Mississippi Today

‘The life and breath of communities’: Hospital leaders say Medicaid expansion still needed

Published

9 months ago

February 1, 2024

‘The life and breath of communities’: Hospital leaders say Medicaid expansion still needed

Gov. Tate Reeves’ Medicaid payment changes, pitched during the eleventh-hour of a heated reelection campaign and his only major health plan during his first four years as governor, delivered $658.2 million to hospitals in January.

Hospital leaders say the influx of federal money is a lifeline, but it’s not enough to forgo Medicaid expansion – a long-term solution that would insure hundreds of thousands of working poor people in one of the country’s sickest states.

Quentin Whitwell owns four hospitals in rural Mississippi. He knows intimately the struggles they face. While the extra federal money Reeves secured is helpful, he said, expansion would go further.

“There is no reason to leave funding on the table to assist rural hospitals that are the life and breath of communities,” he said.

As Mississippi hospitals continue to struggle, expanding Medicaid to cover the working poor has been hotly contested over the last decade, most openly during the last two gubernatorial elections. Reeves, as did two of his GOP predecessors, has remained steadfastly opposed, saying it would make Mississippians more reliant on “welfare.”

Medicaid expansion would increase the income threshold needed to qualify for Medicaid to 138% of the federal poverty level, meaning many more Mississippians would qualify for coverage. For a family of four, that would be an annual income of $43,056.

As it stands, low-income, working-class Mississippians who make just above the poverty level don’t qualify for Medicaid but also can’t afford insurance. Nearly one in five Mississippians is uninsured, contributing to the state’s abysmal public health metrics – such as the lowest life expectancy in the country.

Extensive research underlines the policy’s financial and health benefits, and a majority of Mississippians say they want Medicaid eligibility expanded, as it has been in 40 other states. Researchers estimate the policy would insure between 200,000 and 300,000 Mississippians, generate thousands of jobs, help struggling hospitals and bring billions of dollars into the state.

The money’s needed — one report estimates nearly half of the state’s rural hospitals are at risk of closure, largely due to losses related to caring for uninsured patients.

However, the governor and some other Republican leaders have remained staunchly against the policy.

Weeks before the November election, in which Reeves narrowly defeated Democrat Brandon Presley, the governor announced that the state had requested federal approval of changes to its Medicaid payment policies. The changes, Reeves claimed, would bring in nearly $700 million in total to the state’s hospitals.

Reeves’ plan relies on increased extra payments hospitals get for treating patients on Medicaid. It increases a “bed tax” on Mississippi hospitals, in exchange for them drawing down more in federal Medicaid payments. Hospitals and GOP leaders in the Legislature had pitched roughly the same plan the year before, but Reeves’ own Medicaid administration had told them it wouldn’t work.

At the September press conference announcing his plan, Reeves touted the reforms as an alternative to Medicaid expansion, which he referred to as increasing the state’s “welfare rolls.” He was flanked by various hospital leaders from across the state. Most were from hospitals that had recently left the state hospital association under political pressure after the association’s political action committee made a largee donation to Reeves’ pro-expansion opponent Presley.

Months after his announcement, half of Reeves’ plan has been approved and the bulk of the money has gone out.

And while hospital executives say the money will allow Mississippi hospitals that have been struggling for years to stay above water, the program does nothing to address the egregiously high number of uninsured, working-class Mississippians.

Lee McCall, chief executive officer of Neshoba General Hospital in Philadelphia, said his hospital loses more than $4 million a year on uncompensated care.

“These proceeds are going to help offset that … but it hasn’t done anything to expand access to coverage for Mississippians that are uninsured,” he said. “So yes, we’re still proponents of expansion, in whatever form it could come in, really to help out Mississippians, so that they can seek the care that they need.”

McCall said while he was thankful for the extra money, he acknowledged the governor’s plan gave more money to the state’s larger hospitals, rather than the ones struggling the most in rural parts of the state.

While the reimbursement plan helps hospitals recoup losses they face when caring for uninsured people, Baptist Memorial Health Care‘s vice president of government affairs Keith Norman said it doesn’t replace the need for Medicaid expansion, which would insure more people.

“We have never seen the (payment increases) and Medicaid expansion as being exclusive of one another,” Norman said. “We’ve always seen the both-and approach, not either-or. Because when we start talking about Medicaid expansion, we’re talking about covering working Mississippians … and we’re looking to adopt both.”

From a strictly financial perspective, the reimbursement plan is seen by some hospital executives as comparable to the benefits of expansion.

“It is injecting close to $40 million in additional funding for Singing River Health System, which we really needed after the lingering effects of COVID,” said Singing River chief financial officer Jason McNeil. “From our perspective, it’s really doing about the same as if Medicaid were expanded.”

But in order for the two programs to have comparable financial benefits, the reimbursement plan would need to recur annually. And while hospital executives are expecting that to be the case the plan doesn’t automatically renew. The current payment arrangement applies through June 30, 2024.

“If we lose access to the program, it’s going to destabilize our operations,” said Greenwood Leflore Hospital’s interim chief executive officer Gary Marchand.

Greenwood Leflore’s financial struggles have been well-documented — the hospital, once poised to close, has managed to hold on until through the end of its fiscal year.

McCall said that while the expectation is that the money from the reforms will continue to arrive annually, “we won’t know until it’s submitted.”

Even assuming it is a permanent change, the plan only benefits hospitals, explained Marchand, and not other forms of care – such as outpatient care and preventative care patients receive at clinics. One of the consequences of the current system of coverage is that the indigent population does not have access to preventative care – leading to tragedies such as widespread amputations among diabetics whose condition went unchecked and untreated.

In addition to the devastating consequences a lack of coverage has for patients, it’s also not cost effective for hospitals. The population not currently covered by Medicaid tends to only have access to health care in the context of an emergency room, which can’t turn anyone away – regardless of insurance coverage. But it’s also the most expensive place to receive health care.

The hospital reimbursement plan helps offset some of the money hospitals lose when caring for uninsured patients. But it’s throwing money at a problem that wouldn’t exist under Medicaid expansion.

“I haven’t spoken to anyone in health care or hospital administration that says we’re no longer interested in expansion,” McCall said.

Hospital leaders from Merit Health System, Delta Health System in Greenville, North Mississippi Health System in Tupelo and Forrest General Hospital in Hattiesburg declined interviews.

Leaders from the University of Mississippi Medical Center and Gulfport’s Memorial Hospital System also refused an interview. South Central Regional Medical Center’s chief executive officer Greg Gibbes did not respond to multiple requests for comment. Representatives from all three were part of a cohort of medical leaders that flanked the governor at his September election-time press conference.

A second, smaller part of Reeves’ plan is still pending approval from the federal government. Medicaid expansion will likely be a major policy discussion during the Legislature’s 2024 session, and several Republican legislative leaders have said they’ll devote attention to the topic.

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

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Mississippi Today

Senate panel weighs how much — or whether — to cut state taxes

Published

5 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Taylor Vance – 2024-11-04 15:42:00

A group of state senators on Monday grappled with how much to slash state taxes or if they should cut them at all, portending a major policy debate at the Capitol for next year’s legislative session.

The Senate Fiscal Policy Study Group solicited testimony from the state government‘s leading experts on budget, economic and tax policies to prepare for an almost certain intense debate in January over how much they should trim state taxes while balancing the need to fund government services.

Senate Finance Chairman Josh Harkins, a Republican from Flowood whose committee has jurisdiction over tax policy, told Mississippi Today that he wanted senators to have basic facts in front of them before they help decide next year if Mississippi should cut taxes.

“We’re getting a tax cut the next two years whether we do anything or not,” Harkins said. “I just want to make sure we have all the facts in front of people to understand we have a clear picture of how much revenue we’re bringing in.”

Mississippi is already phasing in a major tax cut. After a raucous debate in 2022, lawmakers agreed to phase in an income tax cut. In two years it will leave Mississippi with a flat 4% tax on income over $10,000, one of the lowest rates in the nation.

However, the top two legislative leaders, Lt. Gov. Delbert Hosemann who oversees the Senate and House Speaker Jason White, have both recently said they want legislators to consider new tax cut policies.

Hosemann, the Republican leader of the Senate, has publicly said he would like to see the state’s grocery tax, the highest of its kind in the nation, reduced, though he hasn’t specified how much of a reduction or how long it would take for the cut to be implemented.

White, a Republican from West, said last week that he would like to see the state’s 4% income tax phased out and have the state’s 7% grocery tax cut in half over time.

“We are hoping to construct a tax system that, yes, prioritizes certain needs in our state, but it also protects and rewards taxpayers,” White said last week.

But it’s difficult to collect accurate data on the state’s grocery tax, and state lawmakers must grapple with a laundry list of spending needs and obligations based on testimony from state agency leaders on Monday.

Mississippi currently has a 7% sales tax, which is applied to groceries. The state collects the tax but remits 18.5% back to cities. For many municipalities, the sales tax is a significant source of revenue.

If state lawmakers want to reduce the grocery tax without impacting cities, they could pass a new law to change the diversion amounts or appropriate enough money to make the municipalities whole.

State Revenue Commissioner Chris Graham said the Mississippi Department of Revenue, the agency in charge of collecting state taxes, does not have a mechanism in place for accurately capturing how much money cities collect in grocery taxes. This is because the tax on groceries is the same as non-grocery items.

However, Graham estimates that the state collects roughly $540 million in taxes from grocery items.

The other problem lawmakers would have in implementing significant tax cuts is a growing list of spending needs in Mississippi, a state with abject poverty, water and sewer and other infrastructure woes and some of the worst health metrics in the nation.

Representatives from the Legislative Budget Office, the group that advises lawmakers on tax and spending policy, told senators that lawmakers will also be faced with rising costs in the public employee retirement system, the Medicaid budget, public education, state employee health insurance, and state infrastructure projects.

State agencies, including the employee retirement system, also requested $751 million more for the coming budget year.

“That’s the billion dollar question, I guess,” Senate Appropriations Chairman Briggs Hopson, a Republican from Vicksburg, said. “How we’re able to fund basic government services?”

Harkins and Hopson said the committee would likely meet again before the Legislature convenes for its 2025 session on January 7.

A House committee on tax cuts has also been holding hearings, and White in September held a summit on tax policy.

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

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Mississippi Today

Already dire lack of affordable housing for low-income Mississippians on verge of worsening

Published

9 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Simeon Gates – 2024-11-04 11:00:00

In Mississippi, where there’s already a dearth of 50,000 or more affordable homes for extremely low-income residents, that number could grow in the next five years.

Housing units available under the federal Low Income Tax Credit program could lose their affordability by 2030 –a number estimated nationwide to be 350,000 with 2,917 in Mississippi, alone; 496 in the state already have.

The federal program responsible for most of the nation’s affordable housing is expiring.

The Low Income Housing Tax Credit, introduced as part of the Tax Reform Act of 1986, provides for developers to buy, build and restore low-income housing units. Under the deal, the housing only needs to stay low-rent for 30 years. Construction began in the early 1990s.

Some LIHTC housing will remain affordable due to other subsidies, nonprofits, state law and individual landlords.

“I think the low-income housing tax credit has done everything that it can to address the need for affordable housing around the state,” said Scott Spivey, executive director of the Mississippi Housing Corporation, a state office that administers the program and works with the state government and those in the affordable housing industry to create and support affordable housing

Spivey supports the proposed Affordable Housing Credit and Improvement Act, a federal bill that would expand upon the low-income housing tax credit in several ways, including giving developers more credit for certain projects for low-income households and changing tenant eligibility rules.

The bill was introduced in the House and the Senate last session, and is co-sponsored by Mississippi Sens. Cindy Hyde-Smith and Roger Wicker and in the House by Reps. Mike Ezell, and Michael Guest. As of this spring, both bills are in committee.

While housing has become a major issue for Americans, getting legislation passed has been challenging. “Everybody knows that housing is an issue, but it gets caught up with everything else…and it kind of gets lost in the shuffle,” said Spivey.

This issue is especially important in Mississippi, where demand for housing is high across all incomes.

“All the market studies that we see that come with the applications tell us that there’s a huge need for affordable housing across the state at all the income bands” said Spivey.

According to the National Low Income Housing Coalition, almost a third of Mississippi renters are extremely low income; 65% of them are severely cost burdened, meaning they spent more than half their income on rent. The majority of these households are seniors, disabled people, single caregivers of young children, people enrolled in school, or other.

Director of Housing Law at the Mississippi Center for Justice, Ashley Richardson said housing problems worsened after Mississippi stopped participating in the federal rental assistance program in 2022.

MCJ’s work on housing includes a statewide eviction hotline, investigating instances of housing discrimination, and more.

Richardson praised the LIHTC program, but echoed Spivey’s concerns. “Even with the affordable housing we do have in Mississippi, we are still at a lack,” she said.

The National Housing Preservation Database estimates Mississippi is short 52,421 affordable and available rental homes for low-income people. The National Low Income Housing Coalition puts the figure at 49,478.

Richardson wants the state to deal with issues like providing more tenant protections and rental assistance. There’s also a need to improve homes that are rundown or in poor condition, and many housing nonprofits are running out of funding.

Spivey said people should talk to their property managers and learn about their rights. MHC’s website has resources for homebuyers and renters.

As the housing crisis goes on, there are options for people struggling to find and keep affordable housing and an effort to take action at the federal and state levels.

Some aspiring low-income homeowners may qualify for Habitat for Humanity, a program that builds homes for families in need. Families who qualify work on the homes alongside volunteers, pay an affordable mortgage and receive financial literacy education.

New applicants must meet the qualifications, including a good debt-income ratio, 125 hours of sweat equity and taking classes on financial literacy, home repairs, and being a good neighbor.

Merrill McKewen, executive director for Habitat for Humanity Mississippi Capital Area, emphasized the importance of housing to individuals and communities.

“There are untold studies that have been done that, you’ve gotta have a safe, decent, affordable place to live. The children are better students, the parents are better employees…it grounds you to a community that you can contribute to and be a part of. It is the American dream, to own a home, which is what we’re all about,” she said.

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

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Mississippi Today

Mississippi Election 2024: What will be on Tuesday’s ballot?

Published

9 hours ago

November 4, 2024

Staff Editor

mississippitoday.org – Bobby Harrison – 2024-11-04 10:00:00

Mississippians will go to the polls on Tuesday, Nov. 5, to elect federal and state judicial posts and some local offices, such as for election commissioners and school board members.

Polls will be open from 7 a.m. to 7 p.m. on Tuesday. To find your polling place, use the secretary of state’s locator, or call your local county circuit clerk.

The following is a list of the candidates for federal and judicial posts with brief bios:

President

Kamala Harris, current vice president and Democratic nominee for president. Her running mate is Tim Walz.
Donald Trump, former president and current Republican nominee. His running mate is J.D. Vance.
Robert Kennedy Jr. remains on the ballot in Mississippi even though he has endorsed Trump. His running mate is Nicole Shanahan.
Jill Stein is the Green Party candidate. Her running mate is Rudolph Ware.
Five other candidates will be on the Mississippi ballot for president. For a complete list of presidential candidates, see the sample ballot.

U.S. Senate

Ty Pinkins is the Democratic nominee. He is a Rolling Fork native and attorney, representing, among other clients, those alleging unfair working conditions. He served 21 years in the U.S. Army, including combat stints, other overseas deployment and posts in the White House,
Roger Wicker is the Republican incumbent senator. He resides in Tupelo and has served in the U.S. Senate since late 2007 after first being appointed to fill a vacancy by then-Gov. Haley Barbour. He was elected to the post in 2008. He previously served in the U.S. House and as a state senator. He is an attorney and served in the United States Air Force.

House District 1

Dianne Black is the Democratic nominee. She is a small business owner in Olive Branch in DeSoto County.
Trent Kelly is the Republican incumbent. He was elected to the post in a special election in 2015. He previously served as a district attorney and before then as a prosecuting attorney for the city of Tupelo. He is a major general in the Mississippi Army National Guard.

House District 2

Bennie Thompson is the Democratic incumbent. He was first elected to the post in 1993. Before then, he served as a Hinds County supervisor and as alderman and then as mayor of Bolton.
Ronald Eller is the Republican nominee. He grew up in West Virginia and moved to central Mississippi after retiring from the military. He is a physician assistant and business owner.

House District 3

Michael Guest is the Republican incumbent and is unopposed.

House District 4

Mike Ezell is the Republican incumbent first being elected in 2022. He previously served as Jackson County sheriff.
Craig Raybon is the Democratic nominee. Raybon is from Gulfport and began a nonprofit “focused on helping out the community as a whole.”

Central District Supreme Court

Jenifer Branning currently serves as a member of the state Senate from Neshoba County.
Byron Carter is a Hinds County attorney and previously served as a law clerk for Supreme Court Justice Armis Hawkins.
James Kitchens is the incumbent. He has served on the state’s highest court since 2008.
Ceola James previously served on the Court of Appeals.
Abby Gale Robinson is a Jackson attorney. She previously was a commercial builder.

Southern District Supreme Court

Dawn Beam is the incumbent, having been first appointed in 2016 by then-Gov. Phil Bryant and later winning election to the post. She is a former chancellor for the Hattiesburg area.
David Sullivan is an attorney in Harrison County and has been a municipal judge in D’Iberville since 2019. His father, Michael, previously served on the state Supreme Court.

Northern District Supreme Court seats

Robert Chamberlin of DeSoto County is unopposed.
James Maxwell of Lafayette County is unopposed.

Court of Appeals 5^th District seat

Ian Baker is an assistant district attorney in Harrison County.
Jennifer Schloegel is a Chancery Court judge for Harrison, Hancock and Stone counties.
Amy St. Pe is a Municipal Court judge in Gautier.