Mississippi Today

Can a Mississippi governor expand Medicaid on his own? Depends on who you ask.

Published

1 year ago

August 23, 2023

Editor’s note: Mississippi Today interviewed two Deep South governors about why they chose to champion and pass Medicaid expansion in their states and what the outcomes have been. Those articles will publish on August 24.

Brandon Presley, the Democratic nominee for governor, has at times spoken of expanding Medicaid through executive action without approval of the Republican-controlled Mississippi Legislature should he win the November general election.

“Day 1, I’m going to expand Medicaid so that 220,000 working Mississippians can get access to affordable healthcare,” Presley wrote on social media in July.

At other times, perhaps recognizing the obstacles such a solo effort to expand Medicaid might face, Presley has indicated he would work with the Legislature, which he has said he believes would be amenable to Medicaid expansion.

As nearly half of the state’s rural hospitals are at risk of closing and hospitals across the state are laying off staff or cutting services because of budget problems, Medicaid expansion has become a key campaign issue in 2023.

Forty states and the District of Columbia have expanded Medicaid, a federal opt-in program that provides health care coverage to poor Americans who can’t otherwise afford it themselves. Two of Mississippi’s neighbors, Arkansas and Louisiana, have expanded Medicaid with great success and improved outcomes.

But leaders in Mississippi, the poorest state in America with one of the nation’s highest percentages of uninsured residents, have resisted expansion for more than 10 years — despite the fact that it would bring more than $1 billion per year in new funds to the state and directly help hospitals.

In some states, such as Louisiana, expansion was done through executive orders instead of by approval of the Legislature. But there are questions about whether a governor in Mississippi could expand Medicaid without legislative approval.

Republican Gov. Tate Reeves, who is seeking reelection and faces Presley in the November general election, has long opposed expanding Medicaid.

The Division of Medicaid, which is under the statutory direction and purview of the governor, takes the position that Medicaid expansion requires legislative approval.

“State law defines who can be eligible for Medicaid in Mississippi. Our understanding is that a governor is not authorized to unilaterally establish a new Medicaid coverage group through an executive order or a federal demonstration waiver,” said Matt Westerfield, a spokesperson for the state’s Division of Medicaid.

State Sen. Kevin Blackwell, R-Southaven, who chairs the Senate’s Medicaid Committee, referred questions about whether a governor could expand Medicaid on his or her own to the Division of Medicaid. His House counterpart, Joey Hood, R-Ackerman, could not be reached for comment.

Former state Rep. Steve Holland, who for years was considered one of the leading authorities in the Legislature on Medicaid issues as the longtime chair of Public Health Committee, said the governor has considerable authority over the Medicaid program. After all, Medicaid is a division within the governor’s office.

Still, Holland said, “We have the most codified Medicaid program in the country. We have put all the eligibility requirements in law … I know Brandon (Presley) as well as anyone. If he is fortunate enough to be elected governor, he is smooth enough and prepared enough to begin immediately to expand Medicaid. And I think he can work with the Legislature to do that.”

The Presley campaign has cited the ability of the Division of Medicaid — hence the governor — to seek a federal waiver to alter the state Medicaid program. A campaign spokesperson said the governor would have authority to seek the waiver under state law, though waivers are granted for only five years and they normally are granted in coordination with the Legislature, which often must provide funding to pay for the waiver.

Holland said state law provides the Division of Medicaid under the governor significant flexibility to seek waivers from the federal government to enact programs that are not codified in state law.

The bottom line is that if there was an effort to expand Medicaid through the waiver program, an appropriation by the Legislature to fund the program most likely still would be needed. But if a governor did expand Medicaid and figure out a way to pay for the program without the Legislature, it likely would result in litigation and be left to the state courts to determine whether it was legal.

Specific sections of state law define who is eligible for Medicaid based on income levels and health issues. In general terms, in Mississippi only poor pregnant women, poor children, the disabled, certain groups of the elderly and some groups who fall into extreme poverty categories and are providing care for family members on Medicaid are eligible for Medicaid coverage.

Most able-bodied people are not eligible for Medicaid in Mississippi.

With Medicaid expansion, those earning up to 138% of the federal poverty level — or about $18,750 annually — would be eligible for coverage. The intent with Medicaid expansion is to provide health care to primarily the working poor who cannot afford private insurance and who are not provided coverage by their employers.

The most clear cut way to expand Medicaid would be for the Legislature to approve a bill to incorporate the new eligibility requirements in state law.

Whether it would be feasible for the Legislature to agree to such a change in state law is the unknown question. If Presley is elected, Mississippians will find out.

At least in the current Legislature, there is a significant appetite to at least consider the merits of expansion. Last legislative session, Mississippi Today surveyed most of the 174 lawmakers and asked them directly if they supported Medicaid expansion.

In response, voting majority in the House said they either supported Medicaid expansion or remained undecided. One vote shy of a voting majority in the Senate said the same.

Just 21 of the House members surveyed, or 18% of the House, said they outright opposed Medicaid expansion. And just 18 of the Senate members surveyed, or 38% of the Senate, said they outright opposed it.

Holland, who served in the Legislature until 2020, says he believes Presley could get Medicaid expansion through the Legislature even with a Republican supermajority.

“Tate Reeves and (House Speaker) Philip Gunn were the two blocking it. Period.” said Holland. Gunn is not seeking re-election this year.

“In my final years in the House I had so many Republicans come to me and say expanding Medicaid is the right thing to do,” Holland said.

Another option would be for the Legislature to reauthorize the ballot initiative program that was ruled unconstitutional in 2021 by the state Supreme Court. Through the initiative process, people can gather signatures to bypass the Legislature and place issues directly on the ballot.

When the initiative process was ruled invalid, there was an effort underway to gather the required number of signatures to place Medicaid expansion on the ballot. The Mississippi Hospital Association was one of the sponsors of the Medicaid expansion initiative proposal and had hoped to have enough signatures to place the proposal on the 2022 ballot.

Multiple polls have indicated strong support among Mississippi voters for Medicaid expansion.

So far, legislative efforts to revive the initiative have been unsuccessful.

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 1956

Published

18 hours ago

December 25, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-12-25 07:00:00

Dec. 25, 1956

Civil rights activist Fred Shuttllesworth Credit: Wikipedia

Fred Shuttlesworth somehow survived the KKK bombing that took out his home next to the Bethel Baptist Church in Birmingham, Alabama.

An arriving policeman advised him to leave town fast. In the “Eyes on the Prize” documentary, Shuttlesworth quoted himself as replying, “Officer, you’re not me. You go back and tell your Klan brethren if God could keep me through this, then I’m here for the duration.’”

Shuttlesworth and Bethel saw what happened as proof that they would be protected as they pursued their fight against racial injustice. The next day, he boarded a bus with other civil rights activists to challenge segregation laws that persisted, despite a U.S. Supreme Court decision that ordered the city of Montgomery, Alabama, to desegregate its bus service.

Months after this, an angry mob of Klansmen met Shuttlesworth after he tried to enroll his daughters into the all-white school in Birmingham. They beat him with fists, chains and brass knuckles. His wife, Ruby, was stabbed in the hip, trying to get her daughters back in the car. His daughter, Ruby Fredericka, had her ankle broken. When the examining physician was amazed the pastor failed to suffer worse injuries, Shuttlesworth said, “Well, doctor, the Lord knew I lived in a hard town, so he gave me a hard head.”

Despite continued violence against him and Bethel, he persisted. He helped Martin Luther King Jr. found the Southern Christian Leadership Conference and was instrumental in the 1963 Birmingham Campaign that led to the desegregation of downtown Birmingham.

A statue of Shuttlesworth can be seen outside the Birmingham Civil Rights Institute, and Birmingham’s airport bears his name. The Bethel church, which was bombed three times, is now a historic landmark.

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

Mississippi Today

On this day in 1865

Published

2 days ago

December 24, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-12-24 07:00:00

Dec. 24, 1865

The Ku Klux Klan began on Christmas Eve in 1865. Credit: Zinn Education Project

Months after the fall of the Confederacy and the end of slavery, a half dozen veterans of the Confederate Army formed a private social club in Pulaski, Tennessee, called the Ku Klux Klan. The KKK soon became a terrorist organization, brutalizing and killing Black Americans, immigrants, sympathetic whites and others.

While the first wave of the KKK operated in the South through the 1870s, the second wave spread throughout the U.S., adding Catholics, Jews and others to their enemies’ list. Membership rose to 4 million or so.

The KKK returned again in the 1950s and 1960s, this time in opposition to the civil rights movement. Despite the history of violence by this organization, the federal government has yet to declare the KKK a terrorist organization.

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

Mississippi Today

An old drug charge sent her to prison despite a life transformation. Now Georgia Sloan is home

Published

2 days ago

December 24, 2024

Staff Editor

mississippitoday.org – Mina Corpuz – 2024-12-24 04:00:00

CANTON – Georgia Sloan is home, back from a potentially life-derailing stint in prison that she was determined to instead make meaningful.

She hadn’t used drugs in three years and she had a life waiting for her outside the Mississippi Correctional Institute for Women in Pearl: a daughter she was trying to reunite with, a sick mother and a career where she found purpose.

During 10 months of incarceration, Sloan, who spent over half of her life using drugs, took classes, read her Bible and helped other women. Her drug possession charge was parole eligible, and the Parole Board approved her for early release.

At the end of October, she left the prison and returned to Madison County. The next day she was back at work at Musee, a Canton-based bath products company that employs formerly incarcerated women like Sloan and others in the community facing difficulties. She first started working at the company in 2021.

“This side of life is so beautiful. I would literally hold on to my promise every single minute of the day while I was in (prison),” Sloan told Mississippi Today in December.

Next year, she is moving into a home in central Mississippi, closer to work and her new support system. Sloan plans to bring her daughter and mother to live with her. Sloan is hopeful of regaining custody of her child, who has been cared for by her aunt on a temporary basis.

“This is my area now,” she said. “This has become my family, my life. This is where I want my child to grow up. This is where I want to make my life because this is my life.”

Additionally, Sloan is taking other steps to readjust to life after prison: getting her driver’s license for the first time in over a decade, checking in monthly with her parole officer and paying court-ordered fines and restitution.

In December 2023, Sloan went to court in Columbus for an old drug possession charge from when she was still using drugs.

Sloan thought the judge would see how much she had turned her life around through Crossroads Ministries, a nonprofit women’s reentry center she entered in 2021, and Musee. Her boss Leisha Pickering who drove her to court and spoke as a witness on Sloan’s behalf, thought the judge would order house arrest or time served.

Circuit Judge James “Jim” Kitchens of the 16th District.

Instead, Circuit Judge James Kitchens sentenced her to eight years with four years suspended and probation.

He seemed doubtful about her transformation, saying she didn’t have a “contrite heart.” By choosing to sell drugs, Kitchens said she was “(making) other people addicts,” according to a transcript of the Dec. 4, 2023, hearing.

“I felt like my life literally crumbled before my eyes,” Sloan said about her return to prison. “Everything I had worked so hard for, it felt like it had been snatched from me.”

She was taken from the courtroom to the Lowndes County Detention Center, where she spent two months before her transfer to the women’s prison in Rankin County.

Sloan found the county jail more difficult because there was no separation between everyone there. But the prison had its own challenges, such as violence between inmates and access to drugs, which would have threatened her sobriety.

She kept busy by taking classes, which helped her set a goal to take college courses one day with a focus on business. Visits, phone calls and letters from family members and staff from Musee and Crossroads were her lifeline.

“I did not let prison break me, I rose above it, and I got to help restore other ladies,” Sloan said.

She also helped several women in the prison get to Crossroads – the same program that helped her and others at Musee.

Sloan credits a long-term commitment to Crossroads and Musee for turning her life around – the places where she said someone believed in her and took a chance on her.

Georgia Sloan, left, and Leisha Pickering, founder and CEO of Musee Bath, sit for a portrait at the Musee Bath facility in Canton, Miss., on Wednesday, Dec. 11, 2024. Pickering has supported Sloan through her journey of recovery and reentry, providing employment and advocacy as Sloan rebuilds her life after incarceration. Credit: Eric Shelton/Mississippi Today

Pickering, Musee’s CEO, said in the three years she’s known Sloan, she’s watched her grow and become a light for others.

The bath and lifestyle company has employed over 300 formerly incarcerated women in the past dozen years, but Pickering said not everyone has had the same support, advocacy and transformation as Sloan. Regardless, Pickering believes each person is worth fighting for.

When Sloan isn’t traveling for work to craft markets with Pickering, she shares an office with her Musee colleague Julie Crutcher, who is also formerly incarcerated and a graduate of Crossroads’ programs. She also considers Crutcher a close friend and mentor.

Sloan has traveled to Columbus to see her mother and daughter whom she spent Thanksgiving with. She will see them again for Christmas and celebrate her daughter’s 12th birthday the day after.

Her involvement with the criminal justice system has made Sloan want to advocate for prison reform to help others and be an inspiration to others.

“I never knew what I was capable of,” Sloan said. “I never knew how much people truly, genuinely love me and love being around me. I never knew how much I could have and how much I could offer the world.”

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