Mississippi Today
Inside Mississippi’s coverage gap, workers say health care is a ‘pipe dream’ or ‘whimsical idea’
When Brandon Allred woke up in the hospital after suffering heat stroke and a series of seizures at work, all he could think about was how much it was going to cost.
It was a legitimate concern: Seven years later, he’s still paying off the medical debt.
“It’s not just anxiety,” the 35-year-old father said, “but also the conscious, embarrassing fact that I’m living in one of the richest countries in the world and I am a natural born citizen and I have to sit here day by day and think ‘I dream of healthcare.’ I dream of a day where I can get all my teeth fixed and not have to worry about that. Or maybe I can figure out what was going on with me with those seizures.”
Allred, a prep cook and the primary provider for his six young daughters, works full-time but falls into Mississippi’s coverage gap, where he says health care is but a “pipe dream” and a “whimsical idea.”
The coverage gap is made up of low-income workers who make more than 28% of the federal poverty level — the maximum income allowed to currently qualify for Medicaid in the state — but less than the 100% of the federal poverty level needed to get subsidies that would make private insurance plans affordable. And it’s surprisingly big, comprising roughly 74,000 Mississippians, according to a recent KFF study.
If Medicaid were expanded in Mississippi – one of only 10 states that has not done so – Allred and tens of thousands of other working Mississippians like him would be covered. Income-eligible adults without children would also be covered.
It’s estimated that 123,000 uninsured Mississippians would gain coverage under expansion – that includes the 74,000 people under the poverty level and an additional 49,000 uninsured adults whose income is between 100% and 138% of the FPL. That means that under expansion, a family of four could make up to $43,056 and qualify for Medicaid.
Critics of expansion argue that anyone, even if they’re not offered health insurance through their employer, can purchase it through the marketplace. Those plans exist, but are so expensive that for those in the coverage gap, they practically do not exist.
Other critics of expansion argue that because there is a chance that some privately-insured Mississippians would switch to Medicaid under expansion, that’s reason to keep the 123,000 uninsured Mississippians uninsured — and turn down at least $1 billion a year in federal money to cover most of the cost.
Private insurance plans, especially ones with low premiums, have high deductibles that can easily run $5,000 a year. A plan with a deductible on the higher end of that spectrum would equate to about $400 a month – on top of premiums and copays – that an individual would need to pay in order for insurance companies to start picking up the slack.
A majority of uninsured adults make slightly too much to qualify for Medicaid under the present eligibility criteria, and so have no path toward health care.
As it stands, Medicaid eligibility for adults in Mississippi is very limited.
Firstly, Medicaid in Mississippi doesn’t currently cover childless adults – period. And even adults who have children would need to be making less than 28% of the federal poverty level to be eligible for Medicaid. For a family of two, such as a single mother and her child, 28% of the federal poverty level would be about $5,700 a year, or $475 a month.
That means that a working mother making incrementally more, such as 29% of the federal poverty level, would not qualify for Medicaid but would have to use nearly her entire salary if she were to pay out of pocket for a private insurance plan through the marketplace. This is an obvious impossibility for someone paying for rent and food and other basic necessities.
Nobody knows that better than Lakeisha Preston, a single working mother who couldn’t afford the deductibles on her insurance plan, and therefore was stuck paying out of pocket for a bout of pneumonia that put her in the hospital in 2019.
Over four years later she’s still paying off that medical bill – which forced her to move back in with her parents and take out personal loans.
“I had health insurance, it’s just that the deductibles were so high,” Preston explained. “I don’t go to the doctor all the time, and of course you have to meet the deductible first before the insurance covers you. So I was in that predicament.”
Ironically, Preston works at a federal Medicaid call center. She helps thousands of people, with incomes similar to hers, enroll in Medicaid in states with Medicaid expansion. As a Mississippian, she cannot get that coverage.
Preston said: “As a call center worker, I expect more from the state of Mississippi.”
Mississippi lawmakers have debated the need for expansion — mostly over partisan political reasons — for over a decade, despite the state’s abysmal public health metrics and pleas from doctors, hospital leaders and other health providers.
On Thursday, the deadline day for bills to pass their original chambers, Care4Mississippi, a coalition of 36 organizations whose goal is health care for all Mississippians, held a press conference at the Capitol. Doctors and health officials shared experiences from the frontline and urged lawmakers to pass expansion bills.
“As a pediatrician, I have seen firsthand the impact of parents’ health on their children,” Dr. Anita Henderson said during the press conference. “Children need their parents, and their parents need to act healthy, mentally, physically, and able to engage with their children. I have seen patients whose parents worked, sometimes two jobs, and lacked health insurance … The men and women in Mississippi are living almost a decade less than the people of Hawaii.”
This is the first year since Medicaid expansion was offered to states under the Affordable Care Act in 2014 that Mississippi Republican legislative leadership is considering it seriously. A House Republican bill overwhelmingly passed the full House and now sits in the Senate – which just killed its own expansion bill, according to Medicaid Chair Kevin Blackwell, R-Southaven.
But Allred said that after a decade, lawmakers aren’t moving fast enough or treating the situation for the health care crisis that it is.
“If there was a state that needed to have a red flag pinned on it to say ‘you have a medical emergency to take care of,’ it would be Mississippi,” he said. “And we need a rethinking of what health care is for our citizens in the state.”
Allred saw his father lose all his money as he battled cancer in the last six months of his life – despite the fact he’d worked hard at one company for 30 years. Growing up, his mother warned him not to let a medical debt go to collections, and said it always felt like “the medical industry was there to be feared.”
The father of six said he hopes that by the time his daughters are grown, they won’t have to choose between paying rent or paying a medical bill. Right now, his children are covered by Medicaid. But he worries if legislation isn’t passed, they’ll be in the same predicament he’s in once they turn 18.
“I don’t want them to follow in the same footsteps as me when they shouldn’t have to,” Allred reflected. “When they’re being told their whole life they’re being raised in the greatest country in the world but they’re also being told the greatest country in the world can not take care of you.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
IHL deletes the word ‘diversity’ from its policies
The governing board of Mississippi’s public universities voted Thursday to delete the word “diversity” from several policies, including a requirement that the board evaluate university presidents on campus diversity outcomes.
Though the Legislature has not passed a bill targeting diversity, equity and inclusion initiatives in higher education, the Institutions of Higher Learning Board of Trustees approved the changes “in order to ensure continued compliance with state and federal law,” according to the board book.
The move comes on the heels of the re-election of former President Donald Trump and after several universities in Mississippi have renamed their diversity offices. Earlier this year, the IHL board approved changes to the University of Southern Mississippi’s mission and vision statements that removed the words “diverse” and “inclusiveness.”
In an email, John Sewell, IHL’s communications director, did not respond to several questions about the policy changes but wrote that the board’s goal was to “reinforce our commitment to ensuring students have access to the best education possible, supported by world-class faculty and staff.”
“The end goal is to support all students, and to make sure they graduate fully prepared to enter the workforce, hopefully in Mississippi,” Sewell added.
On Thursday, trustees approved the changes without discussion after a first reading by Harold Pizzetta, the associate commissioner for legal affairs and risk management. But Sewell wrote in an email that the board discussed the policy amendments in open session two months ago during its retreat in Meridian, more than an hour away from the board’s normal meeting location in Jackson.
IHL often uses these retreats, which unlike its regular board meetings aren’t livestreamed and are rarely attended by members of the public outside of the occasional reporter, to discuss potentially controversial policy changes.
Last year, the board had a spirited discussion about a policy change that would have increased its oversight of off-campus programs during its retreat at the White House Hotel in Biloxi. In 2022, during a retreat that also took place in Meridian, trustees discussed changing the board’s tenure policies. At both retreats, a Mississippi Today reporter was the only member of the public to witness the discussions.
The changes to IHL’s diversity policy echo a shift, particularly at colleges and universities in conservative states, from concepts like diversity in favor of “access” and “opportunity.” In higher education, the term “diversity, equity and inclusion” has traditionally referred to a range of efforts to comply with civil rights laws and foster a sense of on-campus belonging among minority populations.
But in recent years, conservative politicians have contended that DEI programs are wasteful spending and racist. A bill to ban state funding for DEI in Mississippi died earlier this year, but at least 10 other states have passed laws seeking to end or restrict such initiatives at state agencies, including publicly funded universities, according to ABC News.
In Mississippi, the word “diversity” first appeared in IHL’s policies in 1998. The diversity statement was adopted in 2005 and amended in 2013.
The board’s vote on Thursday turned the diversity statement, which was deleted in its entirety, into a “statement on higher education access and success” according to the board book.
“One of the strengths of Mississippi is the diversity of its people,” the diversity statement read. “This diversity enriches higher education and contributes to the capacity that our students develop for living in a multicultural and interdependent world.”
Significantly, the diversity statement required the IHL board to evaluate the university presidents and the higher learning commissioner on diversity outcomes.
The statement also included system-wide goals — some of which it is unclear if the board has achieved — to increase the enrollment and graduation rates of minority students, employ more underrepresented faculty, staff and administrators, and increase the use of minority-owned contractors and vendors.
Sewell did not respond to questions about if IHL has met those goals or if the board will continue to evaluate presidents on diversity outcomes.
In the new policy, those requirements were replaced with two paragraphs about the importance of respectful dialogue on campus and access to higher education for all Mississippians.
“We encourage all members of the academic community to engage in respectful, meaningful discourse with the aim of promoting critical thinking in the pursuit of knowledge, a deeper understanding of the human condition, and the development of character,” the new policy reads. “All students should be supported in their educational journey through programming and services designed to have a positive effect on their individual academic performance, retention, and graduation.”
Also excised was a policy that listed common characteristics of universities in Mississippi, including “a commitment to ethnic and gender diversity,” among others. Another policy on institutional scholarships was also edited to remove a clause that required such programs to “promote diversity.”
“IHL is committed to higher education access and success among all populations to assist the state of Mississippi in meeting its enrollment and degree completion goals, as well as building a highly-skilled workforce,” the institutional scholarship policy now reads.
The board also approved a change that requires the universities to review their institutional mission statements on an annual basis.
A policy on “planning principles” will continue to include the word “diverse,” and a policy that states the presidential search advisory committees will “be representative in terms of diversity” was left unchanged.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Closed St. Dominic’s mental health beds to reopen in December under new management
The shuttered St. Dominic’s mental health unit will reopen under the management of a for-profit, Texas-based company next month.
Oceans Behavioral Hospital Jackson, a 77-bed facility, will provide inpatient behavioral health services to adults and seniors and add intensive outpatient treatment services next year.
“Jackson continuously ranks as one of the cities for our company that shows one of the greatest needs in terms of behavioral health,” Oceans Healthcare CEO Stuart Archer told Mississippi Today at a ribbon cutting ceremony at its location on St. Dominic’s campus Thursday. “…There’s been an outcry for high quality care.”
St. Dominic’s 83-bed mental health unit closed suddenly in June 2023, citing “substantial financial challenges.”
Merit Health Central, which operates a 71-bed psychiatric health hospital unit in Jackson, sued Oceans in March, arguing that the new hospital violated the law by using a workaround to avoid a State Health Department requirement that the hospital spend at least 17% of its gross patient revenue on indigent and charity care.
Without a required threshold for this care, Merit Health Central will shoulder the burden of treating more non-paying patients, the hospital in South Jackson argued.
The suit, which also names St. Dominic’s Hospital and the Mississippi Department of Health as defendants, awaits a ruling from Hinds County Chancery Court Judge Tametrice Hodges-Linzey next year.
The complaint does not bar Oceans from moving forward with its plans to reopen, said Archer.
Oceans operates two other mental health facilities in Mississippi and over 30 other locations in Louisiana, Oklahoma and Texas.
“Oceans is very important to the Coast, to Tupelo, and it’s important right here in this building. It’s part of the state of Mississippi’s response to making sure people receive adequate mental health care in Mississippi,” said Lt. Governor Delbert Hosemann at the Nov. 21 ribbon cutting.
Some community leaders have been critical of the facility.
“Oceans plans to duplicate existing services available to insured patients while ignoring the underserved and indigent population in need,” wrote Hinds County Sheriff Tyree Jones in an Oct. 1 letter provided to Mississippi Today by Merit Health.
Massachusetts-based Webster Equity Partners, a private-equity firm with a number of investments in health care, bought Oceans in 2022. St. Dominic’s is owned by Louisiana-based Catholic nonprofit Franciscan Missionaries of Our Lady Health System.
Oceans first filed a “certificate of need” application to reopen the St. Dominic’s mental health unit in October 2023.
Mississippi’s certificate of need law requires medical facilities to receive approval from the state before opening a new health care center to demonstrate there is a need for its services.
The Department of Health approved the application under the condition that the hospital spend at least 17% of its patient revenue on free or low-cost medical care for low-income individuals – far more than the two percent it proposed.
Oceans projected in its application that the hospital’s profit would equal $2.6 million in its third year, and it would spend $341,103 on charity care.
Merit Health contested the conditional approval, arguing that because its mental health unit provides 22% charity care, Oceans providing less would have a “significant adverse effect” on Merit by diverting more patients without insurance or unable to pay for care to its beds.
Oceans and St. Dominic’s also opposed the state’s charity care condition, arguing that 17% was an unreasonable figure.
But before a public hearing could be held on the matter, Oceans and St. Dominic’s filed for a “change of ownership,” bypassing the certificate of need process entirely. The state approved the application 11 days later.
Merit Health Central then sued Oceans, St. Dominic and the State Department of Health, seeking to nullify the change of ownership.
“The (change of ownership) filing and DOH approval … are nothing more than an ‘end run’ around CON law,” wrote Merit Health in the complaint.
Oceans, St. Dominic’s and the Mississippi Department of Health have filed motions to dismiss the case.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
How Mississippi’s Supreme Court Runoff Election Could Impact Criminal Cases
Mississippi voters have dealt defeat to one conservative state Supreme Court justice and forced a moderate justice into a Nov. 26 runoff, with the final outcome possibly making the court more open to considering the rights of criminal defendants.
The nine-member court is largely conservative but justices have recently split in high-profile decisions that sharply affected state politics, including a ruling that shut down citizen-led ballot initiatives in Mississippi and allowed some state control over local criminal cases in its majority-Black capital. The court has also rendered rulings that have made the state increasingly unfavorable to defendants appealing their cases.
“The ability of death row inmates in particular, and inmates in general, to access the courts has been recently curtailed significantly,” Matthew Steffey, a professor at Mississippi College School of Law, told The Marshall Project – Jackson and Bolts following the Nov. 5 election.
Justice Dawn H. Beam joined the majority in those decisions, acquiring a reputation of being hostile to appeals by criminal defendants, and she ran for reelection this fall as the Republican Party’s favored candidate. However, she lost in the state’s 2nd District on Nov. 5 to David P. Sullivan, a defense attorney who has worked as a public defender.
Judicial races in Mississippi are nonpartisan and Sullivan has given few explicit signals about his judicial outlook. He has supported at least some criminal justice reforms and would be the third justice with experience as a defense attorney on this court. Some reformers nationwide have pushed for more professional diversity on the bench.
Even if Sullivan turns out to be more centrist or independent than Beam on criminal law, any overall shift in power on the court depends on the outcome of a runoff election next week.
Two-term Justice Jim Kitchens and challenger Jenifer B. Branning will face each other in the Nov. 26 runoff election after neither won more than 50% of the vote on Nov. 5. The runoff will take place across the 22 counties that make up the Supreme Court’s central district, including Hinds County, home to Jackson. Throughout the campaign, the state GOP targeted Kitchens with attacks, while Branning, a Republican state senator with a conservative voting record, is endorsed by the party.
Kitchens is one of two reliably moderate-to-liberal high court justices. Justices from among an additional group of four sometimes veer away from the majority, as well, but can be more unpredictable, and this group does not vote as a bloc.
Quinn Yeargain, a Michigan State University law professor who closely watches state courts, recently analyzed the court’s voting patterns and found Beam was consistently more conservative than Kitchens in recent cases. Yeargain told The Marshall Project – Jackson and Bolts that conservative and liberal voters often have few signals about how to select a candidate in judicial races. “It’s very hard to label the justices,” they said.
Sullivan — whose father was a Mississippi Supreme Court justice from 1984 to 2000 — called himself a “conservative” throughout his campaign. But he has also touted the value of judicial independence and criticized Beam for campaigning on her endorsement by the state Republican Party.
“I think that rubbed a lot of people the wrong way,” Sullivan told the Sun Herald newspaper, speaking of Beam’s use of the endorsement. “Judicial races are nonpartisan for a reason. A judge’s impartiality could be called into question.”
Sullivan has broad legal experience, but much of his career has focused on private criminal defense while also doing some public defense work. He told The Marshall Project – Jackson and Mississippi Today that he supported a new administrative rule handed down in 2023 by the state Supreme Court to require continuous legal representation for poor criminal defendants from the beginning of their cases. An investigation by The Marshall Project, ProPublica and the Northeast Mississippi Daily Journal last year found, however, that many courts were unready at the time to implement the new representation rules.
During the campaign, Sullivan told The Marshall Project – Jackson and Mississippi Today that more work is needed to improve public defense.
Kitchens has also advocated for public defense reforms during his two terms on the court. He told a committee of legislators last year that the “playing field is far from level” between prosecutors and poor defendants.
On other criminal justice issues, he has sometimes dissented from opinions upholding death sentences. His decisions have scrutinized prosecutorial conduct and inadequate legal representation.
Branning, the Republican senator, has a voting record on criminal justice issues that suggests a harsher approach toward criminal defendants. She has supported higher mandatory minimum sentences and reclassifying misdemeanors as felonies, has opposed expansion of parole and was among only a few lawmakers who voted against legalizing medical marijuana.
She also supported increasing the jurisdiction of a controversial, state-run police force inside the majority-Black city of Jackson as well as increasing state control over many felony cases in Jackson. The Supreme Court unanimously curtailed much state power over these felony cases, but a majority left some control intact, with Kitchens and another judge dissenting.
Branning did not respond to questions from The Marshall Project – Jackson and Mississippi Today during the Nov. 5 campaign about her possible judicial outlook.
Kitchens was a prosecutor and then in private practice before joining the bench. Branning is a practicing attorney who typically handles civil cases.
The winner of the Nov. 26 runoff will join Sullivan on a court that in recent years has been restricting the ability of people who say the legal system has wronged them to seek relief, legal experts told The Marshall Project – Jackson and Bolts this month.
Krissy Nobile, director of the state’s Office of Capital Post-Conviction Counsel, said it’s become “increasingly more difficult to correct a wrongful conviction.” Her office provides legal counsel for indigent people on death row.
She said a number of recent cases showed the barriers the high court has erected for criminal defendants appealing their convictions, and demonstrated indifference to civil rights violations. Kitchens disagreed with the majority, in full or in part, in all but one of the appeals, which the court unanimously denied.
In a case earlier this year, the Court ruled to monetarily fine an incarcerated person for filing any future post-conviction relief petitions that lacked merit. Kitchens joined a dissenting opinion condemning the fine. In another, the court denied a man who argued that his lawyers were ineffective and that they did not challenge prosecutorial misconduct or false forensic evidence presented by a medical examiner with a checkered past. The court’s majority denied the motion, and in the process, overturned a precedent that allowed ineffective counsel as an adequate reason to give a case another look in some types of appeals. Kitchens dissented, along with two other justices.
“For decades in Mississippi, the Court held that it would correct errors if there was a violation (of) a person’s fundamental rights,” Nobile said. But she added this has changed considerably. Now, if you land a terrible lawyer who rushes your case, “You are out of luck,” she said, “even if your core constitutional rights have been clearly violated.”
For the court’s majority, Nobile added, “The legal technicalities now trump a person’s constitutional rights.”
The runoff is the nation’s final supreme court race of the year. Thirty-two states held elections for their high courts earlier this year, resulting in a muddled picture, with liberals and conservatives each gaining ground in different places, Bolts reports.
Mississippi’s runoff outcome will heavily depend on turnout and the composition of the electorate. In the Supreme Court’s central district, voters split narrowly between Democrat Kamala Harris and Republican Donald Trump in the presidential election on Nov. 5, but the runoff is just two days before Thanksgiving and will likely see a large dropoff in turnout. Branning received 42% of the vote in the first round, and Kitchens received 36%, with three other candidates making up the rest.
There will also be a runoff the same day in the Gulf Coast area between Amy Lassiter St. Pé and Jennifer Schloegel for an open seat on the state Court of Appeals. The Court of Appeals hears both criminal and civil cases that have been appealed from lower courts. The Mississippi Supreme Court can hear cases directly on appeal or can assign cases to the Court of Appeals.
Observers agreed that against the national legal backdrop, neither a Kitchens victory nor a Branning victory would lead to a seismic change since neither outcome would flip the court’s conservative lean. Still, a modest shift could impact some of the most controversial cases, such as a rare 5-4 decision that upheld the death sentence in Willie Manning’s case.
A Kitchens win, coupled with Sullivan’s upset earlier this month, would deal the Republican Party rare setbacks in a state where it has been dominant and could put moderate forces in a position to grow their numbers further in future elections.
“You might end up with a normal conservative court,” law professor Yeargain said, “instead of one of the most conservative courts in the country.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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