is not necessary to reconvene.”

The reason for the possible return on Tuesday presumably is to give the Legislature the opportunity to take up and try to override any veto by Gov. Tate Reeves. The only problem is the final bills passed by the Legislature — more than 30 — are not due action by Reeves until Monday, May 13. And technically the governor has until midnight Monday to veto or sign the bills into law or allow them to become law without his signature.

Spokespeople for both Hosemann and White say the governor has committed to taking action on that final batch of bills by Monday at 5 p.m.

“The governor's office has assured us that we will receive final word on all bills by Monday at 5 p.m.,” a spokesperson for Hosemann said. “In the meantime, we are reminding senators of the possibility of return on Tuesday.”

A spokesperson for White said, “Both the House and Senate expect to have all bills returned from the governor before 5 p.m. on Monday. The lieutenant governor and speaker will then decide if there is a reason to come back on May 14.”

The governor has five days to act on bills after he receives them while legislators are in session, which technically they still are. The final batch of bills were ready for the governor's office one day before they were picked up by Reeves staff. If they had been picked up that day earlier, Reeves would have had to act on them by Saturday.

At times, the governor has avoided picking up the bills. For instance, reporters witnessed the legislative staff attempt to deliver a batch of bills to the governor's Capitol office one day last week, but Reeves' staff refused to accept the bills. They were picked up one day later by the governor's staff, though.

Among the bills due Monday is the massive bill that funds various projects throughout the state, such as tourism projects and infrastructure projects. In total, there are more than 325 such projects totaling more than $225 million in the bill.

In the past, the governor has vetoed some of those projects.

The governor already has taken action of multiple bills passed during the final days of the session.

He allowed a bill to strip some of the power of the Public Employees Retirement System Board to become law without his signature. The bill also committed to providing a 2-and-one-half percent increase in the amount governmental entities contribute to the public employee pension plan over a five year period.

A bill expanding the area within the Capitol Complex Improvement District, located in the city of Jackson, also became law without his signature. The CCID receives additional funding from the state for infrastructure projects. A state Capitol Police Force has primary law enforcement jurisdiction in the area.

The governor signed into law earlier this week legislation replacing the long-standing Mississippi Adequate Education Program, which has been the mechanism to send state funds to local schools for their basis operation.

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

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Mississippi Today

On this day in 2007

Published

20 hours ago

May 10, 2024

Staff Editor

MAY 10, 2007

Left to right, John Lewis, Ralph Abernathy, Martin Luther King Jr. and Andrew Young attended the 1965 funeral of Jimmie Lee Jackson, whose death inspired the Selma march to Montgomery. Credit: AP

An Alabama grand jury indicted former state trooper James Bonard Fowler for the Feb. 18, 1965, killing of Jimmie Lee Jackson, who was trying to protect his mother from being beaten at Mack's Café.

At Jackson's funeral, Martin Luther King Jr. called him “a martyred hero of a holy crusade for freedom and human dignity.” As a society, he said, “we must be concerned not merely about who murdered him, but about the system, the way of life, the philosophy which produced the murderer.”

Authorities reopened the case after journalist John Fleming of the Anniston Star published an interview with Fowler in which he admitted, despite his claim of self-defense, that he had shot Jackson multiple times. And Fleming uncovered Fowler's killing of another Black man, Nathan Johnson. In 2010, Fowler pleaded guilty to second-degree manslaughter and was sentenced to six months behind bars.

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

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Mississippi Today

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

Published

2 days ago

May 9, 2024

Staff Editor

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 videos from a woman locked in his jail. He faces up to five years in federal prison when he is sentenced 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, including 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.

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 having sex with her inside the jail, “but you're not going to do anything about it.”

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.”

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 officers were at lunch, Colom said.

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

The deputy continued to demand sex with her on an almost weekly basis between May 2017 and October 2019, according to a lawsuit 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.

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.

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 Reporting at Mississippi Today 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.

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 residents 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.”

Asked if his office could bring state 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.”

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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