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Experts analyze House, Senate Medicaid expansion proposals, offer compromise plan

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Experts analyze House, Senate Medicaid expansion proposals, offer compromise plan

As Mississippi lawmakers look for compromise between widely differing House and Senate Mississippi Medicaid expansion plans, experts with a health research group have projected the costs, savings and efficacy of the plans and offered a third, potential compromise plan.

The analysis shows that under each plan, the would see net annual savings โ€“ ranging from tens of millions to hundreds of millions of dollars โ€“ by expanding the state-federal Medicaid program to working, poor and uninsured Mississippians. The plans, the study says, also vary widely in how many Mississippians would be covered โ€“ from around 50,000 to nearly 200,000.

The study was commissioned by the Center for Mississippi Health Policy and conducted by the Hilltop Institute at the of Maryland, Baltimore County. Hilltop has studied Medicaid expansion nationwide and recently testified before the Mississippi House Medicaid Committee.

“We wanted to get some updated numbers based on publicly available data,” said Morgan Henderson, director of analytics and research for Hilltop. “We really want to make sure folks these discussions have data points they need.”

The study takes the House and Senate plans at face value, even though both contain elements not likely to be approved by the federal Centers for Medicare and Medicaid Services. The Senate plan, for instance, includes a stringent work requirement for coverage that, besides potentially costing millions in administrative fees, isn’t likely to be approved by CMS.

Both the House and Senate plans contain another potential poison pill that could prevent expansion from being implemented. They have 12-month moratoriums on people who qualify for the expanded Medicaid coverage from dropping private coverage and applying for Medicaid. CMS is highly unlikely to approve this, and such moratoriums would probably not meet constitutional muster in a court.

The options

Mississippi Senate plan

One striking difference between the Senate plan and the House and compromise plans is the Senate one would turn down about $1 billion a year in federal money to cover more expansion costs. It also would forego nearly $700 million over the first two years in enhanced federal funding that some refer to as a “signing bonus” for states that fully expand Medicaid per the federal Affordable Care Act.

The Senate plan would provide coverage to people making up to 100% of the federal poverty level โ€“ about $15,000 a year for an individual. Hilltop estimates this plan would cover about 54,000 people, although Senate said they estimate about 40,000 people would sign up.

The Senate plan would require participants to work 120 hours a month or be enrolled as a full-time student or in a workforce training program. It would exempt some from this requirement, of under 6, people mentally or physically unable to work or those who are caregivers to disabled family members.

Cost

The state’s upfront cost of the Senate plan would be paid by a 3% tax on Medicaid managed care providers.

Hilltop estimates the Senate plan would cost the state a little over $114 million per year, including $15 million in administrative costs. But when these costs are offset by the tax on providers, the economic stimulus of expansion and other offsets or revenue, Hilltop estimates a net savings to the state of $43.4 million a year.

Mississippi House plan

The House plan would provide Medicaid coverage for people making up to 138% of federal poverty level, a little more than $20,00 a year for an individual. Hilltop estimates this would cover about 134,000 Mississippians (again, factoring in the “moratorium” on leaving private coverage).

The House plan calls for work requirements โ€“ 20 hours a week or enrollment as a student or in workforce development โ€“ but would still go into effect without the requirements if CMS fails to approve them.

Under this plan, Mississippi would draw down about $1 billion a year in increased federal Medicaid payments, and over the first two years, another nearly $700 million in enhanced federal payments.

Cost

The state share of upfront costs for the House plan would be covered by a 4% tax on Medicaid managed care providers.

Hilltop estimates the House plan, with no work requirement approved, would cost a little over $115 million, including $8 million in administrative costs. But when these are offset by the tax on providers, economic stimulus and other offsets or revenue, Hilltop estimates an annual savings for the state of more than $404 million a year for the first two years, then $79.5 million a year for the third year and beyond.

House Speaker Jason White and others have noted that the enhanced federal payments to the state totaling nearly $700 million over the first two years would cover all state costs for the first four years of the House expansion plan. White also noted that the House plan, even if a work requirement is not approved, would require the managed care organizations to track employment and other data from those covered.

Compromise ‘hybrid plan

Hilltop’s “Mississippi MarketPlus Hybrid Plan” would offer expanded Medicaid coverage through the state’s managed care program for those making under 100% of the federal poverty level. For those making 100% to 138% (up to $20,000 for an individual) of poverty level, the plan would use federal money to provide assistance for them to buy private insurance plans through Mississippi’s marketplace exchange.

Hilltop estimates this plan would provide coverage for 197,000 Mississippians.

The plan would require managed care companies to provide employment and require mandatory referral to workforce training. It would also require those covered to pay marketplace insurance co-pays, but would not include a work requirement or moratorium on people leaving private insurance.

Like the House plan, this plan is expected to qualify the state for enhanced federal Medicaid payments and the two-year “signing bonus” of nearly $700 million.

Cost

The plan, like the Senate’s, includes a 3% tax on Medicaid managed care providers to help cover state costs.

Hilltop estimates the upfront cost to the state for this plan would be a little more than $186 million, including $12 million in administrative costs (including work support). But these would be offset by the tax on providers, economic stimulus from expansion and other offsets or revenue. Hilltop estimates a net savings to the state for this plan of more than $356 million a year for the first two years, then $31.3 million a year in savings for years three and up.

The Hilltop study also noted this plan would allow the state to receive a 90% federal match for services currently funded only with state dollars, including hospital services for incarcerated people and some behavioral health services.

Credit: Chart courtesy of The Hilltop Institute at the University of Maryland, Baltimore County

Other findings

Hilltop’s report says that Medicaid work requirements โ€“ when they were previously allowed by the feds โ€“ have not shown to increase workforce participation. It said, “Moreover, the Arkansas experience demonstrates that the administrative burden in reporting work status can lead to Medicaid coverage loss for the working poor โ€“ thus hurting the exact individuals designed to be covered under work requirements.”

A Georgia program similar to the Mississippi Senate’s plan in several regards, has shown that stringent work requirements result in low enrollment and high administrative costs, the Hilltop study notes. As of recently, the Georgia program had enrolled only a few thousand people and over 90% of its costs to-date have been administrative costs and consulting fees. Georgia is still battling the federal in court over its work requirements.

The Hilltop study found the Senate’s plan “contains high budget risk” to the state. Since the plan eschews extra federal funding available for expansion, “if enrollment exceeds estimates, there would be proportionally greater budget overruns in the Senate version than the alternative plans.” It noted that to protect state coffers, language could be inserted to the House or hybrid plan that rescinds the expansion should the enhanced federal match drop.

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 1875

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mississippitoday.org – Jerry Mitchell – 2024-11-02 07:00:00

Nov. 2, 1875

Pictured here are U.S. Sen. Hiram Revels of Mississippi, left, with six Black members of the U.S. House, Ben J.S. Turner of Alabama, Josiah T. Walls of Florida, Jefferson H. Long of Georgia, and Robert C. De Large, Joseph H. Rainy and R. Brown Elliot, all of South Carolina. Credit: Library of

The first Mississippi Plan, which included violence against Black Americans to keep them from , resulted in huge victories for white Democrats across the

A year earlier, the Republican Party had carried a majority of the votes, and many Black had been elected to office. In the wake of those victories, white leagues arose to Republican rule and began to use widespread violence and fraud to recapture control of the state. 

Over several days in September 1875, about 50 Black Mississippians were killed along with white supporters, a school teacher who worked with the Black community in Clinton. 

The governor asked President Ulysses Grant to intervene, but he decided against intervening, and the violence and fraud continued. Other Southern states soon copied the Mississippi plan. 

John R. Lynch, the last Black congressman for Mississippi until the 1986 election of Mike Espy, wrote: โ€œIt was a well-known fact that in 1875 nearly every Democratic club in the State was converted into an armed military company.โ€ 

A federal grand jury concluded: โ€œFraud, intimidation, and violence perpetrated at the last election is without a parallel in the annals of history.โ€

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

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Mississippi Todayโ€™s NewsMatch Campaign is Here: Support Journalism that Strengthens Mississippi

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mississippitoday.org – Mary Margaret White – 2024-11-01 12:34:00

High-quality journalism like ours depends on reader ; without it, we simply couldn’t exist. That’s why we’re proud to join the NewsMatch movement, a national initiative aimed at raising $50 million for nonprofit newsrooms that serve communities like ours here in Mississippi, where access to reliable information has often been limited.

In a time when trusted journalists and sources are disappearing, we believe the stakes couldn’t be higher. Without on-the-ground, trustworthy , civic engagement suffers, accountability falters and corruption often goes unaddressed. But it doesn’t have to be this way.

Here at Mississippi we act as watchdogs, holding those in power accountable, and as storytellers, giving a platform to voices that have been ignored for too long. And we’re committed to keeping our stories free for everyone because information should be accessible when it’s needed most.

Why NewsMatch and Why Now?

This year’s NewsMatch campaign runs from November 1 through December 31, giving us a special opportunity to make each dollar you give go even further. Through matching funds provided by local foundations like the Maddox Foundation, and national funders like the MacArthur Foundation, the Rural Partner Fund and the Hewlett Foundation, your gift will be dollar for dollar up to $1,000. Plus, if 100 new donors join us, we’ll unlock an additional $2,000 in funding, bringing us even closer to our goal. Boiled down: your donation goes four times as far.

Every dollar raised strengthens our ability to serve you with fact-based journalism on issues that impact your everyday โ€”whether it’s covering local election issues or reporting on decisions affecting schools, safety and economic growth in Mississippi. Your support makes it possible for us to stay rooted in the community, offering nuanced perspectives that Mississippians understand and engage with what’s happening around them.

Special Event: โ€œFreedom of the Press: Southern Challenges, National Impactโ€

As part of the campaign, we’re excited to host a special virtual , โ€œFreedom of the Press: Southern Challenges, National Impact.โ€ Join Deep South Today newsrooms Mississippi Today and Verite News, along with national experts on press freedom, for an in-depth discussion on the unique challenges facing journalists in the Deep South. This one-hour will explore the critical role local newsrooms play in holding power accountable, highlighting recent restrictions on press freedom such as Louisiana’s โ€œ25-foot law,โ€ which affects journalists’ ability to report vital .

We’ll examine what’s at stake if local newsrooms lose press freedoms and will discuss how you, as members of the public, can help protect it. This event is open to Mississippi Today and Verite News members as a special thank-you for supporting local journalism and standing with us in this mission. Donate today to RSVP!

How You Can Help

Make Your Gift Today

Together, let’s ensure Mississippi has the robust, independent journalism it needs to thrive. Your support fuels our ability to expose the truth, elevate marginalized stories and build a more informed Mississippi.

Thank you for believing in the power of journalism to strengthen the communities we loveโ€”not only during election season but year-round. With your help, we’ll keep Mississippi informed, engaged and connected for generations to come.

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

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Hinds County loses fight over control of jail

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mississippitoday.org – Mina Corpuz – 2024-11-01 12:57:00

The sheriff and Board of Supervisors have lost an appeal to prevent control of its jail by a court-appointed receiver and an injunction that orders the county to address unconstitutional conditions in the facility.   

Two members from a three-judge panel of the 5th U.S. Circuit Court of Appeals agreed with decisions by U.S. District Judge Carlton Reeves to appoint a receiver to oversee day-to-day jail operations and keep parts of a previous consent decree in place to fix constitutional violations, a failure to protect detainees from harm. 

However, the appeals court called the new injunction โ€œoverly broadโ€ in one area and is asking Reeves to reevaluate the scope of the receivership.

The injunction retained provisions relating to sexual assault, but the appeals court found the provisions were tied to general risk of violence at the jail, rather than specific concerns about the Prison Rape Elimination Act. The court reversed those points of the injunction and remanded them to the district court so the provisions can be

The court also found that the receiver should not have authority over budgeting and staff salaries for the Raymond Detention Center, which could be seen as โ€œfederal intrusion into RDC’s budgetโ€ โ€“ especially if the receivership has no end date. 

Hinds County Board of Supervisors President Robert Graham was not immediately available for comment Friday. Sheriff Tyree Jones declined to comment because he has not yet read the entire court opinion.ย 

In 2016, the Department of Justice sued Hinds County alleging a pattern or practice of unconstitutional conditions in four of its detention facilities. The county and DOJ entered a consent decree with stipulated changes to make for the jail system, which people facing trial. 

โ€œBut the decree did not resolve the dispute; to the contrary, a yearslong battle ensued in the district court as to whether and to what extent the County was complying with the consent decree,โ€ the appeals court wrote.  

This prompted Reeves to hold the county in contempt of court twice in 2022. 

The county argued it was doing its best to comply with the consent decree and spending millions to fix the jail. One of the they offered was building a new jail, which is now under construction in

The county had a to further prove itself during three weeks of hearings held in February 2022. Focuses included the of seven detainees in 2021 from assaults and suicide and issues with staffing, contraband, old and use of force. 

Seeing partial compliance by the county, in April 2022 Reeves dismissed the consent decree and issued a new, shorter injunction focused on the jail and removed some provisions from the decree.

But Reeves didn’t see improvement from there. In July 2022, he ordered receivership and wrote that it was needed because of an ongoing risk of unconstitutional harm to jail detainees and staff. 

The county pushed back against federal oversight and filed an appeal, arguing that there isn’t sufficient evidence to show that there are current and ongoing constitutional violations at the jail and that the county has acted with deliberate indifference. 

Days before the appointed receiver was set to take control of the jail at the beginning of 2023, the 5th Circuit Court ordered a stay to halt that receiver’s work. The new injunction ordered by Reeves was also stayed, and a three-person jail monitoring team that had been in place for years also was ordered to stop work. 

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

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