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Medicaid expansion: What are its chances in 2025?

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1 month ago

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mississippitoday.org – Sophia Paffenroth – 2025-01-02 06:00:00

Arguably the biggest issue of the 2024 legislative session, Medicaid expansion is likely to come up again next year. But did the historic 2024 session create the momentum needed for it to cross the finish line in 2025, or was it merely a one-off?

The two most influential lawmakers for this issue in the Senate, Lt. Gov. Delbert Hosemann, who oversees the Senate, and Senate Medicaid Chair Kevin Blackwell, both told Mississippi Today they would not consider an expansion plan that didn’t include a work requirement. 

Hosemann, who said he was disappointed with the way expansion died last year, confirmed in an emailed statement that he would push for an expansion bill next session as long as it had a work requirement in it. Blackwell declined to comment whether he would push the issue next year.

A work requirement is more likely to be approved by the federal government this year than last, since President-elect Donald Trump will be in office and approved work requirements in his last term. 

Still, the Trump administration only ever approved work requirements in states that had expansion – as a means of limiting it – and never in states seeking to expand Medicaid for the first time. That means the Senate is banking on the president making an unprecedented move for Mississippi. 

Including a work requirement is a political tactic meant to make expansion more palatable to a Republican majority Legislature led by a governor who has been vehemently opposed to expansion for years, derisively calling it “Obamacare” and “welfare” on social media. 

The bureaucracy of requiring monthly or semi-annual proof of employment ends up being another stressor on low-income people already facing a slew of socioeconomic barriers – as well as a stressor on the state Medicaid system, some experts say. 

Currently, Georgia is the only expanded state with a work requirement, and it remains in litigation with the federal government over the issue. The plan has only covered 4,300 people – despite lawmakers predicting 345,000 people would be eligible – and cost taxpayers $26 million as of last March. More than 90% of that went toward administrative costs. 

“Georgia’s plan has proven to be very profitable for large companies like Deloitte (the primary consultant for Georgia’s project) but has provided health care to almost no one who needs it,” said Joan Alker, Medicaid expert and executive director of Georgetown University’s Center for Children and Families. “It’s been a terrible waste of taxpayer dollars so far.”

Meanwhile, Hosemann and Blackwell’s counterparts in the House chose not to speak to Mississippi Today on the details of the issue ahead of the session, despite being the main drivers of last year’s expansion bill – the first expansion bill authored by Republicans in the history of the Mississippi Legislature, and which garnered more support than any other expansion bill in the last decade. 

Speaker of the House Jason White did not respond to Mississippi Today’s questions about his plans for the session.

White told business leaders at the Mississippi Economic Council’s annual Hobnob event that he would make Medicaid expansion a 2025 legislative priority.

“We trust our elected officials and state agencies to use federal dollars responsibly to invest in critical infrastructure, promote education and workforce training and maintain a balanced regulatory framework that all promote economic development,” White said. “Let’s give our hospitals and health care experts the same opportunity, so that hardworking, low-income Mississippians will benefit.”

House Medicaid Chairwoman Missy McGee told Mississippi Today that it will be a priority for the House Medicaid Committee.

The 2024 House expansion bill included a provision that if federal authorities did not approve the waiver necessary to allow a Mississippi work requirement by a certain deadline, Medicaid would still be fully expanded to people up to 138% of the federal poverty level – about $20,000 for an individual or $43,000 for a family of four. Ultimately, the Senate scratched that provision in conference, and also lowered the income threshold to 99% of the federal poverty level – about $15,000 for an individual or $31,000 for a family of four. The Senate’s plan isn’t considered traditional expansion and wouldn’t qualify for the increased federal match that makes expansion a prudent economic policy for states. 

Since the Affordable Care Act made it possible in 2014, states have had the option to expand Medicaid to cover the working poor. Mississippi is one of only 10 states not to do so. 

Tens of thousands of working Mississippians go without health coverage each year, making too little to afford the high deductibles on the cheapest marketplace insurance plan but too much to qualify for Medicaid under the current stipulations. 

Medicaid eligibility varies from state to state, and Mississippi has one of the strictest income requirements in the nation. Childless adults don’t qualify, and parents must make less than 28% of the federal poverty level, a mere $7,000 annually for a family of three, to qualify. More times than not, that means that working a full-time job counts against an individual – despite anti-expansion critics arguing that Medicaid should only apply to those who work.

Expanding Medicaid would cover adults – including those without children – who make up to 138% of the federal poverty level.

But it would also alleviate an enormous burden that Mississippi hospitals currently shoulder: uncompensated care costs. 

Without health insurance, many Mississippians are forced to let their health conditions deteriorate. That, in conjunction with the fact that the emergency room is the only place health care providers can’t turn patients away for not having money, means that some Mississippians use the emergency room as their only source of primary care. 

The emergency room is also the most expensive place to receive care. When patients can’t pay, hospitals pick up the slack covering their care, and the practice – called uncompensated care – costs hospitals millions. 

That’s why Mississippi Hospital Association’s CEO, Richard Roberson, is again asking the Legislature to consider expansion. 

“The upside for hospitals could be several hundred million dollars,” he said. “Right now, the hospitals continue to see the patients that don’t have any form of insurance, which is financially harmful for hospitals because they’re having to provide that care for which they’re not being paid. But probably the bigger and most important part of that is you’re having people that are showing up in the hospitals for what really amounts to primary care services – and that’s not what hospitals are for.”

Without expansion, he said, it’s “very possible” more rural hospitals will be forced to shut down in the coming years.

Right now, they’re being kept afloat by enhanced Medicaid payments Gov. Tate Reeves passed in the eleventh-hour of his heated 2023 reelection campaign. But Roberson said there’s no guarantee those payments will continue, which makes it hard for hospitals to plan services and staff. 

“We don’t want to rely on a program that’s a one-year program, because that enhanced payment, we’ve got to ask for it every single year,” he said. “And so, as hospitals try to plan for the services they’re going to provide, or as they’re trying to recruit physicians and other staff members, you know you’ve got this for one year … but there are no guarantees.”

Roberson says he’s hopeful going into 2025, given how far expansion got last session. 

“I’m more hopeful than I have been, because we now know what a starting place is – for both the Senate and the House. We now know from that conference report what a meeting of the minds was seven months ago. So, that makes me hopeful that whatever concerns still remain, it’s a shorter path to get to those. We’re not starting from scratch.”

But because many Republicans still oppose expansion, any expansion bill in 2025 will likely need the help of the minority party to achieve a veto-proof majority. Last year, Democrats came under fire for blocking a Medicaid expansion compromise in the final days of the session – despite pushing expansion bills for years to no avail – because they felt that the compromise Republican leaders reached wasn’t expansion at all. 

Getting both chambers and both parties to agree could prove difficult again this year. 

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

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Sending taxpayer money to private schools advances in Mississippi House

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4 hours ago

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February 4, 2025

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mississippitoday.org – Michael Goldberg – 2025-02-04 17:31:00

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.

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Mississippi midwives push for licensure: ‘If we don’t do something now, it’s going to get done for us’

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6 hours ago

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February 4, 2025

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mississippitoday.org – Sophia Paffenroth – 2025-02-04 16:14:00

State Sen. Brice Wiggins, R-Pascagoula, speaks with midwives Savanna Boyd, from left, Tanya Smith-Johnson, and Kashuna Watts at the Capitol in Jackson, Miss., Friday, Jan. 30, 2025. The midwives are advocating for legislation to create a midwifery training program, establish regulations for the profession, and secure insurance coverage for licensed midwifery services. Credit: Eric Shelton/Mississippi Today

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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Mississippi Stories: James Storey

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10 hours ago

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February 4, 2025

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mississippitoday.org – Marshall Ramsey – 2025-02-04 12:18:00

Mississippi Stories: James Storey

by Marshall Ramsey, Mississippi Today
February 4, 2025

People still remember where they were on that hot, muggy Mississippi afternoon when Ole Miss fullback James Storey caught two touchdown passes to defeat Notre Dame 20-13 at Mississippi Veterans Memorial Stadium. Nearly 50 years later, people also remember all the ways that Coach Storey has changed their lives for the better.  Moving back to his hometown of Ripley, Storey left the gridiron for the classroom. Dedicating his life to a mindset of humility, generosity, and selflessness that involves serving others without expecting anything in return, he truly has a servant’s heart.  I traveled to north Mississippi to meet up with him to discuss his football days and his long career as an educator, principal and coach.  He also shared his passion of helping the Boys & Girls Club of North Mississippi as well. Storey is a hero on and off the gridiron.  And while the 1977 Notre Dame team may not agree, he’s also a heck of a nice guy.

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

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