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Where’s the plan? Senate still has only ‘dummy bill’ for Medicaid expansion

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Facing a Thursday deadline for passage, the state Senate leadership has refused to detail its Medicaid expansion plan, leaving members in the dark and health experts worried the plan could ultimately include elements that are unfeasible, costly and counterproductive.

Two-and-a-half months into the legislative session, and after 10 years of debate, Senate Medicaid Chairman Kevin Blackwell told Mississippi Today on Monday afternoon that there was no update on a Senate proposal to expand Medicaid eligibility to the working poor and said, “we’re still working on it.”

Two weeks after the House overwhelmingly passed a bill to expand Medicaid, the Senate has not brought the House measure up, even in committee, and Senate leaders refuse to comment on it.

The Senate expansion bill, which only has the necessary code sections to expand Medicaid with no details, passed committee the first week of March. But trying to have the full Senate pass such a “dummy bill” could prove counterproductive, with senators on the fence unlikely to support a bill they know nothing about.

Blackwell declined to elaborate whether he would advance the dummy bill for a floor vote, if he would let it die or if he planned to propose a substantive expansion plan before the Thursday deadline.

“You’ll just have to wait and see,” he said on Monday.

READ MORE: Gov. Tate Reeves privately tells senators he will veto any Medicaid expansion bill

The only detail Blackwell and Lt. Gov. Delbert Hosemann have confirmed about the plan is that it would contain a work requirement for new coverage recipients — a prerequisite which could kill the effort to expand the health program if the feds don’t approve it.

Members of the Senate have voiced concerns about supporting a skeletal bill without knowing what it might eventually contain.

Sens. Scott DeLano, R-Biloxi, and Daniel Sparks, R-Belmont, say they have never favored expansion, but not having a real bill in front of them doesn’t help the cause. If they were presented a real bill, they say, they would consider the policy.

“I’ve always been pragmatic. If you show me there’s a sustainable way to do something, I will listen,” DeLano said. “I am a compassionate person as well. I want to help people as much as we can. But show me where the sustainable funding will come from … I haven’t seen a bill. If you want me to support something — I haven’t seen a bill, we haven’t seen a bill yet.”

Sparks echoed the sentiment.

“I have not seen the language of the Senate Medicaid expansion plan,” Sparks said. “As I do with all legislation, though, I will review it, study it and ask questions about it.”

The only detail Blackwell has made public is that the bill would need to contain a work requirement, meaning enrollees would need to prove employment or exemption in order to be covered. That requires approval from federal Centers for Medicaid Services, which under the Biden administration has rescinded work requirements previously approved for other states during the Trump administration and has not approved new ones. Georgia remains in litigation with the federal government over the work requirement issue, and has suffered low enrollment and missed out on millions in federal funds by not expanding fully.

Even if a work requirement were approved, it would be costly to implement and could cause a host of administrative difficulties, resulting in loss of coverage even for employed individuals. To the extent that work requirements lead to lower-than-expected enrollment, certain economic benefits of expansion such as additional tax revenue would be muted, according to a March 2024 study conducted by The Hilltop Institute at the University of Maryland, Baltimore County.

Hilltop previously conducted a more comprehensive report on Medicaid expansion in Mississippi, which it presented to the House Medicaid committee in mid-February. During the panel, the researchers outlined how it would boost the economy, generate thousands of jobs and help struggling hospitals.

The work requirement study estimates that if Medicaid were expanded in Mississippi, the majority of enrollees would be either employed or exempt from employment due to disability or extenuating circumstances.

Under the Arkansas Works program, the state saw 45% of new enrollees were employed. Of those unemployed, over 75% were exempt, and only a small number were unemployed and not eligible for exemption.

Arkansas briefly had a Medicaid work requirement from 2018-2019. Research shows it did not lead to more people entering the workforce.

Furthermore, explained Morgan Henderson, Hilltop’s principal data scientist, the cost and administrative chore of implementing work requirements far exceeds the cost of insuring a small number of unemployed, non-exempt individuals along with the rest of the employed or exempt population.

“It would be very challenging to have a robust Medicaid expansion program with a work requirement,” Henderson said.

That’s because implementing work requirements would involve enrollees submitting proof of employment monthly. It would require more staff, and would “introduce substantial confusion among enrollees,” according to the study, which could mean that “if working individuals do not realize that they must report their work status, working enrollees may also lose coverage.”

And others might not even apply.

“There’s a lot of research to show that even seemingly very small paperwork barriers can prevent folks from signing up for health insurance,” Henderson said, “even very affordable health insurance, and so it will reduce uptake – work requirements – we know this for a fact.”

Georgia, the only state currently trying to implement work requirements, has a very low uptake. Georgia’s Department of Community Health had estimated the state would see 64,000 new enrollees from expansion, but as of Dec. 15, 2023, only 2,344 individuals were actively enrolled.

“Some people don’t have internet access,” Henderson explained, “some people just don’t complete the requirements for whatever reason, and so there are folks who are legitimately employed, who should be income-eligible, who would certainly be frozen out just because of the administrative confusion.”

Eligible enrollees who were deemed ineligible due to procedural errors would have to reapply, causing an even greater strain on a system that is already understaffed and backlogged. That’s due in part due to “unwinding,” the process in which state Medicaid divisions across the country have been reviewing their rolls for the first time in three years after the end of COVID-19 restrictions that prevented them from kicking people off.

“In this era of PHE unwinding, it would be extremely cumbersome, I think, to actually implement this work requirement in Mississippi,” Henderson said.

Per a 2019 GAO report, the administrative costs of implementing work requirements range from $6.1 million in New Hampshire to $271.6 million in Kentucky.

In addition to that, if CMS does not consider the Mississippi plan to be Medicaid expansion under the Affordable Care Act — as is the case with Georgia — the state would only receive its traditional share of federal funds for its program, instead of the increased incentive of 90% for states that expand. Georgia is only receiving 65.9% federal share under its “Georgia Pathways to Coverage,” missing out on the millions more of federal funds it would receive under true expansion.

The Mississippi House expansion bill, which passed 98-20 without discussion and now sits untouched in the Senate, calls for a work requirement but says the state’s Medicaid program will be expanded regardless of whether the federal government approves the requirement.

The Senate would have to pass its expansion bill Thursday — whether it’s a skeletal bill or full-fledged bill — to keep it alive.

If the bill dies or is not passed, the Senate could still take up the House bill.

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

Did you miss our previous article…
https://www.biloxinewsevents.com/?p=340053

Mississippi Today

Gloster residents protest Drax’s new permit request

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mississippitoday.org – Alex Rozier – 2024-11-15 13:33:00

GLOSTER — Drax, the United Kingdom-based wood pellet producer that’s violated air pollution limits in Mississippi multiple times, is asking the state to raise the amount of emissions it’s allowed to release from its facility in Gloster.

In September, the state fined Drax $225,000 for releasing 50% over the permitted limit of HAPs, or Hazardous Air Pollutants, from its facility Amite BioEnergy. In a pending permit application that it submitted to the Mississippi Department of Environmental Quality in 2022, the company is seeking to transition from a “minor source” of HAPs to a “major source.”

A “major source” permit would remove the limit over the facility’s total HAP emissions, but it would apply a new limit over the rate at which Drax could release the pollutants.

This year’s fine was its second penalty for violating Mississippi law around air pollution limits. In 2020, the state fined the company $2.5 million for releasing over three times the legal threshold of Volatile Organic Compounds, or VOCs, one of the largest such fines in state history. Drax underestimated its VOC releases since the facility opened in 2016, but didn’t realize it until 2018. The facility didn’t come into compliance until 2021.

The Environmental Protection Agency lists a variety of potential health impacts from exposure to HAPs, including damage to the immune system and respiratory issues. VOCs can also cause breathing problems, as well as eye, nose and throat irritation, according to the American Lung Association.

About sixty people packed into a Gloster public library for MDEQ’s public hearing over Drax’s permit application on Nov. 14, 2024.

For years since Drax’s violations became public, nearby residents have attributed health issues to living near the facility. During a public hearing on Drax’s permit request Thursday in Gloster, attendees reiterated those concerns.

“We all experience headaches every day,” resident Christie Harvey said about her and her grandchildren. Harvey said she has asthma too, and her doctor was “baffled” by her symptoms. “Each week I have to take (my grandchildren) to the clinic for upper respiratory issues … It’s not fair that we have to go through this. Drax needs to lower the pollution as much as possible.”

Part of the public outcry is the proximity of people’s homes to the plant, which is within a mile of Gloster’s downtown.

A screenshot of Google Maps showing the location of Drax’s Amite BioEnergy facility relative to the rest of Gloster. The facility is within a mile of the downtown area.

“The wood pellet plant in Lucedale is situated in an industrial park outside of town,” Andrew Whitehurst of Healthy Gulf, an environmental group dedicated to protecting the Gulf of Mexico’s natural resources, said at the meeting. “The wood pellet plant that (Enviva is) trying to put in Bond will be situated north and west of the downtown area. Not like this when it’s right smack in the middle (of the city). It’s totally inappropriate. People can’t take it, they don’t deserve it.”

In a statement to Mississippi Today, Drax said it prioritizes the public health and environment in Gloster, adding that the permit modification is a part of standard business practice.

“When we first began operations, some of our original permits were not fit for purpose,” spokesperson Michelli Martin said via e-mail. “We are now working to acquire the appropriate permits for our operating output and to improve our compliance. Within these permits the requirements may change based on engineering data and industry standards. This permit modification is part of our ongoing plan to provide MDEQ with the most accurate data. Drax fully supports the resolution of our permitting request and looks forward to working with MDEQ to finalize the details.”

While researchers, including from Brown University, are studying the health symptoms of residents near the wood pellet plant, there is no proven connection between the facility’s emissions and those symptoms.

Erica Walker, a Jackson native who teaches epidemiology at Brown and who’s leading the study, spoke to Mississippi Today earlier this year. Regardless of the cause and effect, she said, the decision to put the plant near disadvantaged communities with poor health outcomes is concerning.

“We want to make sure we aren’t additionally burdening already burdened communities,” Walker said.

Operations resume at Drax in Gloster, Miss., on Friday, Feb. 16, 2024. Some Gloster residents are concerned with the industrial pollution caused by the company that produces wood pellets in the town. Credit: Eric J. Shelton/Mississippi Today

About 1,300 people live in the city, according to Census data, and 39% live below the poverty line.

Moreover, Gloster residents often have to travel hours, to cities such as McComb and Baton Rouge, to find the nearest medical specialist. Amite County, where Gloster is, has a higher rate of uninsured residents than the rest of the state, according to County Health Rankings, and the ratio of residents to primary care physicians is over three times greater in the county than Mississippi as a whole.

As part of its application, Drax is seeking a Title V permit under the Clean Air Act, which the EPA requires for major sources of air pollutants. This gives the EPA the opportunity to review Drax’s application and public comments submitted with it. The public can submit comments on the application until Nov. 26, and can do so through MDEQ’s website.

The Mississippi Environmental Quality Permit Board, which is made up of officials from several state agencies, will then decide whether or not to grant the new permits. A full overview of the process and Drax’s application is available online.

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

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Mississippi Today

Mississippi receives ‘F’ rating on preterm birth rate

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mississippitoday.org – Sophia Paffenroth – 2024-11-15 10:11:00

Mississippi received an F grade for its rate of preterm births in 2023 – those occurring before 37 weeks gestation – from the 2024 March of Dimes report card

Mississippi’s preterm birth rate was 15%, the worst in the country. Any state with a rate greater than 11.5% also received an F. The U.S. average was 10.4%. 

Preterm births in Mississippi have risen steadily over the last decade, increasingly nearly 2% since 2013. In Jackson, the state capital, nearly one in five babies are born preterm, according to the report. 

“As a clinician, I know the profound impact that comprehensive prenatal care has on pregnancy outcomes for both mom and baby,” Dr. Amanda P. Williams, interim chief medical officer at March of Dimes, said in a press release. “Yet, too many families, especially those from our most vulnerable communities, are not receiving the support they need to ensure healthy pregnancies and births. The health of mom and baby are intricately intertwined. If we can address chronic health conditions and help ensure all moms have access to quality prenatal care, we can help every family get the best possible start.” 

In addition to inadequate prenatal care, factors such as smoking, hypertension, diabetes and unhealthy weight can cause people to be more likely to have a preterm birth.

The report highlighted several other metrics, including infant mortality – in which Mississippi continues to lead the nation. 

In 2022, 316 babies in the state died before their first birthday. Among babies born to Black mothers, the infant mortality rate is 1.3 times higher. 

The state’s maternal mortality rate of 39.1 per 100,000 live births is nearly double the national average of 23.2.

Mississippi has yet to expand Medicaid – one of only 10 states not to do so – and tens of thousands of working Mississippians remain without health insurance. It also has not implemented paid family leave, doula reimbursement by Medicaid, or supportive midwifery policies – all of which March of Dimes says are critical to improving and sustaining infant and maternal health care.

The Legislature passed a law last session that would make timely prenatal care easier for expectant mothers, but more than four months after the law was supposed to go into effect, pregnant women still can’t access the temporary coverage.

“March of Dimes is committed to advocating for policies that make healthcare more accessible like Medicaid expansion, addressing the root causes of disparities, and increasing awareness of impactful solutions like our Low Dose, Big Benefits campaign, which supports families and communities to take proactive steps toward healthy pregnancies,” Cindy Rahman, March of Dimes interim president and CEO, said in a press release.

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 2017

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mississippitoday.org – Jerry Mitchell – 2024-11-15 07:00:00

Nov. 15, 2017

Credit: Simon & Schuster

Author Jesmyn Ward became the first Black American to win the National Book Award twice. 

Growing up in DeLisle, Mississippi, “I read everything,” she wrote. “Still, I still felt as if a part of me was wandering. That there was a figure in me, walking the desert, waiting for a word. A word that would sound out of the wilderness to declare that it was speaking to me, for me, within me. The sonic sear of that voice: a new knowing of not only the world I walked, but of me.” 

She became the first person in her family to go to college. She attended Stanford University, where she earned a bachelor’s in English and a master’s in media studies. 

When a drunken driver killed her younger brother, she decided to become a writer in his memory. 

After earning a master’s in fine arts in creative writing from the University of Michigan, she and her family were caught by the floodwaters of Hurricane Katrina, but managed to take shelter with a family. 

She won her first National Book Award for “Salvage the Bones,” which was set during the days of Katrina. 

“When I hear people talking about the fact that they think we live in a post-racial America,” she said, “it blows my mind, because I don’t know that place. I’ve never lived there.” 

She won her second National Book Award for “Sing, Unburied, Sing,” becoming the first woman and first Black American to win two National Book Awards. She also won a MacArthur “genius” grant, one of a handful of Mississippians to receive the award. In 2022, she became the youngest person to ever receive the Library of Congress Prize for American Fiction.

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

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