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Mississippi Medicaid spent a tiny fraction of its budget on gender-affirming care before lawmakers banned it

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Mississippi Medicaid spent a tiny fraction of its budget on gender-affirming care before lawmakers banned it

by Molly Minta and Kate Royals, Mississippi Today
April 11, 2023

The Mississippi Division of Medicaid spent months working to determine how much it paid in claims associated with gender identity disorder or gender dysphoria following an anonymous legislative request, according to emails obtained through a public records request.

The answer: A maximum of $58,900.82 in taxpayer money over the last five years from the agency’s annual budget of $6 billion – nearly half of which paid for a mastectomy to treat a “life-threatening disease” that was not gender dysphoria. No money was paid to providers for intersex surgery for trans men or trans women.

Attorneys for Medicaid initially miscalculated the answer, but after many back and forths over email with a representative from a legislative committee, landed on this imperfect estimate.

It is unclear from the documents how much Medicaid paid in reimbursements specifically for gender-affirming care for trans youth. It is also unclear which procedures are directly related to gender-affirming care. Some include descriptions of routine medical claims such as emergency room visits and lipid panels. Only one reimbursement could be more easily connected to gender-affirming care for trans children: $94.20 for “bone age studies.”

In a letter to Mississippi Today, Medicaid noted that some claims “may not be directed related to” services for a patient’s primary diagnosis of gender dysphoria.

The Division of Medicaid did not answer questions from Mississippi Today for this story.

Earlier this year, Medicaid became the first state agency to take a public position on gender-affirming care for trans children as lawmakers sought to ban it. In mid-February, Executive Director Drew Snyder sent a letter stating that there is not enough medical literature to support that it is a “safe and effective treatment for gender dysphoria” for trans youth.

Snyder’s letter did not mention Medicaid reimbursements for gender-affirming care.

Rob Hill, the state director of Human Rights Campaign of Mississippi, said that Snyder’s letter contradicts Medicaid’s past actions of paying for gender-affirming care. Despite Medicaid’s letter, major medical associations support gender-affirming care for trans youth.

“I’ve always known Drew Snyder to be a fair-minded person, so I would say I was really disappointed to see this letter released that was not based on fact,” Hill said. “There is plenty of research that he or his folks in the department could’ve done. It’s easily found on the internet. I could have sent him a fact sheet.”

For trans people, it can be challenging to get gender-affirming care covered by private health insurance. Trans people report being uninsured at a rate seven times higher than cis people, due in significant part to job discrimination and the employment-based health insurance model in the U.S., according to a report from the Center for American Progress. That same report found that 46% of trans respondents – and 56% of trans respondents of color – said their health insurance denied coverage for gender-affirming care.

“Honestly, I’m glad to know that people have received (gender-affirming) care in Mississippi through Medicaid, through taxpayer dollars,” Hill said. “But I would like to see it be a lot more because this care is well-researched for decades and supported by all the major medical associations.”

One of the first signs that gender-affirming care would become a flashpoint during the legislative session came last fall when the Mississippi Freedom Caucus, a far-right wing of the Legislature, published a blog post by Rep. Dana Criswell of Olive Branch that claimed public dollars were funding the “mutilation of children” at the University of Mississippi Medical Center.

“You read that correctly, you, the taxpayers of Mississippi, are paying for children to receive hormone therapy and for mutilation of children,” the post read.

But during the legislative session, lawmakers spent little time on the issue of state funds supporting gender-affirming care despite efforts to determine the amount.

Lawmakers’ first inquiry to Medicaid came in mid-December from Lonnie Edgar, the deputy director of the Joint Legislative Performance Evaluation and Expenditure Review Committee. The PEER Committee is tasked with assisting legislators with requests for information and the results of its research are confidential.

On Dec. 13, 2022, Edgar sent an email to Cody Smith, an attorney for Mississippi Medicaid, asking if the agency had reimbursed claims for gender-affirming care “anywhere else in the state besides UMMC.” Edgar noted that “this is similar to the request you all provided information on about Planned Parenthood facilities on September 13, 2022.”

Edgar told Mississippi Today he is not allowed to disclose who made the request or whether any similar requests have been made in the past. He also did not have an answer as to why the request excluded UMMC.

It could be that PEER already had information about the medical center. In August 2022, the PEER committee also sent an inquiry to UMMC asking if it had billed gender-affirming services to Medicaid.

Smith responded to Edgar about two weeks later, writing that Medicaid had determined a total of $131,865.03 was paid for 47 visits. He noted that no payments were made to the Spectrum Clinic in Hattiesburg, the only clinic in the state that exclusively serves transgender patients. Medicaid’s research found that the agency has reimbursed providers across the state, including Singing River and UMMC, for care given to people with gender dysphoria.

After House lawmakers passed HB 1125 early in the session, the inquiries from Edgar continued.

“This request seems to change every iteration,” Edgar wrote on Jan. 26. “Based on the information you provided on Medicaid claims broken out by provider … can you also determine the amounts spent on puberty blocking hormones or cross sex hormone treatment?”

It doesn’t appear that Medicaid was able to determine that amount since Medicaid-enrolled prescribers are not required to give a diagnosis code to pharmacists.

Soon after, Smith and Brett Brown, a technology specialist at Medicaid, discovered an error in the initial accounting.

Brown realized that the previous number Medicaid had provided lawmakers – $131,865.03 – was more than double the actual amount the agency had paid out because it included Medicaid “crossover claims.” Crossover claims occur for people who are eligible for both Medicare and Medicaid. Medicare, federal health insurance for people 65 or older, pays a portion of the claim, and Medicaid is billed for any remaining deductible or coinsurance.

Hill said there’s “no number” that can be put on the positive impact gender-affirming care has on trans people and especially trans youth.

“Anybody who suggests that it’s wasted money – one, I would think that they don’t have a heart,” he said, “and two, they’re just absolutely wrong.”

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

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Mississippi Stories: Michael May of Lazy Acres

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January 21, 2025

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mississippitoday.org – rlake – 2025-01-21 14:51:00

In this episode of Mississippi Stories, Mississippi Today Editor-at-Large Marshall Ramsey takes a trip to Lazy Acres. In 1980, Lazy Acres Christmas tree farm was founded in Chunky, Mississippi by Raburn and Shirley May. Twenty-one years later, Michael and Cathy May purchased Lazy Acres. Today, the farm has grown into a multi seasonal business offering a Bunny Patch at Easter, Pumpkin Patch in the fall, Christmas trees and an spectacular Christmas light show.  It’s also a masterclass in family business entrepreneurship and agricultural tourism.

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

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On this day in 1921

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18 hours ago

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January 21, 2025

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mississippitoday.org – Jerry Mitchell – 2025-01-21 07:00:00

Jan. 21, 1921

George Washington Carver Credit: Wikipedia

George Washington Carver became one of the first Black experts to testify before Congress. 

His unlikely road to Washington began after his birth in Missouri, just before the Civil War ended. When he was a week old, he and his mother and his sister were kidnapped by night raiders. The slaveholder hired a man to track them down, but the only one the man could locate was George, and the slaveholder exchanged a race horse for George’s safe return. George and his brother were raised by the slaveholder and his wife. 

The couple taught them to read and write. George wound up attending a school for Black children 10 miles away and later tried to attend Highland University in Kansas, only to get turned away because of the color of his skin. Then he attended Simpson College in Indianola, Iowa, before becoming the first Black student at what is now Iowa State University, where he received a Master’s of Science degree and became the first Black faculty member. 

Booker T. Washington then invited Carver to head the Tuskegee Institute’s Agriculture Department, where he found new uses for peanuts, sweet potatoes, soybeans and other crops. 

In the past, segregation would have barred Carver’s testimony before Congress, but white peanut farmers, desperate to convince lawmakers about the need for a tariff on peanuts because of cheap Chinese imports, believed Carver could captivate them — and captivate he did, detailing how the nut could be transformed into candy, milk, livestock feed, even ink. 

“I have just begun with the peanut,” he told lawmakers. 

Impressed, they passed the Fordney-McCumber Tariff of 1922. 

In addition to this work, Carver promoted racial harmony. From 1923 to 1933, he traveled to white Southern colleges for the Commission on Interracial Cooperation. Time magazine referred to him as a “Black Leonardo,” and he died in 1943. 

That same year, the George Washington Carver Monument complex, the first national park honoring a Black American, was founded in Joplin, Missouri.

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

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Legislative recap: 2025 tax cut battle has been joined

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2 days ago

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January 20, 2025

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mississippitoday.org – Geoff Pender – 2025-01-20 12:00:00

After relatively brief debate and questioning given its magnitude, the state House passed the first meaningful legislation of the new session: House Bill 1, a measure that would eliminate the state income tax, trim taxes on non-prepared food and raise sales and gasoline taxes.

It would mark a sea change in state tax structure, a shift from income to consumption taxation.

“We are at a place where we can finally tell the hard-working people of Mississippi we can eliminate the tax on work,” House Ways and Means Chairman Trey Lamar, HB1’s author, told his colleagues.

The measure passed the House 88-24. It gained some Democratic support in the supermajority Republican House, with nine Democrats voting in favor, 24 against and 12 voting present.

The proposal garnered some bipartisan support because it includes at least a couple of items Democratic lawmakers have championed in the past: A gasoline tax to help fix crumbling roadways, and a reduction in the “grocery” tax, or the sales tax levied on unprepared food, of which Mississippi has the highest overall rate in the nation.

It still met with some Democratic opposition in part because it is a sea change toward more “regressive” taxation. Proponents say this is just, people should pay more for state services they use, such as roadways, and for things they buy as opposed to taxing income. Opponents say this places a proportionately higher tax burden on people of modest means.

“I would say the people hurt the most with this would be working people who have to put gas in their car to go to work or those who have to purchase materials to do a job,” House Democratic Leader Robert Johnson said.

Beyond that concern, opponents or skeptics worry that the foundation of the proposed tax overhaul would be built on shifting sands — a state economy that has been so rosy primarily from the federal government dumping billions of dollars in pandemic spending into Mississippi. With the federal spigot being cut off, some worry, the state economy could slump, and the massive tax cuts in this new plan could provide a state budget crisis, of which Mississippi has much experience, and underfunding of crucial services such as schools, roads, health care and law enforcement.

The largest hurdle Republican House leaders face in seeing their tax plan through to law is not in garnering bipartisan support. It’s internecine disagreement with the Senate Republican leadership, which still appears to harbor abovementioned concerns about overhauling tax structure in uncertain economic times and betting on growth to cover massive tax cuts.

Senate leaders have said they want to enact more tax cuts, but their plan has not yet been released. Lt. Gov. Delbert Hosemann has provided some details of what he wants to see, but it would appear he wants a more cautious approach on cuts. He has not publicly opined on the tax increases in the House plan.

Quote of the Week

“Have you ever worn a belt and suspenders, lady? It’s a belt and suspenders approach.” — Rep. Trey Lamar, R-Senatobia, to Rep. Omeria Scott, D-Laurel, during floor debate on Lamar’s bill to eliminate the state income tax and raise other taxes.

“No. I have not worn a belt and suspenders. I don’t know anyone who has worn a belt and suspenders,” Scott replied.

In Brief

House will renew push to legalize mobile sports betting

House Gaming Committee Chairman Casey Eure, R-Saucier, told Mississippi Today he plans on taking another crack at legalizing mobile sports betting in the state. In 2024, the House and Senate passed versions of legislation to permit online sports betting, but never agreed on a final proposal. Some lawmakers raised concerns that gambling platforms would have no incentive to partner with smaller casinos, and most of the money would instead flow to the Mississippi Gulf Coast’s already bustling casinos. Proponents say legalization would undercut the influence of illicit offshore sports betting platforms.

“I’ve been working on this bill for many years and I’m just trying to satisfy any concerns that the Senate may have so we can pass this and start collecting the tax dollars that the state deserves and not allowing everyone to place bets with these offshore accounts,” Eure said. “I feel like the state is losing between $40-$80 million a year in tax revenue.”

Sports wagering has been permitted in the state for years, but online betting has remained illegal amid fears the move could harm the bottom line of the state’s brick-and-mortar casinos. Mobile sports betting is legal in 30 states and Washington, D.C.,  according to the American Gaming Association. — Michael Goldberg

Hosemann makes Senate committee chair changes

Republican Lt. Gov. Delbert Hosemann last week named new chairmen of committees, after former state Sen. Jenifer Branning was sworn into office as a new justice on the Mississippi Supreme Court. 

Sen. Chuck Younger, a Republican from Columbus, previously led the Senate Agriculture Committee and will replace Branning as chairman of the Transportation Committee. Sen. Neil Whaley, a Republican from Potts Camp, previously led the Senate Wildlife, Fisheries and Parks Committee, but will now lead the Senate Agriculture Committee. 

Here are the other changes to Senate committees: 

Sen. Ben Suber, a Republican from Bruce, will be the new chairman of the Senate Wildlife, Fisheries and Parks Committee 

Sen. Bart Williams, a Republican from Starkville, is the new chairman of the Senate Public Property Committee

Sen. Scott DeLano, a Republican from Gulfport, will lead the Senate Technology Committee 

Sen. Robin Robinson, a Republican from Laurel, will chair the Senate Labor Committee 

Sen. Angela Turner Ford, a Democrat from West Point, will lead the Senate Drug Policy Committee.  — Taylor Vance

What’s in a name? Democratic Rep. Scott hopes GOP majority will pass ‘Donald J. Trump Act’ bills

Perhaps tired of seeing many measures she authors ignored or shot down in flames by the Republican supermajority in the Mississippi Legislature, Democratic Rep. Omeria Scott of Laurel is trying a new strategy: naming bills after Republican President-elect Trump.

For this session, Scott has authored: House Bill 61, the “Donald J. Trump Voting Rights Restoration Act;” House Bill 62, the “Donald J. Trump Ban-The-Box Act … to prohibit public employers from using criminal history as a bar to employment;” and House Bill 249, the “Donald J. Trump Early Voting Act.” — Geoff Pender

More bills filed to criminalize abortion

Since the 2022 Dobbs Supreme Court decision overturned the constitutional right to an abortion, Mississippi lawmakers have proposed bills to criminalize workarounds to the state’s strict abortion ban – including criminalizing the abortion pill and out-of-state abortions. The 2025 legislative session is no exception. 

Rep. William Tracy Arnold, R-Booneville, filed House Bill 616 that would make it a felony to manufacture or make accessible medication abortion. Anyone convicted of the crime would be subject to a fine between $1,000 and $5,000, as well as imprisonment between two and five years. Last year, about 250 Mississippians each month requested medication abortion from Aid Access, the only online telemedicine service supplying medication abortion via mail in the U.S. 

Helping a minor receive an abortion would also be criminalized under House Bill 148 filed by Rep. Mark Tullos, R-Raleigh. That would include transporting a minor out of state to undergo an abortion, as well as helping a minor procure a medication abortion – both of which would be punishable by not less than 20 years in prison or a fine of not less than $50,000. — Sophia Paffenroth

By the Numbers

$1.1 billion

The estimated net annual cost of the House plan to eliminate the state income tax and raise sales taxes, once fully phased in. Proponents say economic growth would allow the state budget, currently about $7 billion a year, to absorb the cut. Eliminating the income tax would cost the state $2.2 billion in revenue, but the House plan would raise about $1.1 billion in other taxes in offset.

0

The amount of income tax Mississippians would pay after a 10-year phased in elimination of the state income tax. With previous cuts being phased in, state income taxes next year will already be reduced to 4%, among the lowest rates in the nation.

8.5 %

The new Mississippi sales tax, up from current 7%, under the House tax plan assuming most local governments would not opt out of adding a new 1.5% local sales tax.

13 cents more a gallon

The cost of the House’s proposed new 5% gasoline tax, based on last week’s average cost of gasoline in Mississippi of $2.62. The new 5% tax would be on top of the flat 18.4 cents a gallon current state excise on gasoline.

4%

The tax on unprepared food once a reduction of the current 7% would be phased in over a decade under the House plan. The state would over time reduce its sales tax on such groceries to 2.5%, but local governments would add a 1.5% sales tax to such items unless they opt out.

Full Legislative Coverage

Lawmakers must pass new legislation to improve access to prenatal care

Lawmakers will file another bill this session to help low-income pregnant women get into the doctor earlier – after the federal government rejected the program set up under last year’s law, because of discrepancies between what was written into state law and federal regulations for presumptive Medicaid eligibility. Read the story.

Proposal: eliminate income tax, add 5% tax on gas, allow cities, counties to levy local sales tax

House leaders last week unveiled a sweeping tax cut proposal that would eventually abolish the state income tax, slash taxes on groceries, increase local sales taxes and shore up funds for state and local road work. Read the story.

A new Mississippi law aims to limit jailing people awaiting mental health treatment. Is it working?

Officials say a new law to decrease the number of people being jailed solely because they need mental health treatment has led to fewer people with serious mental illness detained in jails – but the data is contradictory and incomplete. Lawmakers plan legislation to make more counties report the data. Read the story.

How soon we forget: Mississippi House push for record tax cuts revives fear of repeat budget crises

Eight years ago, from a combination of dozens of tax cuts the Legislature approved and a slumping economy, the state saw a budget crisis that resulted in severely underfunded schools, government layoffs, a near halt to building new roads and highways and problems maintaining the ones we have, too few state troopers on the highways and cuts to most major state services. Read the story.

NAACP legislative redistricting proposal pits two pairs of senators against each other

The Mississippi chapter of the ACLU has submitted a proposal to the courts to redraw the state’s legislative districts that creates two new majority-Black Senate districts and pits two pairs of incumbent senators against one another. Read the story.

Legislation to send more public money to private schools appears stalled as lawmakers consider other changes

Some top lawmakers in Mississippi’s Republican-controlled Legislature are prepared to make it easier for students to transfer between public schools but remain skeptical of sending more public money to private schools. Read the story.

House passes $1.1 billion income tax elimination-gas and sales tax increase plan in bipartisan vote

A bill that phases out the state income tax, cuts the state grocery tax and raises sales taxes and gasoline taxes passed the House of Representatives with a bipartisan vote on Thursday. Read the story.

Tate Reeves and other top Mississippi Republicans owe thanks to President Joe Biden

The tremendous cash surpluses that some state Republicans cite when defending their plan to eliminate the state’s income tax would not exist if not for the billions of dollars in federal funds that have been pumped into the state during Biden’s presidential tenure. Read the story.

Podcast: Mississippi transportation director discusses proposed new gasoline tax

Mississippi Department of Transportation Director Brad White tells Mississippi Today’s Geoff Pender and Taylor Vance he’s staying “in his lane” and out of the politics of a House tax overhaul that would eliminate the income tax and raise sales and gasoline taxes, but that he’s pleased lawmakers are trying to address the long running need for a steady new stream of money to help cover highway maintenance needs. Listen to the podcast.

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

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