Mississippi Today

Experts say Gov. Tate Reeves’ plan will help hospitals, but not uninsured Mississippians

Published

1 year ago

September 25, 2023

Gov. Tate Reeves, after months of inaction, has unveiled a plan he says will turn Mississippi’s health care crisis around.

However, even some health care experts were stumped by how the Governor’s proposed reforms will work.

The plan, which Reeves announced at a press conference Thursday while flanked by state health care leaders, is essentially a complex scheme to increase extra payments hospitals get for treating patients on Medicaid — and notably doesn’t include Medicaid expansion.

Some Mississippi leaders say Reeves’ ideas aren’t even that new. It’s not certain they’ll be approved, either.

The announcement comes less than two months before Election Day, and after his opponent in the gubernatorial race, Democrat Brandon Presley, has repeatedly stated his intention to expand Medicaid if elected and largely campaigned on the state’s hospital crisis.

Two things were clear at the conference: Reeves claims the changes would put a much-needed $700 million in hospitals’ pockets, and he does not plan to expand Medicaid.

Everything else, however, was not as easy to understand.

How will Gov. Reeves’ plan work?

The plan relies on two major changes that bolster supplemental payments to hospitals for the care they provide to people with Medicaid. Supplemental payments are extra payments hospitals receive to offset low Medicaid reimbursement rates or uncompensated care, which is money hospitals lose caring for patients who are uninsured and can’t pay their hospital bill. Medicaid is a federal-state program that provides health coverage to millions of people in the U.S., including low-income adults, children, pregnant women, elderly adults and people with disabilities. The income requirement for people in Mississippi to qualify is extremely stringent.

The first is a change to the Mississippi Hospital Access Program, which typically pays hospitals for the gap between payments for services rendered for Medicaid managed care patients (which are usually lower) and Medicare patients (which are usually slightly higher). Under the proposed changes, hospitals will instead be paid for the gap between Medicaid patients and people insured by commercial plans, which tend to reimburse at higher rates.

The state Division of Medicaid was granted a similar change to the program in March for outpatient services, resulting in $40.2 million for hospitals. However, Medicaid officials had expected it to generate an additional $450 million. But because Mississippi’s average commercial rate is so low, the payout was much less.

What’s not clear is how, in Reeves’ plan, the average commercial rate results in nearly triple what hospitals typically get for these payments — going from a total of $562 million to $1.522 billion. Reeves didn’t say at the press conference what average commercial rate was actually being used (whether a state, regional or national rate).

Drew Snyder, Mississippi Division of Medicaid executive director, answers questions from the media after Gov. Tate Reeves announced his plans for a series of Medicaid reimbursement reforms during a press conference at the Walter Sillers Building in Jackson, Miss., on Thursday, September 21, 2023. Credit: Eric Shelton/Mississippi Today

When asked what had changed since the spring regarding these rates, Medicaid Executive Director Drew Snyder did not directly answer the question.

“I think the difference is, we got the right people in the room … sometimes it makes sense to get a second opinion,” he said before stepping back in line on stage.

The second initiative modifies the Upper Payment Limit Supplemental Payments, which are aimed at also increasing payments for hospitals that receive low payments from Medicaid. This program will yield an increase of an additional $137 million in fiscal year 2024, according to Reeves.

State leaders did something similar earlier this year after the Mississippi Hospital Access Program projections came in much lower than originally expected, said Tim Moore, former leader of the state hospital association. It resulted in an extra one-time payment of $137 million.

The supplemental payment programs are meant to reduce disparities in insurance payments and the cost of caring for uninsured people. By changing them, the state is drawing down more federal money because of our state’s high Federal Medical Assistance Percentage match, which is the highest in the country at 77.27% because of our state’s high poverty rate. Hospitals have to put up more in “bed taxes” for the state portion, and then the federal government matches.

In other words, if a Medicaid patient receives a service at a Mississippi hospital that costs $100, the hospital is reimbursed $77.27 from federal funds. The remaining $22.73 must be paid by the state – that $22.73 comes from the hospitals themselves in the form of a tax.

Harold Miller, leader of the Center for Healthcare Quality and Payment Reform described it this way: “When the state is paying for a Medicaid service, the state has to find the state share — that 23% — somewhere. They have to find that money, and ordinarily they would have to tax the taxpayers to do that.” Instead, Mississippi asks the hospitals for that money, he said.

In short, hospitals will have to pay $178 million in taxes for Mississippi Hospital Access Program payments to go up by $960 million, Upper Payment Limit payments will yield $137 million and disproportionate share hospital payments — which make up the difference for hospitals that lose money on serving a significant population of Medicaid-insured and uninsured people — will decrease by $230 million because the other payments are bridging the gap. The net gain for hospitals will be $689 million total.

Who will the plan help?

Experts agree this plan will keep hospitals open for longer. Even if it’s unclear how the expected payments will increase, it’s still a significant amount of money — money that hospitals have been asking for for a long time. However, critics say it’s not ensuring more people receive health care.

According to federal data, Mississippi has the highest uninsured rate of people aged 18-64 in the country, as of September. About one in every six Mississippians is uninsured.

Emergency rooms by law cannot turn down people, regardless of their insurance status, who come for care — but doctors’ offices can and so can pharmacies. That means people who are uninsured in Mississippi, one of the unhealthiest states in the nation, cannot receive preventative care or medications that they need. They generally must rely on the emergency room for their health care needs.

“People typically need a lot more care than care in a hospital, and a lot of that care is preventive care… outpatient care,” said Adam Searing, an associate professor at Georgetown University’s McCourt School of Public Policy’s Center for Children and Families whose work focuses on Medicaid. “If you get cancer and you need prescriptions and drugs and outpatient care from a team of specialists, this has nothing to do with that. So, the key differences, this is an issue about the finances of hospitals.

“And Medicaid expansion is about financial security for families.”

How much money is it bringing to hospitals?

Reeves said a little over $689 million will go to the state’s hospitals under this plan.

And although he said Thursday the money would benefit all hospitals, it appears larger hospitals will benefit most, even though most agree that small rural hospitals are the facilities feeling the strain of the health care crisis most acutely.

Additionally, nearly half of the money — 45% or about $309 million — will go to hospitals that have left the state hospital association in recent months. In the spring, after the Mississippi Hospital Association’s PAC made a $250,000 donation to Presley, several hospitals left the organization.

Most of those hospitals’ leaders stood behind Reeves as he announced his plan Thursday.

Is this a new plan?

Reeves said at the press conference this plan has been in the works for four to five months.

According to Tim Moore, former head of the state hospital association, and another state leader, that’s not true.

A year ago, Moore learned of similar measures in Louisiana and brought the idea to state leaders. Lt. Governor Delbert Hosemann recently told Mississippi Today that hospital payment initiatives were discussed by stakeholders last year, but the Division of Medicaid told his office that those changes weren’t possible.

Will it cost the taxpayers anything?

Reeves repeated at the conference that the changes would come at no cost to taxpayers, though he noted Snyder and his division employees are paid by state tax dollars.

That’s mostly true — taxpayers will likely not feel the brunt of this big tax increase for hospitals, according to one expert. Even if hospital charges increase, it should be eaten by the insurance companies and services for people who are uninsured will continue to go uncompensated and be claimed as charity care.

Is it final?

The plan is being submitted to the Centers for Medicaid and Medicare Services for approval. Snyder estimated at the conference that the state would likely hear from the federal government within two to three months. If it’s approved, it would be retroactively effective beginning July 1, 2023.

It’s hard to say what the likelihood of approval is, though several other states have passed similar Medicaid reforms intended to draw down more federal dollars.

One expert said it was unlikely that Mississippi state leaders announced the plan without expecting CMS approval, and historically, the agency has erred on the side of keeping hospitals open — even if it comes at the cost of forgoing expansion.

How is this different from Medicaid expansion?

Medicaid expansion has long been pointed to as a solution to the state’s worsening hospital crisis. Republican state leadership – Reeves most prominently – has staunchly opposed the policy adoption, despite support from a majority of Mississippians.

At the press conference Thursday, Reeves repeatedly incorrectly referred to the program as “welfare,” and claimed the solution to the issue was putting more people in the workforce. He said if more people are added to Medicaid’s rolls, hospitals will keep losing money because Medicaid payments are so low.

That’s better than losing money on people who are uninsured, said Adam Searing, the associate professor whose work focuses on Medicaid.

“These are two disconnected things,” he said. “Reimbursement rates for hospitals and expanding Medicaid are completely separate issues.”

While hospital leaders agree that these policy reforms will make a huge difference for many hospitals in the state, it still might not be enough to single handedly solve the crisis. In other states, such as Louisiana, similar policy reforms work in tandem with Medicaid expansion to create a holistically supported health care system.

The way Moore sees it, the state is putting up $170 million for a $700 million net gain, when with expansion, it could put up $100 million for a $1 billion reward.

States that have not expanded Medicaid have been offered a financial incentive to do so — an estimated $600 million in federal funds over two years.

And, despite more hospitals that will probably be able to stay open as a result of these reforms, uninsured Mississippians still won’t have health care. That means they will have to continue to rely on emergency rooms for their medical care — the most expensive place to receive health care — and uncompensated care costs will continue.

Searing said these reforms “improve the financial bottom line for some hospitals” and keep them open longer, but people are still going without health coverage.

“You’re really not solving the problem,” he said. “You’re just putting a Band-Aid on one aspect of it.”

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 1867

Published

12 hours ago

November 23, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-11-23 07:00:00

Nov. 23, 1867

Extract from the Reconstructed Constitution of the State of Louisiana, 1868. Credit: Library of Congress

The Louisiana Constitutional Convention, composed of 49 White delegates and 49 Black delegates, met in New Orleans. The new constitution became the first in the state’s history to include a bill of rights.

The document gave property rights to married women, funded public education without segregated schools, provided full citizenship for Black Americans, and eliminated the Black Codes of 1865 and property qualifications for officeholders.

The voters ratified the constitution months later. Despite the document, prejudice and corruption continued to reign in Louisiana, and when Reconstruction ended, the constitution was replaced with one that helped restore the rule of white supremacy.

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

Mississippi Today

Crystal Springs commercial painter says police damaged his eyesight

Published

1 day ago

November 22, 2024

Staff Editor

mississippitoday.org – Mina Corpuz – 2024-11-22 12:21:00

CRYSTAL SPRINGS – Roger Horton has worked decades as a commercial painter, a skill he’s kept up with even with the challenge of having what his wife has called “one good eye.”

It hasn’t stopped him from being able to complete detailed paint jobs and create straight lines without the help of tape. But last year following a head injury, he and others said people have been pointing out a change in his work. Horton says the sight in his right eye is clouded, like he is looking underwater.

Affected vision, short term memory and periods of irritability – potential symptoms of concussion – followed after he was arrested last September. During an encounter with several police officers, Horton alleges more than one slammed his head into a cruiser and placed handcuffs on so tight that he started to bleed.

“(The officer) was kind of rough with me and all, and he takes my head and I said, ‘What’d I do?’” he recalled recently.

Horton ended up being convicted of two misdemeanor charges and has paid off the fines, but a year later he still has questions about the arrest and treatment by the police.

To date, he has not seen a doctor to evaluate his eye and check for vision or cognitive issues. Horton and his wife Rhonda don’t have a car, and transportation to doctor’s appointments in the Jackson area remains a challenge.

The Hortons have lived in Crystal Springs all their lives, and they have lived in the home the past five years that belonged to Rhonda’s mother.

More than a quarter of all people in Crystal Springs live below the poverty line, and that includes the couple. Rhonda Horton said it’s hard to make a living because there aren’t a lot of jobs, but they support themselves as painters.

That’s how they met Yvonne Florczak-Seeman, who lived in Illinois and purchased her first historical property in Crystal Springs in 2019. She splits her time between the two states.

“We painted that porch bar and the rest is history,” Rhonda Horton said, adding that they went on to complete detailed work on mantles, kitchen cabinets and a cigar room at Florczak-Seeman’s North Jackson Street residence.

Over the years, the couple built a relationship with Florczak-Seeman, who is seeking to open a women’s empowerment center called the Butterfly Garden, in the building next to city hall.

Yvonne Florczak-Seeman poses for a portrait at her business, The Butterfly Garden, in Crystal Springs, Miss., Tuesday, Oct. 1, 2024. Credit: Eric Shelton/Mississippi Today

Florczak-Seeman has supported the couple numerous times, including helping them pay a late water bill and offering them work. She called them talented painters and hired them again to paint the interior of the future center, located at East Railroad Avenue.

In pieces, Rhonda Horton told Florczak-Seeman about her husband’s arrest and later the injuries she said he sustained from it. Florczak-Seeman had questions about the encounter and other potential injustices at play, so she offered to help.

“I just want them to pay for what they’ve done not just to him, but everybody,” Rhonda Horton said. “That’s what I want, justice.”

The Arrest

On Sept. 24, 2023, Horton was walking home from a friend’s house when officers approached him. One grabbed his arms to handcuff him, and he remembers them cutting his wrist and causing it to bleed.

Then, he said, a second officer slammed his head into the top of the police car, followed by another officer who slammed his head again. During the encounter, a bag of marijuana that Horton said he found fell out of his pocket onto the ground.

An officer put Horton in the back of the cruiser and took him to the station where Horton asked to speak to the police chief and call his wife. He said the police took his phone and clothes.

Afterward, he was taken to the Copiah County Detention Center in Gallman.

Police Chief Tony Hemphill disputed Horton’s allegation of mistreatment, saying he did not sustain any injuries that required hospitalization. He said Horton’s wrist was cut while he resisted arrest.

“He was not brutalized and targeted,” Hemphill said. “If he had just complied, he wouldn’t have had to come up there (to jail) that night.”

Two police reports from the night of the September 2023 arrest detail how officers had responded to a possible assault and were given the description of a white man. While in the area, they encountered Horton — the only person who fit that description.

Hemphill said a mother called police after her daughter told her she was assaulted. He said officers approached Horton on the street and tried to talk with him to rule him out as a suspect.

That’s when Horton began “fighting, pulling away, and kicking against (the officer’s) patrol vehicle, trying to run,” according to a police report from the night and Hemphill. Horton denies doing any of that.

The next day police took Horton from the county jail to the Crystal Springs police station. There, police informed him a teenage girl reported being assaulted. After learning about the assault allegation, Horton remembered feeling shocked and saying it couldn’t be true because he was not on the street where the alleged incident took place.

Hemphill confirmed the police investigated the assault allegation and found it not credible, meaning Horton wouldn’t face any related charges. He said he communicated this to Horton and his wife early on and since then, which the couple disputes.

As Horton was being arrested and detained, his wife grew worried because she had just spoken with him on the phone and expected him to arrive home shortly. Rhonda Horton and her adult son started calling Roger’s phone, each not getting an answer.

Then during one of the calls by her son, someone who did not identify himself answered Roger’s phone and said, ‘Your daddy’s dead’ and then hung up, Rhonda Horton said.

She was starting to assume the worst had happened. Rhonda Horton wouldn’t have confirmation her husband was alive until he called from the county jail in the early morning.

The next morning as she talked with the police chief, Rhonda Horton asked the chief about who answered the phone and told her son that Roger was dead. The chief told her the person who answered must have been from the county.

Hemphill later told Mississippi Today that he did not know about the call and that type of behavior by his staff “is not going to be tolerated.” Similarly, Copiah County Sheriff Byron Swilley said he had not heard about it and could not say whether a member of his department made the comment to Rhonda and Roger Horton’s son.

A Sept. 25, 2023, citation signed by Hemphill, shared with Mississippi Today, summoned Roger Horton to municipal court for the misdemeanor charges of possession of marijuana and resisting arrest and directed him not to have contact with the alleged victim in the assault case. No contact orders are typically for cases such as domestic violence and sexual assault and they are set by a judge.

LaKiedra Kangar, who works in municipal court services, said the no contact order was put in place because of the assault allegation. She confirmed Horton was not charged with the offense following the police department’s investigation of the allegation.

Weeks passed. Roger Horton went to court for the misdemeanor charges, to which he pleaded guilty. Felony assault charges were not part of the hearing. Municipal Court Judge Matthew Kitchens ordered Roger to pay over $900 in fines for the misdemeanors.

Horton was able to pay for some of the fine through at least 10 hours worth of court-ordered community service, which he said involved painting buildings for the city.

Months later after learning about Horton’s arrest and how he said the police treated him, Florczak-Seeman said she wanted to know more. Horton didn’t have access to his arrest documents, so she accompanied him and his wife to the police department to ask for them.

The first visit, Horton asked but did not receive the arrest report. Florczak-Seeman asked if he had a fine for any of the charges, which police said Horton did even after completing some community service hours. Florczak-Seeman paid for the remaining balance and had him work for her for two days to pay that off.

This year, they went to the police department a second time so Horton could ask for his arrest paperwork. An officer told him he didn’t need it and that the rape allegation had been investigated and found not to be credible, Horton told Mississippi Today.

Florczak-Seeman asked why Horton couldn’t receive the report. She said Hemphill asked if she was Horton’s attorney, and Florczak-Seeman clarified she was his representative.

The chief left for a few minutes and returned with two pieces of paper and handed them to Horton. Hemphill told Mississippi Today he did not recall whether he was the one who handed the report to Horton.

Florczak-Seeman took the document from Horton and began to read it as they stood in the lobby. She said she was horrified to see the name of the alleged, underage victim and her address in the report.

Hemphill said the victim’s personal information should have been restricted and not doing so was an oversight.

After reading the report, Florczak-Seeman went down the street to the mayor’s office at city hall to explain what happened, and how she believed the mayor had grounds to fire the police chief because he provided that document to Roger with the alleged victim’s information.

Crystal Springs Mayor Sally Garland Credit: Crystal Springs website

Mayor Sally Garland confirmed she had a conversation with Florczak-Seeman about the police chief’s employment.

She said she reviews all complaints about city officials, and Garland said she goes to the department head to get a better understanding of the situation. If she determines there are potential grounds for termination, a hearing would be scheduled with the Board of Aldermen, and the group would vote on that decision.

Garland did not find grounds for termination, and Hemphill remains police chief.

A Strange Visit

The Hortons and Florczak-Seeman hadn’t given much thought about the 2023 arrest, until weeks ago when a teenaged girl suddenly showed up in Florczak-Seeman’s yard.

At the end of September at the North Jackson Street home, Florczak-Seeman heard screaming and found the teenage girl who came onto her property. She asked what was wrong, and the teenager said she was chased by a dog, which Florczak-Seeman and Rhonda Horton did not see.

The teenager asked for a soda, and Rhonda Horton went inside to get one. Florczak-Seeman asked where the teenager lived, and she gave an answer that Florczak-Seeman said conflicted with what two girls who were standing nearby on the public sidewalk said she told them.

Then Florczak-Seeman asked the teenager’s name and recognized it as the name of the alleged victim on Horton’s arrest record. Immediately, Florczak-Seeman said she turned to Horton and told him to stay back, and she told the teenager to get off her property, which she did.

At the moment, they were not able to verify whether the teenager was the alleged victim from the report. Neither the Hortons nor Florczak-Seeman had seen her before, and they only knew her name from the arrest report.

“That didn’t make sense at all,” Rhonda Horton told Mississippi Today.

Florczak-Seeman called 911 to report the situation and ask for police to come, which they did not. Hemphill told Mississippi Today a dispatcher informed him about the call with Florczak-Seeman, including details with the teenage girl and how she wanted to report the girl for trespassing.

Florczak-Seeman is one of the people who have noticed a difference in Horton’s vision. It’s clear when comparing the detailed and clean paint job Roger completed at her Jackson Street property in 2019 and the center where he painted last year.

During an interview at the center in October, Florczak-Seeman pointed to the ceiling and noted spots that Horton did not paint. She remembers telling him about them and realized that he couldn’t see them.

“The spots on my ceiling are still not painted, and they’re not painted as a reminder of the injustices that happened in this situation and why I got involved,” Florczak-Seeman said.

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

Mississippi Today

Job opening: Jackson Reporter

Published

1 day ago

November 22, 2024

Staff Editor

mississippitoday.org – Mississippi Today – 2024-11-22 15:00:00

Mississippi Today, a Pulitzer Prize-winning newsroom focused on investigative and accountability journalism, is building a dedicated team of reporters to provide in-depth coverage of Jackson, Mississippi.

As the state’s largest and capital city, Jackson matters greatly to us and all Mississippians. Launched in 2016 as the state’s flagship nonprofit newsroom focused on Mississippi government and policy, Mississippi Today is focusing our lens beyond the statehouse and to the city of Jackson, serving our readers with the watchdog reporting they’ve come to expect from Mississippi Today. Our newsroom, with a proven record of providing impactful government accountability, aims to serve the city more directly with this team.

Our Jackson team will focus on sharp investigative reporting, watchdog accountability journalism and meaningful cultural storytelling. We aim to both elevate the voices of those working for positive change in the community while offering a balanced perspective on the city’s obstacles and triumphs. Our goal is to deliver impactful, honest journalism that will inform, inspire and empower Jackson’s citizens.

The team will be led by Pulitzer Prize winner Anna Wolfe, an investigative reporter with a decade of experience covering Jackson.

Roles and Responsibilities:

We are purposefully casting a wide net, hoping to connect with journalists of many different backgrounds who may be uniquely qualified to help us launch this team. If you’re a reporter with any of the following experience or attributes, this team may be for you.
Investigative reporting focused on uncovering systemic issues within government and politics. The bigger the impact of your reporting on government leaders or systems, the better.
Political reporting covering not only high-profile candidates for offices, but experience delving into issues and ideas that affect a community. We hope to delve deeply into a deep distrust in the city’s institutions.
Cultural reporting that highlights the often-overlooked success stories of citizens who are making a positive impact on their communities.
Strong understanding of Jackson (or similar large urban centers) and the unique challenges facing the city and its residents.
Commitment to the mission of balanced, impactful journalism that centers and respects the voice of the community.
Collaborative mindset and ability to work within a team-oriented newsroom.

The starting salary for this position is $58,000. Compensation is commensurate with experience level.

Expectations:

Work with a small team of journalists who are focused on social inequities and racial equality in our area.
Willingness to collaborate closely with a small team of like-minded journalists.
Get people to talk, find willing sources and protect them while telling sensitive and timely stories.
Build trust: Many people who have been impacted by inequities in Mississippi have been victims of predatory practices and forces. This will require empathy, patience and savvy.
Work with our Audience Team and data and visual journalists to create compelling story presentations.

Qualified candidates should have:

Experience working as a reporter in a newsroom.
Ability to work quickly, with accuracy and good news judgment.
Comfortability in digital or multimedia journalism spaces.
Ability to independently develop and cultivate sources.
Ability to use social media for research and to engage readers.

What you’ll get:

The opportunity to work alongside award-winning journalists and make significant contributions to Mississippi’s top nonprofit, nonpartisan digital news and information sources.
Highly competitive salary with medical insurance, and options for vision and dental insurance.
Use of appropriate technology and equipment.
29 days paid time off.
Up to 12 weeks of parental family leave, with return-to-work flexibility.
Simple IRA with 3 percent company matching. Group-term life insurance provided to employees ($15,000 policy).
Support for professional training and attending industry conferences.

How to Apply:

We’re committed to building an inclusive newsroom that represents the people and communities we serve. We especially encourage members of traditionally underrepresented communities to apply for this position, including women, people of color, LGBTQ people and people who are differently abled. Please apply here.

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