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MAP: Mississippi makes it uniquely hard for low-income new moms to get health care

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MAP: Mississippi makes it uniquely hard for low-income new moms to get health care

Low-income women in Mississippi have less access to health care in the months after giving birth than their counterparts in every state except Wyoming.

Mississippi and Wyoming are now the only two states in the country that have neither expanded Medicaid eligibility to low-income working adults, nor extended postpartum Medicaid coverage for new mothers beyond 60 days after birth, according to data compiled by the health nonprofit KFF.

The other nine states that have not expanded Medicaid eligibility have all sought to extend postpartum coverage in recent years. Seven of them, including Alabama, Tennessee, Georgia and South Carolina, have extended coverage to a year after birth. Texas and Wisconsin have sought federal approval to implement shorter extensions of six months and 90 days, respectively.

“We know infant mortality and maternal health are challenges for our state,” said Tennessee Gov. Bill Lee, a Republican who opposes Medicaid expansion, when he introduced his proposal to extend postpartum coverage in 2020. “One in two Tennessee births are covered through our Medicaid program.”

In Mississippi, that number is higher: about six in 10 births are covered by Medicaid.

During the ongoing COVID-19 federal public health emergency, states are not allowed to kick anyone off Medicaid. As a result, women who have given birth since March 2020 will have coverage until the emergency is lifted, potentially as soon as early 2023.

But ordinarily, a Mississippi woman with two kids and a partner together earning $3,000 a month, for example, would lose her Medicaid coverage two months after her baby is born.

The same woman living in Alabama, which has not expanded Medicaid eligibility but approved a 12-month postpartum coverage extension earlier this year, would have health insurance until her baby is a year old. And the same woman living in Arkansas, which has expanded Medicaid but not extended postpartum coverage, would have health insurance before and after her pregnancy, because she would be eligible based solely on her income.

In Mississippi, women whose pregnancies are covered by Medicaid lose the ability to go to check-ups, get treatment for postpartum depression, and receive care for chronic conditions when their babies are just two months old.

(AP Photo/Rogelio V. Solis)

House Speaker Philip Gunn, R-Clinton, has repeatedly rejected postpartum Medicaid extension, which easily passed the Senate last session. He has described the proposal as Medicaid expansion, though it would not make more people eligible for Medicaid. Almost every other state that has refused to expand Medicaid has nevertheless extended postpartum coverage.

Last week, some of the state’s leading doctors told the Senate Medicaid Committee that extending postpartum Medicaid would not only improve abysmal maternal and infant health outcomes but also save money.

Mississippi has the country’s highest infant mortality rate and highest rate of premature births. Dr. Anita Henderson, a pediatrician and president of the Mississippi Chapter of the American Academy of Pediatrics, said the hospital cost of delivering a healthy baby at full term is typically around $5,000 to $6,000. But an extremely preterm baby requires a long stay in a neonatal intensive care unit (NICU), at an average cost of $600,000.

State Health Officer Dr. Daniel P. Edney mentioned that Mississippi is one of just two states that has neither extended postpartum coverage nor expanded Medicaid eligibility.

“What I would beg us to consider is the fact it makes much more economic sense to let Medicaid pay for this rather than the state having to pay for it – either state agencies such as the health department paying, or hospitals paying for it with uncompensated care,” he said.

Pregnant women in Mississippi qualify for Medicaid as long as their family income is below 194% of the federal poverty level– about $4,600 per month for a family of four.

But after giving birth, a Mississippian with kids qualifies for Medicaid only if she has a very low income, earning $578 or less monthly for a family of four.

With such a strict income eligibility requirement, it’s all but impossible for anyone with a full-time job to qualify for Medicaid coverage. (And healthy adults without kids never qualify for Medicaid in Mississippi.)

In states that have expanded Medicaid, including Louisiana and Arkansas, adults with incomes below 138% of the federal poverty level, or about $3,200 for a family of four, qualify for health insurance.

An analysis by the consulting firm Manatt found that expanding eligibility for Medicaid would cut enrollment in pregnancy Medicaid by about half, because many women would qualify based on income alone.

Wil Ervin, deputy administrator for health policy for Mississippi Medicaid, told the Senate Medicaid Committee last week that extending postpartum coverage to a year would cost the state about $7 million.

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

Mississippi Today

‘Trainwreck on the horizon’: The costly pains of Mississippi’s small water and sewer systems

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'Trainwreck on the horizon': The costly pains of Mississippi’s small water and sewer systems

mississippitoday.org – @alxrzr – 2025-04-21 06:00:00

This is the first of a two-part story

“This state ain’t nothing but a big Jackson,” Central District Public Service Commissioner De’Keither Stamps said during a December meeting that harkened back to his time as a capital city councilman. “We got a whole statewide trainwreck that’s on the horizon.”

Over a thousand drinking water systems, most of them small, and hundreds of additional sewer systems operate in Mississippi. Nearly 60 percent of those water systems, according to the Environmental Protection Agency, have committed a violation in the last three years, and one in three sewer systems in the state have violated pollution limits in just the last year.

In 2014, a couple in DeSoto County, the wealthiest part of the state, sent a letter with photos of their yard to the Mississippi Department of Environmental Quality. Tarnishing their garden were small clumps of feces and wads of wet toilet paper stuck together. 

“When having company with children playing in our backyard last summer, suddenly, water and sewage began rushing out of the back flow valve, into the flower bed, across our yard and into the backyard where the children were playing,” the Olive Branch couple wrote. “Everyone had to come inside due to the sewage rushing in our yard…This went on for several hours.”

The culprit, MDEQ later identified, was the malfunctioning collection system at the Belmor Lakes Subdivision sewage treatment facility, which serves about 200 people. The couple continued sending complaints the next four years, while the state sent repeated notices of violation to the plant’s operator. The facility allowed sewage overflows from at least 2011 to 2020, records show, and it remains out of compliance to this day. 

Another facility, at the Openwood Plantation in Vicksburg, exceeded fecal coliform limits as early as 2004. A 2011 inspection noted the plant’s effluent structure “has been leaking for at least two years, still not repaired.” The next year, a neighbor complained to MDEQ about a funky smelling green liquid on their property. The agency found not only was the treatment plant responsible, but it also leaked raw sewage that flowed into a local recreational lake. Over two decades after the initial violation, the facility still regularly exceeds, by significant degrees, water pollution limits for chemicals such as E.coli, chlorine and ammonia nitrogen. 

Small water and sewer systems around Mississippi have for years struggled to stay afloat because of, to some degree, the nature of being a small water or sewer system. Now, as they try to correct deficiencies during a time of growing regulations and higher costs, many cash-strapped systems are facing the hard reality of needing to raise rates for necessary services in the country’s second poorest state. 

“System officials think that part of the job is to hold rates at a low level, and that doesn’t necessarily jive with what the need is,” said Bill Moody, director of the Bureau of Water Supply at the Mississippi State Department of Health.

Moody spoke anecdotally of system owners who bragged about keeping rates low, unaware of the revenue shortfall they would soon have. 

A 2023 EPA report on funding needs for drinking water systems found that, over the next 20 years, Mississippi will have an $8.1 billion need. That equals $2,751 per Mississippian, the fourth largest per capita need of any state. Small systems in the state had a per capita need 26% higher than that, the report’s data shows, equalling $3,456 per person. 

Treated water at a water treatment facility in the Wellsgate subdivision in Oxford, Miss., on Monday, March 10, 2025.

The United States, and especially Mississippi, suffers from what industry wonks call “fragmentation.” Compared to other countries, the U.S. has a spread out population, meaning its utilities are spread out, too. But by having so many water and sewer systems serving small pockets of people, scant infrastructure funding is spread to the point it loses spending power. 

“ The problems the city of Jackson has had, for instance, is replayed over and over and over again in these smaller systems,” said MDEQ executive director Chris Wells. “ What you have is these small systems that, for one reason or other, aren’t properly functioning.”

For instance, Wells explained, a developer with no utility experience might build and operate a sewage lagoon to serve a subdivision. Sometimes the developer moves or dies and passes the reins onto the homeowners association. 

“We’ve had situations where the person who built the lagoon or the treatment system literally disappears, abandons the system,” Wells said.

While consolidating small systems would help, experts say, some are so far behind that their customers’ bills will go up regardless.

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“It gets a little depressing, I don’t know what the answer is,” Greg Pierce, a water policy expert at the University of California, Los Angeles said. “Usually these systems are under-maintained. They have low rates, but they also have low quality and low reliability.”

Each year, the Health Department takes the temperature of the state’s drinking water systems. In the last two years, the agency found 83 providers that were in “poor” condition. While the median population for a water system in Mississippi is around 1,400 people, that number drops to 422 for the “poor” performing systems, about 80% of which serve under a 1,000 people. 

In the small town of Utica, for instance, the Reedtown Water Association has frequent power outages and boil water notices. Stamps, the Public Service commissioner for the area, said necessary repairs would cost $4 million to $5 million, “an amount far beyond what the water association and its (1,200) customers can afford.”

One water association with just 829 customers – Cascillia, in Tallahatchie County – had 83 violations in just the last 5 years, including exceeding arsenic limits in 2023. Several other small water systems (such as the Moore Bayou Water Association in Coahoma County, or Truelight Redevelopment in Sharkey County) are considered “serious violators” by the EPA for, in part, not meeting limits on disinfectant byproducts that were set in 2006. Of the state’s 19 “serious violators,” more than half serve 1,200 or fewer people. The EPA defines a small water system as serving 3,300 people or fewer. 

Kyle Cummings stands next to a water tank as he discusses the treatment process at a water treatment facility in the Wellsgate subdivision in Oxford, Miss., on Monday, March 10, 2025.

Smaller systems struggle nationwide. A 2018 study from researchers at the University of California, Irvine and Columbia University found that systems in rural areas around the country see “substantially” more violations than those in urban areas.

Wells, of MDEQ – which oversees sewer compliance – said it’s a challenge motivating struggling systems to meet permit limits. The state can technically take over a system, but MDEQ doesn’t have the resources to do so, and levying large fines can be counterproductive because ratepayers ultimately have to make up the difference.

“Every dollar that we take in penalties is one less dollar that the community has to spend toward the upgrades that they need to make,” he said. 

Wells described that, for some repeat offenders, sending them violation notices is like “trying to get blood out of a turnip.” While MDEQ works with systems to correct deficiencies, he said, sometimes the best answer is a third-party utility coming in to save the day.

The American Society of Civil Engineers’ 2024 “Infrastructure Report Card” estimated that Mississippi, between all its water and sewer systems, needed $9.4 billion in investments over the next 20 years. 

“The capacity of drinking water systems in the state is mediocre,” the report says, adding that “wet weather conditions, inconsistent maintenance, and a lack of rehabilitation pose extreme threats to the state’s wastewater infrastructure.”

Soda ash at a water treatment facility in the Wellsgate subdivision in Oxford, Miss., on Monday, March 10, 2025.

Between the historic amounts of federal funding from the American Rescue Plan Act and the Infrastructure Investment and Jobs Act, Mississippi received roughly $1.2 billion for water and wastewater improvements, or just 13% of the state’s projected need. 

Especially with large expenses looming to meet the new national standards for PFAs, some small systems are looking to consolidate to ease financial headaches. The Oxford Eagle reported last year, for instance, that the Punkin Water Association would soon join the city of Oxford’s service area after years of water quality issues. 

But given the spacial challenges of connecting far apart systems – especially in Mississippi, which, according to Census data, has the fourth most rural population of any state – some say there are limits to how much water providers can actually unify. 

“When it comes to the physical pipes in the ground, you can’t move them,” said Mildred Warner, a professor of city and regional planning at Cornell University, explaining that many systems can only consolidate in terms of management. 

Mississippi is experimenting with consolidating management for some of its small, privately owned water and sewer systems. In 2021, a company called Great River began buying struggling systems around the state. A subsidiary of the national firm Central States Water Resources, the company focuses on struggling, poorly financed systems that most large utility firms wouldn’t touch. Now operating in 11 states, the company has access to more resources than what a small operator would, and can reduce overall costs by spreading them out throughout its service area. 

In Mississippi, part of the PSC’s job is to make sure private utilities that have a monopoly over a given service area, like Great River, only charge customers for what their services are worth, plus enough profit to stay in business. Given the challenges of some small systems in the state, the PSC welcomed the company’s help. But Great River, as is common when a large private utility takes over, quickly imposed steep rate increases to fund its repairs.

As Great River’s ratepayers plead with the PSC to soften the financial blow, the condition of some Mississippi water and sewer providers suggest those basic services will have to cost much more than they used to, especially for customers of small systems. 

Part two of this story will further explore the Great River’s impact on ratepayers, and what the future holds for small water and sewer systems struggling to stay afloat.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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On this day in 1939, Billie Holiday recorded ‘Strange Fruit’

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mississippitoday.org – @MSTODAYnews – 2025-04-20 07:00:00

April 20, 1939

Billie Holiday recorded “Strange Fruit” about the lynchings of Black Americans.

Legendary jazz singer Billie Holiday stepped into a Fifth Avenue studio and recorded “Strange Fruit,” a song written by Jewish civil rights activist Abel Meeropol, a high school English teacher upset about the lynchings of Black Americans — more than 6,400 between 1865 and 1950. 

Meeropol and his wife had adopted the sons of Julius and Ethel Rosenberg, who were orphaned after their parents’ executions for espionage. 

Holiday was drawn to the song, which reminded her of her father, who died when a hospital refused to treat him because he was Black. Weeks earlier, she had sung it for the first time at the Café Society in New York City. When she finished, she didn’t hear a sound. 

“Then a lone person began to clap nervously,” she wrote in her memoir. “Then suddenly everybody was clapping.” 

The song sold more than a million copies, and jazz writer Leonard Feather called it “the first significant protest in words and music, the first unmuted cry against racism.” 

After her 1959 death, both she and the song went into the Grammy Hall of Fame, Time magazine called “Strange Fruit” the song of the century, and the British music publication Q included it among “10 songs that actually changed the world.” 

David Margolick traces the tune’s journey through history in his book, “Strange Fruit: Billie Holiday and the Biography of a Song.” Andra Day won a Golden Globe for her portrayal of Holiday in the film, “The United States vs. Billie Holiday.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Mississippians are asked to vote more often than people in most other states

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Mississippians are asked to vote more often than people in most other states

mississippitoday.org – @BobbyHarrison9 – 2025-04-20 06:00:00

Not long after many Mississippi families celebrate Easter, they will be returning to the polls to vote in municipal party runoff elections.

The party runoff is April 22.

A year does not pass when there is not a significant election in the state. Mississippians have the opportunity to go to the polls more than voters in most — if not all — states.

In Mississippi, do not worry if your candidate loses because odds are it will not be long before you get to pick another candidate and vote in another election.

Mississippians go to the polls so much because it is one of only five states nationwide where the elections for governor and other statewide and local offices are held in odd years. In Mississippi, Kentucky and Louisiana, the election for governor and other statewide posts are held the year after the federal midterm elections. For those who might be confused by all the election lingo, the federal midterms are the elections held two years after the presidential election. All 435 members of the U.S. House and one-third of the membership of the U.S. Senate are up for election during every midterm. In Mississippi, there also are important judicial elections that coincide with the federal midterms.

Then the following year after the midterms, Mississippians are asked to go back to the polls to elect a governor, the seven other statewide offices and various other local and district posts.

Two states — Virginia and New Jersey — are electing governors and other state and local officials this year, the year after the presidential election.

The elections in New Jersey and Virginia are normally viewed as a bellwether of how the incumbent president is doing since they are the first statewide elections after the presidential election that was held the previous year. The elections in Virginia and New Jersey, for example, were viewed as a bad omen in 2021 for then-President Joe Biden and the Democrats since the Republican in the swing state of Virginia won the Governor’s Mansion and the Democrats won a closer-than-expected election for governor in the blue state of New Jersey.

With the exception of Mississippi, Louisiana, Kentucky, Virginia and New Jersey, all other states elect most of their state officials such as governor, legislators and local officials during even years — either to coincide with the federal midterms or the presidential elections.

And in Mississippi, to ensure that the democratic process is never too far out of sight and mind, most of the state’s roughly 300 municipalities hold elections in the other odd year of the four-year election cycle — this year.

The municipal election impacts many though not all Mississippians. Country dwellers will have no reason to go to the polls this year except for a few special elections. But in most Mississippi municipalities, the offices for mayor and city council/board of aldermen are up for election this year.

Jackson, the state’s largest and capital city, has perhaps the most high profile runoff election in which state Sen. John Horhn is challenging incumbent Mayor Chokwe Antar Lumumba in the Democratic primary.

Mississippi has been electing its governors in odd years for a long time. The 1890 Mississippi Constitution set the election for governor for 1895 and “every four years thereafter.”

There is an argument that the constant elections in Mississippi wears out voters, creating apathy resulting in lower voter turnout compared to some other states.

Turnout in presidential elections is normally lower in Mississippi than the nation as a whole. In 2024, despite the strong support for Republican Donald Trump in the state, 57.5% of registered voters went to the polls in Mississippi compared to the national average of 64%, according to the United States Elections Project.

In addition, Mississippi Today political reporter Taylor Vance theorizes that the odd year elections for state and local officials prolonged the political control for Mississippi Democrats. By 1948, Mississippians had started to vote for a candidate other than the Democrat for president. Mississippians began to vote for other candidates — first third party candidates and then Republicans — because of the national Democratic Party’s support of civil rights.

But because state elections were in odd years, it was easier for Mississippi Democrats to distance themselves from the national Democrats who were not on the ballot and win in state and local races.

In the modern Mississippi political environment, though, Republicans win most years — odd or even, state or federal elections. But Democrats will fare better this year in municipal elections than they do in most other contests in Mississippi, where the elections come fast and often.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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