Mississippi Today

Q&A: Why Arkansas could be a model for Mississippi Medicaid expansion

Published

7 months ago

April 11, 2024

Q&A: Why Arkansas could be a model for Mississippi Medicaid expansion

As leaders from the House and Senate will soon begin meeting to find common ground on their dueling Medicaid expansion proposals, some people have pointed to Arkansas as a model that could prove successful in Mississippi.

Arkansas, a red state that shares many demographic similarities with Mississippi, implemented its expansion plan, now called Arkansas Health and Opportunity for Me (ARHOME), in 2014. The program provides health coverage to about 250,000 Arkansans. It has cut the state’s uninsured rate in half, and it has helped struggling hospitals stay open.

The expansion program in Arkansas has been so successful that it’s been renewed each year since 2014 by a supermajority of the state’s Republican-controlled legislature.

Mississippi Today invited Dr. Joe Thompson, who was Arkansas’ surgeon general under Republican Gov. Mike Huckabee and Democratic Gov. Mike Beebe, to explain how Arkansas’ expansion program has worked. Thompson now serves as president and CEO of the Arkansas Center for Health Improvement.

Mississippi Today: Arkansas implemented a pretty unique Medicaid expansion model. How does your state’s program work?

Dr. Joe Thompson: Instead of enrolling uninsured people in the state-run Medicaid program, Arkansas obtained permission from the federal government to use federal Medicaid funds for “premium assistance” — an historically available but rarely used strategy by states. Arkansas purchases private health insurance plans offered on the health insurance marketplace to provide adult Arkansans earning up to 138% of the federal poverty level insurance coverage — with 90% of the costs coming from the federal government.

Newly covered individuals effectively get private coverage and the healthcare access they need; providers get paid commercial insurance rates far higher than Medicaid rates; and insurers benefit because the state is a large, guaranteed purchaser in an otherwise risky individual insurance market.

Governors and legislators have made changes to the program over the years, including a work requirement that was implemented in 2018 and blocked by a federal judge the following year, but the basic structure has remained the same.

MT: How has the program impacted Arkansas?

Thompson: For starters, it cut our adult uninsured rate, which had been among the highest in the nation, by half. Newly insured Arkansans gained access to treatment for chronic conditions that had gone untreated for years, as well as preventive care that allowed them to avoid other health problems and associated costs.

The newly insured also became able to pay for hospital visits, reducing uncompensated care costs at Arkansas hospitals by more than half. Since 2012, no rural Arkansas hospital has closed without being reopened or replaced, while 59 rural hospitals have closed in the six states surrounding Arkansas, including five hospitals in Mississippi.

MT: Some Mississippians are concerned about being able to afford the state match to draw down federal dollars. How has that gone in Arkansas?

Thompson: The federal government pays 90% of expansion costs, but even so, opponents of Medicaid expansion warned that Arkansas’ obligation to pay the remaining 10% would break the budget. In 2016, however, a consultant hired by the Republican legislative leadership analyzed the economic impact of Medicaid expansion and found it would have a net positive impact of $757 million on the state budget between 2017 and 2021 through reduced state expenditures and increased tax revenues.

It’s important to note that the residents of Mississippi and the other holdout states have not been spared from paying for Medicaid expansion. They have been helping to fund it for over a decade through their federal tax dollars, but the money has been flowing into states like Arkansas and Louisiana instead of benefiting the working poor, hospitals, and economies of their home states.

MT: There’s been some concern expressed about how expansion would affect insurers in Mississippi. How has the Arkansas model addressed similar concerns there?

Thompson: Some benefits Arkansas has received from Medicaid expansion are tied to unique aspects of the state’s program. Medicaid expansion is a huge decision for states — they can focus on the expansion decision alone or, as Arkansas did, use expansion to shape both the private and public health insurance systems.

Prior to our expansion, insurance carriers could cherry-pick the counties in which they would offer coverage. Arkansas now requires insurers participating in the exchange to offer coverage statewide, creating competition and consumer choice in all areas of the state. Arkansas also enrolled people deemed “medically frail” in traditional Medicaid, creating an expansion population that was relatively young, healthy and low-risk for insurers to cover. In 2014, average marketplace premiums in Arkansas were among the highest in the region, but since 2017 they have been lower than in any of the surrounding states, including Mississippi.

Arkansas’ decision to provide private health coverage has also been advantageous for enrollees. Private coverage does not carry the stigma of Medicaid, and because payment rates are higher for commercially insured patients than for Medicaid patients, Medicaid expansion enrollees in Arkansas have been less likely to encounter barriers to care than traditional Medicaid enrollees.

MT: How many people are actually enrolled in Arkansas, and should Mississippians worry about costs if more people enroll as time goes on?

Thompson: Some opponents of Medicaid expansion have accused Arkansas’ program of out-of-control growth, pointing out that enrollment was projected at the program’s inception to be about 250,000 but grew to more than 340,000 in 2022. In fact, enrollment only reached that level because of a now-defunct rule that required states to keep people continuously enrolled in Medicaid programs during the COVID-19 public health emergency. Arkansas resumed eligibility checks for Medicaid programs last April, and by the end of 2023, total enrollment in ARHOME was just under 252,000 — very close to original projections.

Medicaid expansion’s slow journey toward nationwide adoption is reminiscent of the original federal-state Medicaid partnership, which was enacted by Congress in 1965 but not adopted by every state until 1982, when the last holdout, Arizona, came on board. Change can be hard, but polls show that voters, including Mississippi voters, favor Medicaid expansion. It’s no wonder that the number of holdout states keeps dwindling.

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

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Mississippi Today

On this day in 1875

Published

8 hours ago

November 2, 2024

Staff Editor

mississippitoday.org – Jerry Mitchell – 2024-11-02 07:00:00

Nov. 2, 1875

Pictured here are U.S. Sen. Hiram Revels of Mississippi, left, with six Black members of the U.S. House, Ben J.S. Turner of Alabama, Josiah T. Walls of Florida, Jefferson H. Long of Georgia, and Robert C. De Large, Joseph H. Rainy and R. Brown Elliot, all of South Carolina. Credit: Library of Congress

The first Mississippi Plan, which included violence against Black Americans to keep them from voting, resulted in huge victories for white Democrats across the state.

A year earlier, the Republican Party had carried a majority of the votes, and many Black Mississippians had been elected to office. In the wake of those victories, white leagues arose to challenge Republican rule and began to use widespread violence and fraud to recapture control of the state.

Over several days in September 1875, about 50 Black Mississippians were killed along with white supporters, including a school teacher who worked with the Black community in Clinton.

The governor asked President Ulysses Grant to intervene, but he decided against intervening, and the violence and fraud continued. Other Southern states soon copied the Mississippi plan.

John R. Lynch, the last Black congressman for Mississippi until the 1986 election of Mike Espy, wrote: “It was a well-known fact that in 1875 nearly every Democratic club in the State was converted into an armed military company.”

A federal grand jury concluded: “Fraud, intimidation, and violence perpetrated at the last election is without a parallel in the annals of history.”

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

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Mississippi Today

Mississippi Today’s NewsMatch Campaign is Here: Support Journalism that Strengthens Mississippi

Published

20 hours ago

November 1, 2024

Staff Editor

mississippitoday.org – Mary Margaret White – 2024-11-01 12:34:00

High-quality journalism like ours depends on reader support; without it, we simply couldn’t exist. That’s why we’re proud to join the NewsMatch movement, a national initiative aimed at raising $50 million for nonprofit newsrooms that serve communities like ours here in Mississippi, where access to reliable information has often been limited.

In a time when trusted journalists and media sources are disappearing, we believe the stakes couldn’t be higher. Without on-the-ground, trustworthy reporting, civic engagement suffers, accountability falters and corruption often goes unaddressed. But it doesn’t have to be this way.

Here at Mississippi Today we act as watchdogs, holding those in power accountable, and as storytellers, giving a platform to voices that have been ignored for too long. And we’re committed to keeping our stories free for everyone because information should be accessible when it’s needed most.

JOIN THE MOVEMENT

Why NewsMatch and Why Now?

This year’s NewsMatch campaign runs from November 1 through December 31, giving us a special opportunity to make each dollar you give go even further. Through matching funds provided by local foundations like the Maddox Foundation, and national funders like the MacArthur Foundation, the Rural Partner Fund and the Hewlett Foundation, your gift will be matched dollar for dollar up to $1,000. Plus, if 100 new donors join us, we’ll unlock an additional $2,000 in funding, bringing us even closer to our goal. Boiled down: your donation goes four times as far.

Every dollar raised strengthens our ability to serve you with fact-based journalism on issues that impact your everyday life—whether it’s covering local election issues or reporting on decisions affecting schools, safety and economic growth in Mississippi. Your support makes it possible for us to stay rooted in the community, offering nuanced perspectives that help Mississippians understand and engage with what’s happening around them.

Special Event: “Freedom of the Press: Southern Challenges, National Impact”

As part of the campaign, we’re excited to host a special virtual event, “Freedom of the Press: Southern Challenges, National Impact.” Join Deep South Today newsrooms Mississippi Today and Verite News, along with national experts on press freedom, for an in-depth discussion on the unique challenges facing journalists in the Deep South. This one-hour session will explore the critical role local newsrooms play in holding power accountable, highlighting recent restrictions on press freedom such as Louisiana’s “25-foot law,” which affects journalists’ ability to report vital news.

We’ll examine what’s at stake if local newsrooms lose press freedoms and will discuss how you, as members of the public, can help protect it. This event is open to Mississippi Today and Verite News members as a special thank-you for supporting local journalism and standing with us in this mission. Donate today to RSVP!

How You Can Help

Make Your Gift Today

Together, let’s ensure Mississippi has the robust, independent journalism it needs to thrive. Your support fuels our ability to expose the truth, elevate marginalized stories and build a more informed Mississippi.

Thank you for believing in the power of journalism to strengthen the communities we love—not only during election season but year-round. With your help, we’ll keep Mississippi informed, engaged and connected for generations to come.

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

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Mississippi Today

Hinds County loses fight over control of jail

Published

1 day ago

November 1, 2024

Staff Editor

mississippitoday.org – Mina Corpuz – 2024-11-01 12:57:00

The Hinds County sheriff and Board of Supervisors have lost an appeal to prevent control of its jail by a court-appointed receiver and an injunction that orders the county to address unconstitutional conditions in the facility.

Two members from a three-judge panel of the 5th U.S. Circuit Court of Appeals agreed with decisions by U.S. District Judge Carlton Reeves to appoint a receiver to oversee day-to-day jail operations and keep parts of a previous consent decree in place to fix constitutional violations, including a failure to protect detainees from harm.

However, the appeals court called the new injunction “overly broad” in one area and is asking Reeves to reevaluate the scope of the receivership.

The injunction retained provisions relating to sexual assault, but the appeals court found the provisions were tied to general risk of violence at the jail, rather than specific concerns about the Prison Rape Elimination Act. The court reversed those points of the injunction and remanded them to the district court so the provisions can be removed.

The court also found that the receiver should not have authority over budgeting and staff salaries for the Raymond Detention Center, which could be seen as “federal intrusion into RDC’s budget” – especially if the receivership has no end date.

Hinds County Board of Supervisors President Robert Graham was not immediately available for comment Friday. Sheriff Tyree Jones declined to comment because he has not yet read the entire court opinion.

In 2016, the Department of Justice sued Hinds County alleging a pattern or practice of unconstitutional conditions in four of its detention facilities. The county and DOJ entered a consent decree with stipulated changes to make for the jail system, which holds people facing trial.

“But the decree did not resolve the dispute; to the contrary, a yearslong battle ensued in the district court as to whether and to what extent the County was complying with the consent decree,” the appeals court wrote.

This prompted Reeves to hold the county in contempt of court twice in 2022.

The county argued it was doing its best to comply with the consent decree and spending millions to fix the jail. One of the solutions they offered was building a new jail, which is now under construction in Jackson.

The county had a chance to further prove itself during three weeks of hearings held in February 2022. Focuses included the death of seven detainees in 2021 from assaults and suicide and issues with staffing, contraband, old infrastructure and use of force.

Seeing partial compliance by the county, in April 2022 Reeves dismissed the consent decree and issued a new, shorter injunction focused on the jail and removed some provisions from the decree.

But Reeves didn’t see improvement from there. In July 2022, he ordered receivership and wrote that it was needed because of an ongoing risk of unconstitutional harm to jail detainees and staff.

The county pushed back against federal oversight and filed an appeal, arguing that there isn’t sufficient evidence to show that there are current and ongoing constitutional violations at the jail and that the county has acted with deliberate indifference.

Days before the appointed receiver was set to take control of the jail at the beginning of 2023, the 5th Circuit Court ordered a stay to halt that receiver’s work. The new injunction ordered by Reeves was also stayed, and a three-person jail monitoring team that had been in place for years also was ordered to stop work.

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

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