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

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1 year ago

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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

House panel approves casino tax increase, a shot over bow on blockage of online sports betting

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12 hours ago

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February 25, 2025

By

mississippitoday.org – Geoff Pender – 2025-02-25 17:59:00

House panel approves casino tax increase, a shot over bow on blockage of online sports betting

by Geoff Pender, Mississippi Today
February 25, 2025

In an obvious shot at the Senate and at least part of the casino lobby for the state not legalizing online gambling, the House Ways and Means Committee on Tuesday approved a tax increase on casinos.

Ways and Means Chairman Trey Lamar said his bill, which would increase taxes on Mississippi casinos from 12% to 16%, is to recoup the tens of millions of dollars a year Mississippi is “losing” from not legalizing online betting. He said, “if everybody’s honest with themselves, online sports betting is already going on” illegally, but the state is not generating any taxes from it.

He said his bill, which now heads to the full House, is also aimed at shedding light on why the online betting bills the House has passed in recent years die in the Senate. Some Mississippi casinos, particularly smaller ones that might struggle to contract or build online betting infrastructure, have opposed the move.

“The goal post continues to be moved on the other end of the building (the Senate),” Lamar told committee members. “We’re going to tax it appropriately. There needs to be some further light shed on this topic … (Illegal online gambling) has reached pandemic level … It’s my understanding that a small handful of casinos are standing in the way of that legislation. “

Lamar said he’s been given estimates ranging from $26 million a year to $80 million a year the state could generate in revenue from online gambling — so he estimates it at about $50 million. Neighboring Tennessee, which legalized online gambling, is making about $140 million a year.

Currently Mississippi casinos pay 12% in taxes, 8% going to the state and 4% to local governments and schools. Lamar said increasing the state’s share to 12% would generate an estimated 50% a year.

Senate Gaming Committee Chairman David Blount criticized Lamar’s tax increase on Tuesday, and the House’s major tax overhaul proposal, which would eliminate the income tax, but raise gasoline and sales taxes.

“The House is fixated on raising sales taxes, increasing the gasoline tax and raising taxes on Mississippi businesses,” Blount said. “I don’t support a 50% tax increase on Mississippi businesses (casinos) that are vital to our state. The House wants to raise taxes on everything Mississippians buy and every time they go to the gas station, and they want to raise taxes on one of the largest employers in our state.”

The move marks the first time in at least a decade that there’s been serious talk of raising the casino tax in Mississippi. The state’s relatively low and stable tax rate on gambling has been credited with helping the industry grow over years. However, some in the industry say gross gambling revenue growth has been stagnant in recent years because of illegal online gambling in Mississippi or legal online gambling in neighboring states.

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

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Mississippi Today

Handling of child care revisions ‘alienates’ providers, advisory board member says

Published

17 hours ago

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February 25, 2025

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mississippitoday.org – Simeon Gates – 2025-02-25 12:59:00

Handling of child care revisions ‘alienates’ providers, one owner says

by Simeon Gates, Mississippi Today
February 25, 2025

Members of the Child Care Advisory Council and child care providers, who had raised issues earlier about new proposed regulations, are voicing more concerns after the state Department of Health shared revisions.

Over 200 child care providers attended a meeting Friday of the Child Care Advisory Council along with members of the advisory council and Nicole Barnes, director of the child care bureau at the Health Department, to discuss the new proposed revisions to child care regulations in the state.

The advisory committee had a week to review the new proposed revisions, which have not been released to the public. They also weren’t shown during the meeting.

Advisory council members Vincent Burke and Roberta Avila spoke on the need for a clearer process for discussing and passing changes to child care regulations. Burke suggested giving council members at least 30 days to review regulation changes. “We feel uninformed as an advisory board,” he said.

Avila explained her point in an email after the meeting. “There is a need for clarity of the process in discussing and approving changes to the Licensure Regulations,” she said.

The council voted to meet again in March to further discuss the new regulations.
During the open comment period, several providers raised concerns about the licensing agency’s conduct. Debbie Ellis, who owns and operates The Learning Center in Greenwood, criticized the licensing agency’s handling of the regulation changes, saying that it was “disrespectful” and “alienates” child care providers.

Two other providers who are also part of the advisory council, Regina Harvey and Lesia Daniel, spoke before the meeting about the advisory council’s role.

“Regulations should not be released to the public until the advisory board has had a chance to read them and advise,” said Harvey, who runs SMART Beginnings Preschool in Ocean Springs. “This is what the board is supposed to be — made up of industry leaders and providers. My experience so far is that this is not happening.”

Daniel, owner of Funtime in Clinton, said that having a week to look at all the new revisions wasn’t practical. “The document is hundreds of pages and so taking the time to compare each section to the current regulations to identify the proposed changes is a waste of everyone’s time. To me, that communicates a lack of respect to providers.”

Barnes explained in the meeting that the revisions were done to comply with the Child Care and Development Block Grant’s health and safety standards. There are no federal child care regulations.

The licensing agency filed its first round of proposed regulation changes in November. Many child care providers criticized the previous revisions and how the licensing agency debuted them. They also felt the licensing agency wasn’t considerate of their perspectives.

The licensing agency acknowledged they did not get input from the Child Care Advisory Council or the Small Business Regulatory Committee. Providers said they were not notified of the revisions until weeks after they were filed, when they should’ve been notified three days after they were filed. The licensing agency maintains that it followed the Mississippi Administrative Procedures Act. 

The controversy over regulations comes at a crucial time for the child care industry. Labor shortages, high prices, and more are contributing to a child care crisis in the U.S.

The licensing agency is set to bring the proposed revisions to the Board of Health in April, as well as all public comments from providers. According to Barnes, the new regulations would take effect in May if the Board of Health approves them.

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

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Mississippi Today

Mayersville mayor eyes big steps for her small town

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18 hours ago

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February 25, 2025

By

mississippitoday.org – Linda Williams-Short – 2025-02-25 11:19:00

Editor’s note: Linda Williams-Short, the mayor of Mayersville, leads one of Mississippi’s smallest towns. This piece is part of an ongoing Mississippi Today Ideas series showcasing perspectives of mayors across the state.

When you think about the Mississippi Delta, you might not always think about Mayersville.

But this small but mighty town I’m proud to lead is as important as any in the Delta, and we are making great strides. We like to think of Mayersville as being a small town with big dreams. We live by that motto.

Linda Williams Short
Linda Williams-Short Credit: Special to Mississippi Today

Perhaps these strides we have made would be considered baby steps in larger cities, but in Mayersville, population 433, according to the 2020 Census, these steps can be considered monumental to our town’s survival.

We strive to follow the lead of former Mayersville Mayor Unita Blackwell, who was the first Black woman mayor of a Mississippi town. She was a leader for all of us in Mayersville, and she inspired me to enter politics.

And today we still follow her lead in working to improve housing in Mayersville and the overall economic condition of all our residents.

We have faced the adversities of other small Delta towns. Through the decades we also have faced natural disasters, including barely missing a direct hit from the awful 2023 tornado that reaped destruction on many of our south Mississippi Delta neighbors.

The natural disasters Mayersville have faced go way back including the historic and devastating 1927 flood that resulted in the levy that separates our town from the direct access to the Mississippi River that was key to our economy decades ago.

Despite the obstacles, town leaders and I are committed to improving the health and well-being of our constituents. As part of this effort, the town of Mayersville became the second smoke-free community in the state of Mississippi.

Since being elected mayor in 2001, we have worked, following in the tradition of Unita Blackwell, to build seven new homes within Mayersville. That might not seem like a big deal, but in a town of our size and with the housing issues we face, we are proud of this accomplishment.

We have strived to repair the town’s failing infrastructure and to bring healthy food options to the community through a partnership with the Mississippi Food Network. We also are working with the Delta Health Center to provide a clinic to assist residents who have limited transportation options.

And like other small Delta towns, tourism is critical. To that end, I helped found the Mayersville Annual Homecoming Festival. This festival brings former and current residents together annually from all over the United States.

These efforts are important to me because Mayersville, which is the county seat for Issaquena County, is important to me. I am a lifelong resident.

I am the youngest daughter of the late Saul & Edie B. Williams. For 29 years I have been married to Larry D. Short. He is my lifelong partner and love of my life. I am the mother of James Jr., Jeremy, JaSona, Kiara, Katerri and the late Jercelle and proud grandmother of 13 grandchildren. I have been a member of one of our great and impactful churches — Rose Hill M.B. Church — for 49 years, and I currently serve as the senior choir director. In addition to being mayor, I am a small business owner operating as Tony’s Grocery and Celle’s Estate Housing complex.

I am passionate, dedicated, driven in terms of my job as mayor of Mayersville.

But my story is not unique. In Mayersville, we all pitch in for the betterment of our town and its residents.

In Mayersville, we live by the motto, “Always service over self.” I am proud to take that motto to heart every single day.

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

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