Mississippi Today
Governor’s allies on advisory board thwart effort to give poor moms timely health care
The state Medicaid director and a hospital CEO — neither of them doctors — bucked recommendations from health care professionals and delayed a vote that could have made it easier for expecting Mississippians to receive timely prenatal care.
The move comes just days after the release of a maternal mortality report that shows Mississippi is still one of the most dangerous places in the country to give birth.
The Mississippi Medical Care Advisory Committee heard presentations from Dr. Anita Henderson, former president of the state pediatric association, and Dr. Jaleen Sims, a Jackson-based OB-GYN. The two said at the committee’s Friday meeting that establishing pregnancy presumptive eligibility for Medicaid could make it easier to receive timely prenatal care in Mississippi.
The committee —made up of 11 members appointed by the governor, lieutenant governor and speaker of the House — is tasked by state law to advise the Division of Medicaid, which covers most births in Mississippi. The committee’s recommendation to the state Legislature this past year to extend postpartum Medicaid coverage was influential in the legislation’s subsequent passage.
Medicaid Director Drew Snyder, appointed by former Gov. Phil Bryant and reappointed by Gov. Tate Reeves, has opposed Medicaid expansion and was reluctant to endorse expanding postpartum care to mothers despite the urging of doctors this past year, in line with Reeves. On Friday, Snyder urged the committee to hold off on recommending presumptive Medicaid eligibility for expectant mothers. Kent Nicaud, a hospital CEO who is a strong political supporter of Reeves, aided Snyder in the effort by amending a motion that would have recommended the policy’s adoption.
Pregnancy presumptive eligibility allows people to receive health care when they’re pregnant, even if they’re not on Medicaid because it’s presumed that they qualify.
It’s an important step to reducing barriers to timely care. It can be complicated to get pregnancy Medicaid coverage, and those complications can mean the difference between a preventable pregnancy-related death and a safe delivery.
Though Medicaid policy states a person can qualify by simply attesting they are pregnant, most doctors and expecting people are under the impression a pregnancy test from a health care provider is required to be covered. Sims previously told Mississippi Today that despite the division’s policy, her patients applying for Medicaid have been asked for further confirmation to verify they’re pregnant.
That means Mississippians generally must pay out-of-pocket for a doctor’s pregnancy test test because they’re not presumed eligible for Medicaid. Then they must wait for their Medicaid application to be approved to receive care, unless they’re willing to continue paying out-of-pocket. Some doctors won’t even see them before they’re insured.
The division does retroactively reimburse prenatal care after applications are approved, but Matt Westerfield, spokesperson for the Division of Medicaid, told Mississippi Today last year that it takes the agency about 24 days to approve pregnancy applications.
Following the doctors’ presentations at the committee meeting, State Health Officer Dr. Daniel Edney made a motion for the committee to recommend the adoption of pregnancy presumptive eligibility to the Legislature or the division.
“Give these women a chance to have their babies,” Edney said. “Why wouldn’t we do it if we’re in such a crisis?”
After the motion was seconded, however, Snyder spoke up in opposition.
“Twenty minutes of discussion from two presenters is not enough on this complex issue,” Snyder said. “Rather than saying, ‘Let’s do everything we can,’ let’s do what’s smart and what works and what’s actually connected to improving outcomes.”
Snyder, an attorney, asked the committee if the division could consider and research the policy and return to the committee with their findings.
Dr. Billy Long, a gastroenterologist based in Madison, then expressed confusion about who had the power to establish the policy.
“I thought I heard you say, ‘Medicaid could not make this decision,’” he said to Snyder.
Snyder replied, “That’s correct, we need to send this to the Legislature,” and then immediately declined to get into the “nuances.”
It’s not clear what agency has the power to establish presumptive eligibility. Snyder, appointed Medicaid director by former Gov. Phil Bryant and reappointed by Reeves, has said previously that the Division of Medicaid wouldn’t utilize pregnancy presumptive eligibility unless directed to by the Legislature. Westerfield previously told Mississippi Today that position is to avoid paying “providers for services for women who subsequently would not qualify for Medicaid.”
Nicaud then suggested that Medicaid bring more information to the committee at a special meeting in January and repeatedly stressed that “educating” patients might be more helpful to improving outcomes for mothers and babies in Mississippi than presumptive eligibility.
Nicaud, who also doesn’t have a medical degree, is the president and CEO of Gulfport’s Memorial Health System and has donated almost $125,000 to Reeves since 2017.
Nicaud encouraged Edney to modify his motion, which Edney declined to do.
“We endorse the concept of presumptive eligibility unless there’s a reason we cannot,” Edney said. “If there’s an extra meeting, I’d be happy to attend.”
Nicaud then amended Edney’s motion to call a special meeting to discuss presumptive eligibility further and then make the committee’s recommendation to the division or Legislature.
Following the meeting, Snyder quickly left the Capitol chamber where the meeting was held and refused to take questions.
Henderson later expressed disappointment about the committee’s decision.
“Personally, I think it’s a no brainer,” she said. “I think this is an issue everyone should be on board with. If the rest of the country is, why aren’t we?”
Mississippi is one of 21 states as of January 2020 that doesn’t offer presumptive eligibility for pregnant people, according to KFF, and Mississippi is one of just three states that has not expanded Medicaid nor established presumptive eligibility.
According to a study commissioned with the University of Mississippi Center for Population Studies by the Center for Mississippi Health Policy, preterm births are less likely for low-income people when they live in a state with presumptive eligibility and expanded Medicaid.
Sen. Kevin Blackwell, R-Southaven, and Sen. Nicole Boyd, R-Oxford, say they will co-author a bill this upcoming Legislative session about presumptive eligibility for pregnant women. A previous attempt to establish presumptive eligibility by Rep. Missy McGee, R-Hattiesburg, did not make it out of committee this past session.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1994
Feb. 5, 1994
A jury convicted Byron De La Beckwith for the 1963 murder of Medgar Evers after seeing evidence that included Beckwith’s fingerprint on the murder weapon and hearing six witnesses share how he had bragged about killing Evers. The judge sentenced Beckwith to life in prison.
Evers’ widow, Myrlie Evers, had prayed for this day, and now that it had come, she could hardly believe it. “All I want to say is, ‘Yay, Medgar, yay!’”
She wiped away tears. “My God, I don’t have to say accused assassin anymore. I can say convicted assassin, who laughed and said, ‘He’s dead, isn’t he? That’s one n—– who isn’t going to come back.’ But what he failed to realize was that Medgar was still alive in spirit and through each and every one of us who wanted to see justice done.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Sending taxpayer money to private schools advances in Mississippi House
A House committee advanced a bill Tuesday that would send taxpayer money from public to private schools,
The move keeps alive a yearslong push from private school advocates and prompted concern among Democrats that the legislation could undermine public schools serving some of the state’s neediest students.
House Education Chairman Rob Roberson’s bill passed after an hour of debate. Roberson advanced the bill by voice vote and denied Democrats’ request for a roll call where each member’s vote could be recorded. Roberson acknowledged the bill faces a tough road ahead in the Legislature before it would have a chance of becoming law. But he said lawmakers needed to discuss solutions for students in disadvantaged areas who aren’t getting a quality education.
“The purpose of this is for us to continue having a conversation about how we help the poorest of the poor (students),” Roberon said. “I do realize that you all are getting a lot of pressure to push back on this, but we’ve got to keep talking about these things. Even if it makes you uncomfortable, even if you’re getting a million phone calls, these kids deserve to have us talking about this.”
Roberson’s bill would allow students who have been enrolled in a district rated D or F within the past five years to use the state portion of their base student cost — money that would normally go to their local public school — and use it to pay for private school tuition.
Students could only use the money at a private school if there is not an A- or B-rated district willing to accept them within 30 miles of their home. The legislation does not cover transportation costs for students, an omission that Democrats on the committee said would exacerbate the economic strain on poor families.
The money from each child’s base student cost would be placed in an education savings account, a provision designed to protect the legislation from a legal challenge.
The constitutionality of education savings accounts in Mississippi remains a subject of debate. Skeptics say ESAs are unconstitutional because they allow public money to be used to support private schools. Supporters say the accounts do not directly fund private schools, but instead allow families to make their own decisions about where to educate their children.
The legislation creates an initial appropriation of $5 million in public money. The Legislature would then need to appropriate funds for the program based on the state Department of Education’s estimation of students attending private schools that are currently receiving public money and the projected number of eligible students who opt to attend a private school.
Students in families that make less than 138% of the federal poverty level would have first access to the money. After that, funds would be disbursed on a first-come, first-served basis.
Students would need to obtain approval from the receiving district in order to transfer to another public school. The district could decline to accept the student if school officials say they don’t have enough room.
Proponents of such “school choice” measures argue that parents should have greater autonomy to customize their children’s education and that students shouldn’t be trapped in low-performing schools. Opponents argue these measures starve already under-resourced public schools of funds they would otherwise receive.
Rep. Cheikh Taylor, D-Starkville, said the bill and similar measures sending taxpayer funds to private schools would widen the “separation of school systems” between rich and poor areas. He also said the bill would be struck down by either a state or federal court if it became law.
“There will be an educational gap that will be furthered by this bill and the constitutionality has not been vetted,” Taylor said. “The intent has always been to divert money to charter schools and private schools. For years we’ve pushed back against it. Now we’re seeing again that this ugly head of the separation of education, those who are afforded more access and those who are not.”
Roberson said that divide already exists in Mississippi and that wealthy families find ways to send their children to the schools of their choosing, either public or private.
“Frankly it comes down to, the rich people can take kids can take their kids and go anywhere they want to. The poor kids, whether transportation is attached or not, end up going to what’s left over,” Roberson said. “If you’re a wealthy person, you have school choice.”
The school choice debate has been intertwined with debates over race and class in education. Those against school choice say the policies could effectively re-segregate schools. School choice supporters say some high-performing school districts fight school choice measures to avoid accepting students from poor and minority backgrounds.
Roberson said he did not believe the Legislature was ready to support “full-blown school choice.” Lt. Gov. Delbert Hosemann and senators with sway over education policy have not said they support sending public money to private schools. Senate Education Chairman Dennis DeBar, R-Leakesville, said this week that he is skeptical that even a measure to ease transfers between public schools could pass.
The bill has already drawn fierce opposition from public education groups, who said the measure could lay the groundwork for an unconstitutional voucher program impacting all public schools in the state
“Just because it is being passed through the parents’ hands before it goes to the private school, doesn’t make the action any less unconstitutional, in our opinion,” said Erica Jones, Executive Director of the Mississippi Association of Educators.
The proposal now awaits a vote on the House floor.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Mississippi midwives push for licensure: ‘If we don’t do something now, it’s going to get done for us’
A group of Mississippi midwives is again advocating for regulations around their profession – a move they say will actually make it easier for midwives to practice in the state in the long run.
Under proposed legislation, midwives who want to practice in Mississippi would need to attain licensure from a board, and in turn would gain multiple privileges. As it stands, Mississippi is one of 13 states that has no regulations around professional midwifery – a freedom that hasn’t benefited midwives or mothers, advocates say.
“Tattoo artists have to apply for a license within our state, but yet someone who’s actually delivering a life and taking care of a mom, prenatal and postnatal – there’s no oversight,” said Rep. Dana McLean, R-Columbus, author of the bill. McLean has proposed similar legislation over the past few years.
This is the first year the legislation made it to a full floor vote. The bill specifically addresses professional midwifery – not nurse midwifery, which requires more extensive medical training.
House Medicaid Chair Missy McGee, R-Hattiesburg, proposed an amendment that would make it unlawful for licensed midwives to do homebirths for breech babies, but withdrew her amendment after other committee members voiced opposition to it. McLean said part of the purpose of the bill is to give women the opportunity to choose to give birth how they feel safest, and it would be the board’s responsibility to determine scope of practice.
Proponents of House Bill 927 say it builds value around midwives, protects mothers and babies, and strengthens the respect and collaboration between midwives and physicians.
“Consumers should be able to birth wherever they want and with whom they want – but they should know who is a midwife and who isn’t,” explained Tanya Smith-Johnson, president of the National College of Midwifery. “… Right now the way the law is, technically my husband could say ‘I’m a midwife,’ and there’s no one to say that you’re not.”
The lack of licensure, despite seeming inclusive, has rendered midwifery services inaccessible to poor women – and has also run some midwives out of business, Smith-Johnson explained.
Without licensure, insurance companies won’t cover midwifery services. Mississippi mothers have to pay out of pocket for the services and midwives end up undervaluing themselves to stay competitive in a market that doesn’t recognize them as licensed professionals.
“It’s hard for a midwife to be sustainable here,” Smith-Johnson said. “ … What is the standard of how much midwifery can cost if anyone and everyone can say they’re a midwife?”
The absence of licensure has also meant that midwives don’t get access to things like labor medication that those certified in states with licensure can access.
“It means that you’re kind of working just rogue … not being able to fully take care of a client, where you can order labs, carry oxygen, have medications a midwife would use for someone who is in labor – all of those things,” she said.
Smith-Johnson is part of Better Birth, a group that has been pushing for this legislation for five years. The group formed in response to an infant death that involved a midwife making questionable choices. The mother involved didn’t want to press charges – she just wanted reform.
“We formed because the mom had two options,” explained Erin Raftery, president of Better Birth. “She could either sue the midwife … but if she did that then it’s almost a guarantee that the profession would either be heavily restricted or outlawed, which is not what that mama wanted … So the other option her attorney gave her was to push for licensure.”
Anyone who practiced midwifery without a license under the bill would be fined $1,000.
In a state riddled with maternity care deserts, the last thing mothers want to see is birth workers leaving the state. But with no clear pathway to becoming a professional midwife, some birth workers are doing just that.
When Amanda Smith, originally from Jackson, was looking for a midwife to attend the births of her last three children, she and her husband couldn’t find a midwife with whom they felt comfortable working. Smith later discovered her calling for birth work while she was supporting her sister through labor, and she ended up getting her professional midwifery license in Colorado.
She returned to Mississippi in 2022 to serve her home state and now practices in Hattiesburg. However, she imagines there are midwives like her who leave the state and don’t come back – in no small part because of the liability risk that lack of licensure poses. While Smith has a Colorado midwifery license, she can’t become licensed in Mississippi because it doesn’t exist.
“It was one thing that really worried me about moving back,” Smith said. “I hired a lawyer to do a consultation and help me look over my paperwork and talk me through any scenario where I could potentially go to jail for being a midwife in Mississippi … I really look at this (bill) as a protection for midwives.”
If the bill becomes law, the board – comprised of nine members, including six midwives and the state health officer – will get to choose the kind of training midwives must undergo in order to attain a license.
In Texas, licensed midwives must complete a minimum of 1,350 hours of supervised clinical experience and pass an examination with NARM, the North American Registry of Midwives.
The bill seems to have more traction this year than it has in years past. Midwives say that in part, that’s due to a growing realization that they have the opportunity to regulate their profession as they see fit – before one too many risky situations causes physicians to impose regulations that don’t have midwives’ best interests in mind.
“I think there’s just been more iffy situations happening in the state, and it’s caused the midwives to realize that if we don’t do something now, it’s going to get done for us,” said Raftery.
The bill now advances to a full floor vote in the House.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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