OurTupelo

Natalie Gunnells had finally secured some assistance from Mississippi’s political class for her 23-year-old son Patrick, who has severe autism.

No sooner had she started receiving relief from the state’s Medicaid agency than her local lawmaker accused her of supporting his political opponent, delivering an ominous warning.

“You’re not in line, you’re not in sync to help you and your family,” said the local senator.

Patrick is one of 2,750 Mississippians on a special Medicaid program that is supposed to provide outpatient services to people with intellectual or developmental disabilities, known as the IDD waiver. The purpose of the waiver — a roughly $125 million-a-year program funded mostly by the federal government but administered by state agencies — is to allow this vulnerable population to live in the community as opposed to an inpatient facility.

But even though he receives the waiver, Patrick has for years lacked a caregiver or specialist.

“I’m telling you this waiver is designed to fail. You don’t fail this many people year, after year, after year if it is not designed to fail,” Natalie Gunnells said at a community meeting in February.

Without the specialized behavioral therapy that he is eligible to receive, Patrick’s potential is unknown. Patrick is nonverbal and cannot perform normal tasks, like using the bathroom on his own. When he was a child, his parents fought for him to receive the special education he was entitled to at the public school. These days, Patrick rarely agrees to leave the family’s Tupelo home, and he’s almost always wearing his large black headphones due to noise sensitivity.

Yet, the Gunnells recently found out that Medicaid has been dishing out thousands for therapy they say Patrick is not receiving under what they believe is a fraud scheme. Documents suggest the alleged abuse was made possible by years of loose oversight at the Department of Mental Health. The state attorney general’s office is currently investigating, according to AG communication obtained by Mississippi Today, though no one has been charged with a crime.

READ MORE: Attorney General investigating provider fraud in Medicaid waiver

Adding insult to injury, when the federal government decided during the pandemic to temporarily allow parents to get paid to deliver care to their disabled adult children, Mississippi chose not to adopt the policy.

Natalie Gunnells and her husband Jamie Gunnells knew they’d have to involve Sen. Chad McMahan, R-Guntown, their local lawmaker, if they wanted a shot at the new benefit.

It was the same way when Patrick got on the waiver, known for its years-long waitlist, more than a decade ago.

“You have to know somebody to get off the waiting list,” said Jamie Gunnells, who owns and runs an independent pharmacy in Tupelo. “It’s pitiful.”

In roughly the last year, Mississippi Division of Medicaid Director Drew Snyder asked one of his division directors to follow up on requests from at least eight sitting lawmakers, all white Republican men, according to text messages obtained by Mississippi Today. The politicians seemed to urge the agency to remove roadblocks for specific beneficiaries who were attempting to access Medicaid.

In each case, Tracy Buchanan, Medicaid’s director of long term services and supports, responded that she was on it.

READ MORE: Texts show lawmaker influence over Mississippi’s Medicaid rolls

McMahan has become particularly known for keenly navigating government red tape to help Mississippians get the public assistance they need. “I am relentless about contacting these agencies on my own,” McMahan told Mississippi Today. “I personally call and take an interest in every one of these cases to help people.”

As part of his stated commitment to help his constituents, McMahan convened a meeting for the Gunnells with Medicaid officials in May of 2022. After it ended, the couple alleged that McMahan casually propositioned them.

“He says, ‘Well, that ought to be worth a $25,000 campaign donation, don’t you think?’” Jamie Gunnells said.

While the Gunnells, who have publicly shared support for various Mississippi politicians, had made contributions to McMahan’s past campaigns, they said they were put off by the request and have not donated to McMahan since.

McMahan adamantly denied making the ask for a campaign donation. “No, I didn’t say anything like that,” he said. “… That’s a terrible thing to say.”

In Mississippi, it’s not uncommon for the state’s Republican leaders, who otherwise revile public assistance programs, to use the system for the benefit of themselves and their political supporters — no better illustrated than within Mississippi’s still-unfolding welfare scandal. One former grant recipient and defendant in the case, Christi Webb, even accused McMahan of delivering a threat on behalf of former Gov. Phil Bryant to withhold grant funding to the nonprofit she ran, Family Resource Center of North Mississippi, because she had supported and hired the wife of a Democratic candidate for governor. McMahan denied the allegation.

McMahan had also been jockeying for funding from Mississippi Department of Human Services, which administers the federal Temporary Assistance to Needy Families (TANF) block grant, to go to the Autism Center of North Mississippi. For a short time years ago, Patrick received services from the autism center, and his parents praised the quality of the program.

Auditors found that the autism center improperly received a $75,000 grant from the welfare agency, as well as more than $300,000 in grants from Family Resource Center.

MDHS employees had expressed hesitation about whether anti-poverty funds could be used to support services for well-to-do families at the autism center, but after a meeting between McMahan, Bryant and the welfare director, grant money flowed to the center anyway.

At the Gunnells’ urging, the Mississippi Division of Medicaid eventually adopted the federal policy allowing parents of severely disabled adults to temporarily become paid caregivers.

Natalie Gunnells, who has a master’s degree in counseling and gave up a promising career in education to care for her son, took courses to become certified through a local personal care provider last year.

Still, Mississippi had chosen the more stringent version of the policy that said legal guardians could not participate. So Natalie Gunnells had to relinquish her guardianship of Patrick — at a price of $2,300 to her attorney — to serve as her son’s taxpayer-funded caregiver. She began receiving the $12-an-hour wage for her work in November. This temporary policy, called Appendix K, only lasts until the end of the public health emergency, currently planned for next month.

In early January, Natalie Gunnells shared what she thought was an innocuous Facebook post from Lauren Smith, a local lab tech consultant and growing social media personality. Smith promotes conservative politics through her Facebook group “P.R.I.M.E” (Patriots for Rights Integrity Morals and Ethics), often taking aim at establishment GOP leaders. She was gearing up to run against McMahan for his Senate seat.

“If you want to know what’s really going on in politics in our great State, then you need to listen to Lauren Smith!” Natalie Gunnells wrote. “Ya’ll, this girl…her passion, knowledge, expertise…JUST LISTEN!”

Then her phone rang.

On the other line, McMahan explained to the Gunnells that “someone in Washington” had alerted him to Natalie Gunnell’s Facebook post, and they weren’t happy.

“There’s some of us out here that are doing everything we can to help your family, and it’s just, it’s just a slap in our face,” McMahan said, according to a recording of the call obtained by Mississippi Today. “… I just want you to know that I may be the face of trying to help you, but there’s a lot of people behind me that’s tried to help you, and y’all are making it difficult for your own cause.”

“We’re making it difficult by liking a post?” Jamie Gunnells said.

“Yes,” McMahan said. “Yes.”

“I don’t understand that,” Jamie said.

“Well, I guess you’ll just have to trust me. I don’t know the pharmaceutical industry, but I know politics. And I guess you’ll just have to trust me,” the lawmaker said, according to the recording.

To the Gunnells, McMahan’s call came off as a veiled threat to withhold help to Patrick.

“That’s terrible. If that’s the impression I left, I’m really, I’m deeply sorry about that,” McMahan told Mississippi Today. “I thought they would deceive my sincerity about how hard I had worked on their behalf, and they know I did.”

But on the call, McMahan also accused his opponent of wanting to end Medicaid — the program that provides not only Patrick’s waiver, but his health insurance. “She (Smith) is against every type of program,” McMahan told the Gunnells. “She would take literally the bread out of your family’s mouth to end any type of government assistance, and you’re supporting her.”

After the interaction, Natalie Gunnells said she felt that the solution they had reached with Medicaid was in jeopardy. She deleted her Facebook post.

“Senator McMahan was referring to a quid pro quo: he was helping us and if we wanted to continue to rely on him and everyone he stated behind him helping, we better not promote Lauren Smith at all,” Natalie Gunnells wrote to Mississippi Today.

McMahan explained his response to the situation, telling Mississippi Today, “It’s a normal reaction when you help somebody and then they’re out there supporting other individuals that are completely opposed to their own need.”

“It is human nature. I mean, come on,” he told Mississippi Today. “You give somebody just hours and hours of help in trying to help their family, and then they’re out there supporting individuals, not just my opponent, but other individuals in general that are against any type of Medicaid enhancements. And it’s just odd.”

The Gunnells are ardent conservatives, backing far-right candidates such as Sen. Chris McDaniel, a Republican candidate for lieutenant governor and tea party populist who’s tried to fracture Mississippi’s establishment GOP since at least his U.S. Senate race in 2014. These candidates are particularly hostile to taxpayer spending on government assistance programs.

But the Gunnells said they don’t believe Smith or any other public servant would genuinely want to eliminate Medicaid.

“I can’t imagine a politician saying that today,” Jamie Gunnells said. “Yeah, they and I would love to see more people working and supporting themselves, but we’re the poorest state in the union, we’re going to have people on Medicaid. And that’s just the fact.”

Smith told Mississippi Today that McMahan, who also filed an unsuccessful residency challenge against Smith, is desperate to hold onto his senate seat, “and he’ll say whatever it takes to do that, no matter if it’s true or a lie.”

“Do I think it (Medicaid) needs reforming? Absolutely. Do I think it is a very, very broken system? Absolutely. And it does need a lot of work. But to do away with it? No, absolutely not,” Smith said. “It’s there for a reason, and that’s to take care of the ones who truly need it.”

Smith also said she is against the extension of postpartum Medicaid coverage from 60 days to one year, which Gov. Tate Reeves recently signed into law. 

“Why is that a Mississippi taxpayer’s problem to have to pay for that?” Smith said. “… Whenever I had my son, I had to go back to work.”

At least 40% of private sector jobs in Mississippi do not come with employer-sponsored health benefits, according to Kaiser Family Foundation.

Regardless of the state’s philosophy around Medicaid, its administration of the IDD waiver has been a disaster, according to several parents who spoke at a public hearing in February. This is largely because of a shortage of quality direct care workers and shoddy oversight.

Medicaid is responsible for submitting a renewal application to the federal government every five years to keep the waiver in operation. It held a hearing to gather feedback from clients in February and sent the new waiver application at the end of March.

The purpose of the waiver is to allow people with intellectual and developmental disabilities to live in the community, as opposed to an inpatient facility. This follows the 1999 U.S. Supreme Court opinion in Olmstead v.s L.C., which gives Americans with disabilities the right to live in the “least restrictive setting” possible for their condition and requires the government to provide the necessary supports.

While there are about 2,750 people on the waiver at any given time, there are almost the same number of people on the waiting list who qualify but do not get the benefit. The state estimates there are a total of between 52,000 to 53,000 Mississippians with intellectual or developmental disabilities.

“People are being institutionalized, I firmly believe, because they can’t get on the waiver,” said Polly Tribble, director of Disability Rights Mississippi.

Around 700 people with intellectual and developmental disabilities live in the state’s six regional facilities. This is down from roughly 1,300 residents in 2012. The IDD waiver has grown in that time from about 1,800 to more than 2,700.

Tribble’s largest concern within the waiver is how few people it serves. She told the story of a mother who had to put her daughter in an institution because she couldn’t afford to give up her job to stay home.

“She was separated from her daughter for years until we found out about it and got her some help,” Tribble said. “There’s stories like that all across the state. We don’t know what the potential is and you’re talking about somebody’s quality of life. And possibly somebody’s life.”

But the waiver doesn’t necessarily ensure a person will receive the services they need.

“If you think this is going to be a golden ticket, it’s not,” Natalie Gunnells said.

Every morning, the Gunnells trade off who is responsible for getting Patrick up, bathing him, getting him dressed, and feeding him breakfast. After that, Natalie Gunnells is almost always at home tending to Patrick, helping him go to the bathroom and bringing him meals. 

The highlight of Patrick’s day is when his 16-year-old brother Stephen gets back from school. The rest of their four siblings, ages 21 to 27, no longer live at home. 

In addition to a primary diagnosis of autism, Patrick also has a genetic disorder called Cri-du-chat. But while his capabilities are limited, Patrick is smart; he can read books on at least a 9th grade level and communicate through a speech-generating device.

Patrick qualifies for 180 hours per month of in-home respite care, which is designed to relieve a primary caregiver of their otherwise round-the-clock work. For six of the last seven years, his mom said Patrick has been without a respite caregiver. 

Not every person on the IDD waiver may need in-home respite, though all would qualify for it. Out of the 2,747 people on the waiver in fiscal year 2022, less than 20%, or 534, received respite care, according to documents from Medicaid. Just 32%, 873, received a similar service called home and community supports.

Patrick can’t participate in community-based services in centers, often referred to as day hab, because DMH doesn’t fund the one-on-one support he would need to acclimate in that environment.

Patrick also qualifies for 30 hours of behavioral therapy each month. Natalie Gunnells said that a local behavior support consultant, Vargas Clark from Mississippi Behavioral Services, did come to the Gunnells’ home to work with Patrick here and there in 2018, only for around 30 minutes a session. But they say Clark hasn’t had much of a presence in their lives since, and while a different therapist from the Behavioral Services came sporadically in 2021, the Gunnells haven’t seen anyone from the organization in over a year. 

According to Medicaid’s billing department, the IDD waiver costs about $125 million annually, with the agency reimbursing about $45,000 worth of services on average for each person on the waiver – though clients like Patrick aren’t receiving nearly that amount.

Some parents who spoke to Mississippi Today are skeptical, considering the worker shortage, that such a large amount of care or therapy is actually being delivered under the waiver.

“They’re receiving funding, but the services are not being delivered as they are designed to be,” Deb Giles, a parent of a son with Down syndrome, said at a recent hearing.

If Natalie Gunnells were paid to provide Patrick’s full allotment of in-home care, it would cost roughly $25,000 each year. To compare, the cost of placing Patrick in one of DMH’s regional centers would be anywhere from $90,000 to $170,000 a year depending on the level of care he qualified for.

The waiver is funded by Medicaid but the administration and oversight, which primarily consists of support coordinators employed by the regional IDD centers, is operated by the Mississippi Department of Mental Health. DMH told Mississippi Today that like private direct care providers, the agency has similarly struggled to hire and retain enough support coordinators.

The support coordinators work with the IDD waiver clients and their parents or guardians to develop what’s called a Plan of Services and Supports. The plan, the state’s primary source of information about how a patient is faring, is a crude worksheet with blank spaces for the support coordinator to fill out. Some of the headers include, “Things People Need to Know to Support Patrick and Keep Patrick Safe,”  “Patrick’s Strengths,” “Patrick’s Dreams,” “Things to Figure Out,” “Good Day,” and “Bad Day.”

At least in Patrick’s case, the plan operates as more of a wishlist than a realistic picture of his participation in the program. In some cases, it seems to the Gunnells that DMH is simply checking boxes, even if that means jotting down inaccuracies. The Gunnells’ support coordinator, Clay Ketchings at North Mississippi Regional Center, repeatedly writes in the plan that Patrick likes to go on car rides, despite the fact that currently, his parents say Patrick is almost entirely homebound.

Ideally, the Gunnells would find a consistent direct care worker and use the behavior support consultant to train the worker on how to best socialize and respond to Patrick’s specific needs. Patrick’s waiver plan explains that he is stubborn to following directions, sometimes falling on the ground and refusing to move. The Gunnells wonder what Patrick would be capable of if he had access to an autism specialist, especially considering the promising progress he made during the short stint he received services from the autism center under Dr. Sheila Williamson, who’s no longer there.

“She would have probably already had him potty trained,” Natalie Gunnells said. “… So we don’t ever really know what his potential is.”

In Mississippi, there are almost two direct care worker job openings for every person working as a direct care worker, according to national policy institute PHI, which ranks Mississippi second to last for its direct care workforce.

Betty Pinion, director of the IDD program for the Department of Mental Health, acknowledged the care shortage in an interview with Mississippi Today. But she also said that in some cases, individuals on the waiver are not receiving the services included in their plan not because the services aren’t available, but because the family refuses to work with the available providers. Some of these agencies are paying direct care workers as low as $8-an-hour.

“There are some (clients) that doesn’t seem to be satisfied with any person that we send,” Pinion said.

Since the Gunnells haven’t found a direct care worker to train, they haven’t been receiving the behavioral support either. 

They and many other parents have raised the issue of lack of services to their support coordinator, who is tasked with addressing any client concerns, but they say it doesn’t yield any results. Mississippi Today observed one family’s Plan of Services and Supports meeting in March. The parents repeatedly complained that they could not find an agency with available workers; the support coordinator explained that she didn’t have any control over the workforce.

In an interview with Mississippi Today, officials from the Department of Mental Health said it is not tracking how many people on the waiver are receiving each service versus the number of people eligible for each service.

This could show the number of people missing out on the benefits to which they’re entitled.

It also does not compile the total number of hours per service people on the waiver are eligible to receive or the total number of hours of services delivered, which might even better quantify the care shortage. Mississippi Today requested this data from the department, but since it is not already compiled in a report, it is not a public record, and the department said the report would require too many hours for the agency to conduct.

“To compile the requested information, each individual’s file (more than 2,700) would have to be reviewed to determine the eligible number of hours and then compiled into a consolidated report,” the agency said in response to the request. “… DMH is considering ways this data can be collected in the future.”

Medicaid declined to answer Mississippi Today’s questions about the waiver and its renewal, but an attorney with the agency Cody Smith told Natalie Gunnells in an email that the agency shared her concerns about the care shortage. He said that Medicaid is working with DMH to “lower barriers on workers entering the industry” and that it has commissioned a workforce study. Medicaid spokesperson Matt Westerfield said the agency is proposing an average reimbursement rate increase of 18%, which affects the hourly wage of the care workers.

Medicaid is currently submitting its paperwork to the federal government to renew the IDD waiver, a process that happens once every five years. Both Medicaid and DMH hosted a public hearing in February to accept suggestions from the public about what changes to make in its renewal.

After Mississippi Today’s inquiry to Medicaid about the IDD waiver, Snyder texted his deputy administrator for policy Wil Ervin, who recently left the agency, asking him to watch a recording of the public hearing to see if there was anything they needed to “watch out for.” 

“We are likely going to have an issue from the hearing,” Ervin responded the next day.

Medicaid spokesperson Matt Westerfield said in an email that Ervin was referring to complaints, such as from Natalie Gunnells, about the policy that legal guardians cannot be paid caregivers under the waiver. Westerfield said last month that the agency was still considering whether to revise this policy in its permanent plan.

But when it came time to submit the waiver application at the end of March, Medicaid moved to include an even more restrictive version of the policy. It added the caveat that people could not be paid to care for their relatives if the service they are providing is “a function that a relative or housemate was providing for the participant without payment prior to waiver enrollment,” which seems to apply to Natalie Gunnells and most parents in her position.

After all her efforts, Natalie Gunnells will likely be back at square one when the public health emergency ends.

In early January of 2022, frustrated by the absence of services for her son, Natalie Gunnells began requesting what are called “utilization reports” from the Department of Mental Health.

The reports contain which services, and the number of hours, that providers are billing to Medicaid under the waiver. The support coordinators are supposed to review the documents with the parent or guardian every month to ensure the client is receiving the services that Medicaid is paying for, but in Natalie Gunnells’s case, she said this hadn’t happened for three years.

“They were so negligent that any agency billing Medicaid that wanted to commit fraud could without detection,” Natalie Gunnells wrote in her own timeline of the alleged fraud.

Once she got the documents, she said she realized that for at least two years, Mississippi Behavioral Services, owned by Vargas Clark in Southaven, had been charging Medicaid for services she says Patrick wasn’t receiving. In some months when Patrick may have received an hour of support, billing records show the company charged for the full 30 hours. Natalie Gunnells estimates Medicaid reimbursed Mississippi Behavioral Services for at least $42,000 for services not rendered.

Clark, who has not been charged with a crime, told Mississippi Today Monday that he was unaware of an investigation into his company. After agreeing to examine his records in order to discuss the alleged billing discrepancies, he did not return several follow up calls or texts.

Natalie Gunnells reported her findings to Medicaid’s fraud division, but she said they never responded. She then took the information to the Attorney General’s Office, which launched an investigation, in September. The Gunnells submitted an affidavit in October. The AG did not respond to several requests for comment for this story. DMH confirmed that it conducted its own internal investigation and referred the matter to Medicaid. DMH Director Wendy Bailey also said the agency recently provided more training to support coordinators to ensure they’re following procedures.

Providers are supposed to submit quarterly review reports describing the patient’s progress, but the Gunnells’ support coordinator hadn’t been collecting them from Mississippi Behavioral Services. 

Eventually, Natalie Gunnells got the records from the investigator. According to a review by Mississippi Today, many of the reports are identical from quarter to quarter, seemingly copy-pasted with only the date at the top changing. The investigator also shared invoices and billing records from Medicaid, some of which include signatures for Natalie Gunnells that she said aren’t hers and indistinguishable scribbles for the others.

The reviews include charts, lines zigzagging across the page, that pretend to reflect the frequency of Patrick’s “target behaviors,” such as noncompliance and physical aggression. As far as Natalie Gunnells is concerned, the data is made up.

“Patrick has shown a positive response to behavior treatment,” one report says, referencing a three-month period in which the Gunnells say no therapist ever came to see Patrick.

The post ‘You’re not in line’: Family battles politics, indifference, and suspected fraud in federal health care program appeared first on Mississippi Today.

Wading through the complexities of Medicaid eligibility in order to secure health insurance for yourself or your family member in Mississippi can be a nightmare. It might even feel impossible.

But if you happen to go to church with a state legislator, you may be in luck.

“Please have someone check on the Medicaid app on (patient),” Rep. Jody Steverson, R-Ripley, wrote to Mississippi Division of Medicaid Director Drew Snyder last summer. “(Patient) has cerebral palsy and I attend church with his grandparents.”

Snyder forwarded the message to Tracy Buchanan, Medicaid’s director of long term services and supports. “Will do,” she responded.

In roughly the last year, Snyder asked Buchanan to follow up on requests from at least eight lawmakers, all white Republican men, according to text messages obtained by Mississippi Today.*

“Being a lawmaker, you can go to the head of the department and start there,” said Rep. Price Wallace, R-Mendenhall, who called and texted Snyder about a Medicaid application in January. “When you can call the top brass and let them know, then the problem seems to get worked out a lot quicker than starting at the bottom and trying to go up the ladder.”

In the texts, the politicians ask for special attention, sometimes explaining the heartbreaking circumstances and the roadblocks that specific beneficiaries faced in attempting to access Medicaid – the public health insurance program reserved for the poorest and most medically fragile citizens.

READ MORE: ‘You’re not in line’: Family battles politics, indifference, and suspected fraud in federal health care program

Medicaid is one of the largest arms of the nation’s social safety net, a maze of taxpayer-funded assistance that ideally exists to level the playing field for needy Americans, if not just simply help them survive.

Mississippi lawmakers – as well as Gov. Tate Reeves, who reappointed Snyder from the previous Gov. Phil Bryant administration – have resisted expanding Medicaid to cover the poor and uninsured. They’ve opted instead for punitive policies that target beneficiaries for suspected fraud, such as the HOPE Act, which they refused to repeal even after recent pleas from the Reeves-appointed welfare director.

Yet they can tap into the programs for those they personally deem worthy.

“Thank you for again helping me,” House Appropriations Chairman Rep. John Read, R-Gautier, texted Snyder in early 2022. “The family at this time can not express how great they feel.”

Looking at it one way, the requests demonstrate the lawmaker’s accessibility, their resourcefulness, tangible constituent representation.

But the texts also reflect the potential influence lawmakers have over the agency, not just in relation to its state budget, but in determining who successfully ends up on the Medicaid rolls in the poorest state in the nation.

“Legislators often reach out to the Division with questions or concerns raised by their constituents, and we take those questions and concerns seriously,” Medicaid said in a written response to Mississippi Today. “However, we strongly disagree with your assertion that these communications demonstrate a pattern of legislative influence on who gets served and how quickly.”

While some of Snyder’s inquiries to Buchanan over the last year came from other connected people, the majority originated from lawmakers. Snyder, who came to Medicaid after working as a deputy chief of staff and policy advisor in Bryant’s office, has an incentive to make lawmakers happy, since they determine his state budget.

“I think it does help, you know, when a lawmaker makes the phone call. It puts a little bit hotter fire under their bottom,” Wallace said. “… When I talked back with Drew, he was like, ‘Yeah, we got everything handled.’ So it was taken care of.”

“That’s what we’re here for,” Wallace said. “In all honesty, that’s why I ran for this job, to help my constituents. That’s where I get the most satisfaction of being a representative for the state of Mississippi District 77 is when one of my constituents calls me with a problem and I’m able to help them resolve that problem.”

Mississippi Today recently published a story about the struggles that a couple in north Mississippi have had navigating a special Medicaid program, called the Medicaid IDD waiver, for their 23-year-old son, who has severe autism.

The couple, Natalie and Jamie Gunnells, sought help from their local lawmaker Sen. Chad McMahan, R-Guntown, which they had supported in his past campaigns. McMahan set up a meeting for the Gunnells with officials from Medicaid, which eventually acquiesced, adopting a temporary policy that allowed Natalie Gunnells to get paid for care for her son.

“I know how to work the system for the people I represent,” McMahan told Mississippi Today. “… I have figured out a way to be very successful in helping my constituents get the medical services or the disability services their family needs. And I’m not gonna reveal how I’ve learned it. I’ve learned the system.”

When McMahan found out the Gunnells had expressed support for his upcoming political opponent, a conservative opposed to Medicaid enhancements, the senator called them out, saying it was a “slap in the face” considering all the hours he spent lobbying on their behalf.

Asked if he thinks about helping people access public assistance as a way to secure votes, McMahan said, “That never crosses my mind. There’s never a wrong time to do the right thing.”

(Medicaid later chose not to permanently adopt the policy).

Rep. John Hines, D-Greenville, said when he’s reached out to Medicaid about concerns, current agency leadership has always been responsive to him, explaining why one of his constituents may or may not be eligible for the assistance. They say they want to help, Hines said, but that they have to stay within strict eligibility guidelines.

To Hines, this scenario illuminates a larger point: There wouldn’t be such a need for lawmaker intervention on specific beneficiary cases if those lawmakers put in place equitable policies for all.

“I think the issue in the whole Medicaid system is the fact that we did not expand,” Hines said. “And a lot of these conversations, a lot of these situations that are happening here in this state, if we would just expand it, we would not be having. There wouldn’t even be a need for you to do the story that you’re doing.”

Hines continued: “The government’s inability to want to expand Medicaid forces representatives and directors of agencies to have to make uncomfortable decisions and conversations around the safety and the health of constituents, which would automatically be eligible for Medicaid if we would expand it, and they wouldn’t have to be making all these special phone calls.”

Below are the texts between Snyder and Buchanan referencing lawmaker interactions with Steverson, Read, Wallace, Rep. Tracy Arnold, R-Boonville, Rep. Rob Roberson, R-Starkville, Rep. Joey Hood, R-Ackerman, Rep. Bubba Carpenter, R-Burnsville, Rep. Sam Creekmore, R-New Albany, and former House Ways and Means Chair Jeff Smith, R-Columbus. Most of them either declined to comment or did not return texts or calls to Mississippi Today.

*The text messages referenced in this story were sent between Snyder and Buchanan from Dec. 1, 2021, to February 16, 2023. They do not reflect the entirety of communication between state lawmakers and Snyder, just the correspondence he forwarded to Buchanan that was then shared with Mississippi Today to fulfill its records request. 

The post Texts: Lawmakers maneuver Mississippi’s Medicaid rolls appeared first on Mississippi Today.

The Mississippi Attorney General’s Office is investigating whether a behavioral therapist provider bilked Medicaid under a special program for people with intellectual and developmental disabilities. 

Natalie Gunnells, the mother of a 23-year-old Medicaid recipient named Patrick, first noticed a billing discrepancy in early 2022 after requesting to see records from the Mississippi Department of Mental Health.

The Department of Mental Health administers the program, called the Medicaid IDD waiver, but the Mississippi Division of Medicaid pays for it. 

Under the waiver, Patrick is eligible to receive over 200 hours of services each month, but in the last several years, he’s received just a handful of hours, if not zero.

READ MORE: ‘You’re not in line’: Family battles politics, indifference, and suspected fraud in federal health care program

That hasn’t stopped Mississippi Behavioral Services, a clinic in Southaven owned by Vargas Clark, from billing Medicaid for thousands of dollars worth of therapy for Patrick, records obtained by Mississippi Today show. 

Clark, who has not been charged with a crime, said he was unaware of the investigation and did not return several follow up calls and texts from Mississippi Today. Gunnells estimates Medicaid reimbursed the company for $42,000 worth of services that her son didn’t receive from 2020 to 2022. She says disregard at the mental health and Medicaid agencies allowed this to continue unnoticed. 

“We provide services as written for the service authorization,” Clark said. “Now there may be individuals that are authorized for, let’s say, 30 hours. We may be providing 10. But we only bill services for services that are actually rendered.”

Mississippi spends about $125 million annually on the waiver program, an average reimbursement of about $45,000 worth of services for each person. 

Several parents who spoke to Mississippi Today and voiced their concerns at a recent public hearing want to know where all that money is going. It’s hard for them to believe that much care is being delivered, considering the worker shortage that has left them without any help for their adult children. 

And they’re worried that a lack of oversight in the program could mean taxpayer dollars are flying out the door of Medicaid while some of the state’s most vulnerable residents go without services. 

“There’s no telling how much fraud is occurring,” Gunnells said.

One of those parents is Deb Giles, who has been unable to find a specialist to provide the speech therapy her son is qualified to receive. But at the hearing in February, Giles focused her concerns on the accountability within the program.

“My recommendation for the Department of Mental Health is to provide the recipients with reports on audits of the providers and to provide more audits,” Giles said. “I’ve run into roadblocks, and not enough information as to how these providers are being audited. Some are not providing the services that they’re being paid for, or reimbursed for, and I would like to see more information for Mississippi on how these providers are being audited. And also I’d like to be able to assess the audits, to read throughout the state of Mississippi what the providers are providing for the recipients.”

Giles told Mississippi Today she wasn’t alleging a specific instance of fraud, but that the waiver program doesn’t collect enough information from providers to ensure they’re performing all the functions they’re supposed to. 

The Department of Mental Health’s primary role in the IDD waiver is to provide clients with support coordinators from the agency’s regional IDD centers. The support coordinator’s job is to consult with the parent or guardian of an individual on the waiver to ensure they are receiving the services outlined in the support plan they create together. For years, Gunnells said her support coordinator did not review service reports with her. Several call logs Mississippi Today reviewed confirmed that this wasn’t happening.

“It seems every standard put in place to ensure appropriate care for P (Patrick) was totally ignored from the Support Coordinator to all his superiors charged with ensuring the documents such as Quarterly Reports, Behavior Support Plan and required IDD service notes were submitted on time and accurate,” Gunnells wrote in a timeline of the alleged fraud.  “They were so negligent that any agency billing Medicaid, that wanted to commit fraud, could without detection.”

Department of Mental Health Director Wendy Bailey said the agency conducted its own internal investigation into the matter and referred it to Medicaid. She said DMH is providing additional training to support coordinators and looking at ways to improve its site visit process at the regional centers. The central office reviews a sample of support coordination records monthly.

The state Medicaid agency is in the process of renewing its application to the federal government for the waiver.

“While we don’t have evidence to believe this type of provider fraud is widespread, we still have to be open to new ways of preventing fraud and be aggressive in rooting it out,” Medicaid spokesperson Matt Westerfield said in a statement to Mississippi Today. “This year, the Division plans to implement an electronic system for the ID/DD waiver that documents the time certain ID/DD services begin and end.”

The Medicaid statement also encouraged anybody who suspects Medicaid fraud to notify the agency here.

The Attorney General’s Office, which began its investigation more than six months ago, did not respond to several requests for comment for this story.

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APRIL 6, 1909

Matthew Henson reached the North Pole, planting the American flag. Traveling with the Admiral Peary Expedition, Henson reportedly reached the North Pole almost 45 minutes before Peary and the rest of the men. 

“As I stood there on top of the world and I thought of the hundreds of men who had lost their lives in the effort to reach it, I felt profoundly grateful that I had the honor of representing my race,” he said. 

While some would later dispute whether the expedition had actually reached the North Pole, Henson’s journey seems no less amazing. Born in Maryland to sharecropping parents who survived attacks by the KKK, he grew up working, becoming a cabin boy and sailing around the world. 

After returning, he became a salesman at a clothing store in Washington, D.C., where he waited on a customer named Robert Peary. He was so impressed with Henson and his tales of the sea that he hired him as his personal valet. Henson joined Peary on a trip to Nicaragua. Impressed with Henson’s seamanship, Peary made Henson his “first man” on the expeditions that followed to the Arctic. 

When the expedition returned, Peary drew praise from the world while Henson’s contributions were ignored. Over time, his work came to be recognized. In 1937, he became the first African-American life member of The Explorers Club. Seven years later, he received the Peary Polar Expedition Medal and was received at the White House by President Truman and later President Eisenhower. 

“There can be no vision to the (person) the horizon of whose vision is limited by the bounds of self,” he said. “But the great things of the world, the great accomplishments of the world, have been achieved by (people with) … high ideals and … great visions. The path is not easy, the climb is rugged and hard, but the glory at the end is worthwhile.” 

Henson died in 1955, and his body was re-interred with full military honors at Arlington National Cemetery. The U.S. Postal Service featured him on a stamp, and the U.S. Navy named a Pathfinder class ship after him. In 2000, the National Geographic Society awarded him the Hubbard Medal.

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Tammie Mullins last saw her mother 45 years ago when she was 3 years old. Family members told her and her younger sister Christi that Tonya Mullins was missing and, if she were able to come home to them, she would.

Over the years, Tammie held on to happy memories of her mother from when they lived in Simpson County. She always wondered what happened to her or where she was. 

Earlier this year, investigators from the Rankin County Sheriff’s Department answered at least one of her questions: For 45 years, Tonya Mullins had been an unidentified homicide victim buried in Pearl under the name “Jane Doe”. Investigators identified her remains using DNA testing and genealogy. 

“That led her back to me and Christi,” said Tammie Mullins, who is 49. 

In 1978, Tonya Mullins was 22 and married to her high school sweetheart, James. They moved from Texas to Mississippi with their young daughters in search of work. 

The couple couldn’t find jobs, so James went back to Texas to find a place to stay for his family, but when he returned to Simpson County, Tonya and the girls were gone. 

That September, Rankin County investigators found the body of a woman –  now identified as Tonya – wrapped in carpet in an illegal dumping site near the old Byram Swinging Bridge. The bridge spans the Pearl River and separates Hinds and Rankin counties.

The woman had been dead for several days. Based on the blunt force head injuries, the coroner ruled her death a homicide. 

Her body was sent to the state forensics lab for an autopsy, and the woman’s fingerprints were recorded and sent to the FBI. Information about her and a composite sketch were released to the public, but nobody came forward. 

Tammie said memories of her mother are limited, such as images of her parents sitting next to each other on the couch as Tonya sewed Tammie’s dress, or jumping on the trampoline together.

With the help of her grandparents and father, Tammie has been able to retell what happened when her mother went missing. 

Three months after Tonya and the girls were last seen, Tammie’s grandmother received a call saying their uncle would bring them to Texas if she and her father met him at the airport. The uncle brought Tammie and Christi and told their father that Tonya would reach out at a later time, but she never did. 

Tammie said her father returned to Mississippi several times to try and find his wife, but was not successful. 

Her uncle had told her father she saw Tonya leave with someone to go to Mexico. The uncle later said Tonya was in Florida. There was supposedly a letter James received from Tonya – which Tammie now knows could not have been possible – but she doesn’t know what it said. 

Tammie said growing up without her mother was an emotional rollercoaster.

She didn’t like Mother’s Day and still doesn’t enjoy it now that she is a mother. At times she felt angry at her mother for leaving. Other times Tammie wished she was there, and that felt like a betrayal of her stepmother who helped raise her. 

“I think those feelings just never go away,” Tammie said. 

Years passed. Tammie and Christi started their own families. Tammie told her children about her mother. She became a grandmother. 

In 2021, Rankin County Coroner David Ruth was reminded about the 1978 Jane Doe case after a detective from Ohio working on an unidentified missing person case reached out. 

Ruth filed a petition with the circuit court to exhume Jane Doe’s body with the hopes of using modern forensic tools to identify her. Once the request was approved, he and Deputy Coroner Clifton Dunlap collected bones to send out for testing. 

Ruth tried three laboratories to help identify Mullins, and one that was successful was Texas-based Othram. 

“There are a lot of homicides that are unsolved because people don’t know who they are … finding out the identity of them is a start,” he said. “If you don’t ask, you’ll never know.” 

Carla Davis, a Mississippi native and Othram’s chief genetic genealogist, used DNA from Jane Done’s bones to build a family tree. 

Davis found the woman had a genetic match with a person who was adopted, and she had to find who that person’s family was. Davis identified a possible close relative who agreed to take a DNA test. 

More testing and work by investigators led to the positive identification of Jane Doe as Tonya Mullins. 

“It’s rewarding beyond measure,” Davis said about her genealogy work for Othram. “It’s proof that, with funding, this works.” 

Davis, who is also a philanthropist, funded the costs to exhume Mullins’ body. She has also helped fund analyses for other unsolved cases in Mississippi and previously did genealogy work for Othram as a volunteer. 

Ruth, the coroner, said Mullins’ death is an open homicide investigation. Now that investigators know who she is, they can go back and find out with whom she was last seen and follow leads, he said. 

Sheriff Bryan Bailey did not immediately respond to a request for comment Wednesday. 

Learning what happened to her mother has given her and her family some closure, Tammie said, but she wants to know who is responsible for her death. 

Next week, Tammie, Christi and other family members will travel to the Floral Hills Memory Gardens to have a funeral service for Tonya, which is where funeral home staff laid her to rest as Jane Doe in 1978. 

Tammie said two of her sons who are ordained ministers will lead the service. 

“It’s the respect my mother deserves, and I wish we could have done this 45 years ago,” she said.

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Mississippi Today has won the University of Mississippi School of Journalism and New Media’s prestigious Silver Em award.

This year marks the first time a news organization has received the award. The Silver Em awards honor Mississippians with notable journalism careers or journalists with notable careers in Mississippi.

“We are very familiar with the prestigious Silver Em award and know full well that it is given to Mississippi journalists with exceptional journalistic contributions to the state or nation,” Editor in Chief Adam Ganucheau said. “We’re immensely proud our organization is now among that number. The UM journalism school has such a rich history of producing impactful journalists and journalism, and we’re proud to carry on that legacy in our home state.”

Ganucheau, CEO Mary Margaret White, Managing Editor Kayleigh Skinner, Audience Development Director Lauchlin Fields, Health Reporter Devna Bose, Education Reporter Julia James and Community Manager Bethany Atkinson are all UM alums.

“It’s an honor to be recognized for this award, because so many staffers in our newsroom are native Mississippians or went to college here and chose to stay and do local journalism in the place they care about,” said Skinner. “This award feels like a reminder to our newsroom and young journalists across the state that you don’t have to leave to make a difference.”

Mississippi Today was founded in 2016 as the state’s first nonprofit newsroom. Today the organization employs 18 reporters and editors to write about politics and policy across a myriad of beats including education, public health, justice, environment, equity and sports.

“We always strive to use our public service platform to the state’s advantage, offering our work completely for free to readers and to any Mississippi news outlet that would like to republish it,” Ganucheau said. “We see our role as helping bolster the state’s journalism outlets, not competing with them, and we firmly believe that the more sunshine that can be shed on our state’s leaders, the better.”

Mississippi Today will be honored during a ceremony on campus on April 12, at 6 p.m. in the ballroom at the Inn at Ole Miss.

“It is only fitting that our school, which is focused on instilling journalistic excellence in our students, has the opportunity to recognize one of the most innovative and high-quality news sites in the country,” UM School of Journalism Associate Dean and Professor Deb Wenger said in a university press release announcing the award. “The fact that Mississippi Today is producing journalism in service to our state just adds to the pleasure we take in honoring these fine reporters and editors.”

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When the Mississippi Community College Board unanimously selected Kell Smith as executive director earlier this year, it discriminated against a more-educated Black applicant who had worked at the agency longer, according to a lawsuit filed in federal court on Tuesday. 

In January, the 10-member board, composed entirely of white people, announced that Smith, a white man, would be the sixth executive director of the agency that oversees state funding for Mississippi’s 15 community colleges. Smith, the agency’s longtime director of communications, was elevated to the position over Shawn Mackey, the deputy executive director for accountability who is Black. 

Now Mackey, through his attorney Lisa Ross, is suing MCCB for discrimination and seeking damages for emotional distress. Smith, who is also serving as communications director for MCCB, said the board had no comment on the lawsuit filed in the Southern District of Mississippi. 

The lawsuit takes place against MCCB’s 36-year history in which it has never had a Black executive director. There have been just five Black board members of MCCB whose terms did not overlap, according to the lawsuit. MCCB’s counterpart, the Institutions of Higher Learning Board of Trustees, hired its first Black commissioner in 2018 when Alfred Rankins was appointed to the role. 

The executive director serves as MCCB’s representative to the leadership and oversees the day-to-day functions of the agency. Unlike Mississippi’s eight public universities, the 15 community colleges are independently governed. 

According to the lawsuit, Mackey started working at MCCB in 2007 and, in the years since, has served in various “executive leadership positions,” such as the director of career and technical education. With a doctorate degree in higher education administration, Mackey “has supervised every department within the agency, except for the finance division,” the lawsuit says. 

“Mackey is well respected by the MCCB staff, community college presidents, elected officials and constituents for his expertise, professionalism, and leadership,” the lawsuit says. 

In 2015, Mackey was a finalist for the executive director role when MCCB hired Andrea Mayfield, at the time a president of a community college in Alabama. That search process saw allegations of political inference, according to the Associated Press. It is unclear if Smith also applied for the job that year. 

On July 16, 2021, the day that Mayfield resigned her post, the board appointed Smith to serve as interim executive director. Since he started working at MCCB in 2008, Smith had only held one position — director of communications and legislative services, a job that did not require him to supervise employees, according to the lawsuit. Smith’s highest degree is a master’s of public policy and administration, according to his bio on MCCB’s website. 

About a week later, Mackey requested a meeting with John Pigott, the board chair, “to discuss his interest in becoming the Executive Director and highlight his qualifications and experience for the job,” the lawsuit says. But Pigott, who was appointed in 2012 by former Gov. Phil Bryant, refused to meet with Mackey, instead asking him to “submit a written strategic vision to him.” 

“Mackey was never contacted by Pigott or any other Board members to examine his strategic vision or discuss his being employed as Executive Director,” the lawsuit alleges. 

The lawsuit alleges that when Smith was appointed to the interim role, he met only one of the minimum qualifications of the position — “proficiency in working with federal and state policymakers.” 

“This fact was underscored by Smith himself, who announced to the Board and to colleagues on various occasions that he did not have the knowledge or experience necessary to serve as Executive Director,” the lawsuit says. 

Mackey informed the board in August 2021 that he wanted to apply for the position and submitted “several letters of support,” but the board chose to keep the position open. Then in January 2022, the lawsuit alleges that board members voted to reduce the minimum qualifications for the position from “an earned doctorate degree from a regionally accredited college or university” to “a master’s degree in any field, and evidence of experience in administration, leadership and engagement at regional, state or national levels.” 

The board interviewed Mackey but kept the position open for 18 months, allowing Smith, the lawsuit alleges, “time to shore up his resume to meet the new criterion established by the board.” 

MCCB members are gubernatorial appointments. All three of Gov. Tate Reeves’ 2021 selections were campaign donors. 

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Mississippi is one step closer to having a permanent U.S. Attorney for the Southern District, who is expected to oversee the prosecution of what’s been called the largest public fraud case in state history.

Both Sens. Roger Wicker and Cindy Hyde-Smith have indicated their approval of President Joe Biden’s nominee for the position, Todd Gee, deputy chief of the Public Integrity Section of the U.S. Department of Justice.

Waiting for Gee in Mississippi are five defendants in the welfare scandal who have pleaded guilty to federal charges and have agreed to help the FBI and U.S. Attorney’s Office with their ongoing probe. These include nonprofit founder Nancy New and her son Zach New, former welfare director John Davis, former nonprofit director Christi Webb and retired professional wrestler Brett DiBiase.

The scandal involves the theft or misspending of $77 million in federal welfare funds from the Temporary Assistance for Needy Families Program, including payments to the pet projects of former NFL quarterback Brett Favre.

Officials have hinted that the investigation is moving higher up the chain and New has already alleged in civil court that former Gov. Phil Bryant directed her to make one of the largest payments in question — $1.1 million to Favre for a radio ad promoting the state’s anti-poverty initiative called Families First for Mississippi. Bryant, whose office oversaw the welfare department during the scandal, has not faced civil or criminal charges.

Meanwhile, Hyde-Smith announced Tuesday she is blocking the confirmation of Scott Colom, Lowndes County District Attorney, for U.S. District Court Judge in Northern Mississippi. Wicker had already given his approval for Colom.

“I visited with the District Attorney recently, and I recognize that he is smart and well liked in his district,” Hyde-Smith said in a statement Tuesday. “However, there are a number of concerns I have regarding his record. As someone with a strong interest in protecting the rights of girls and women, I am concerned about Scott Colom’s opposition to legislation to protect female athletes.”

Hyde-Smith seems to be referring to a letter Colom signed condemning the criminalization of gender-affirming care, rejecting the prosecution of the families of transgender individuals seeking treatment to help them transition. He and dozens of other prosecuting attorneys made the statement in the aftermath of an onslaught of legislation across the country attempting to block trans youth from receiving the care.

While it did condemn anti-trans legislation generally, the prosecutors’ statement did not discuss “legislation to protect female athletes,” which refers to attempts to prohibit trans women from competing in women’s sports.

Hyde-Smith’s statement also criticized Colom for campaign donations he’s received from George Soros, a New York billionaire who has long contributed to criminal justice reform causes, such as legalization of marijuana and progressive sentencing. Hyde-Smith’s statement came on the same day Trump appeared in court on a 34-count indictment for falsifying business records in a scheme during his 2016 presidential campaign to conceal that he’d had an affair with an adult film star.

Following the charges, Trump and his supporters attributed the probe to Soros, who supported the Manhattan district attorney Alvin Bragg leading the case.

“The significant support his (Colom’s) campaign received from George Soros also weighs heavily against his nomination in my view,” Hyde-Smith said in her statement Tuesday. “I simply cannot support his nomination to serve on the federal bench in Mississippi for a lifetime.”

In Colom’s 2015 race for district attorney, Soros funneled money into a Political Action Committee called Mississippi Safety & Justice, which ran ads for Colom. The PAC contributed $716,000 to the race, New York Magazine reported, almost five times what Colom himself raised. But Colom said at the time that he didn’t know and never communicated with Soros, Clarion Ledger reported. He successfully ran again in 2019 without support from the PAC, which filed its termination in 2016 after the race.

Mississippi is also awaiting confirmation of two U.S. Marshals.

Wicker and Hyde-Smith were able to hold up both nominations for several months, or indefinitely, because of a longstanding tradition in the U.S. Senate called “blue slips” – the piece of paper a senator returns to the judiciary committee to indicate they’ll approve the candidate when it comes time for a vote.

The Senate Judiciary Committee, chaired by Sen. Dick Durbin, D-Illinois, could choose to suspend the blue slip process — as the Republican-controlled Senate did when former President Donald Trump made his judicial appointments to the circuit courts of appeals — and bring Colom and others to the committee for a vote. Because of the make-up of the committee, the nominations could pass with only Democratic votes.

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The college basketball season is in the books after another exciting Final Four, but the focus this week is on Augusta National and the 2023 Masters. The Cleveland boys break down the favorites, and Rick gives his perspective from years of playing the course and covering the tournament.

Stream all episodes here.

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