The U.S. Department of Education has placed Mississippi’s public university system under a form of oversight that restricts the flow of federal financial aid dollars and hinders the creation of new academic programs, according to a letter obtained by Mississippi Today.
The Institutions of Higher Learning is planning to appeal the sanction, known as heightened cash monitoring. It comes after IHL was 75 days late in submitting its system-wide annual audit and financial statements for fiscal year 2022.
“This untimely audit submission constitutes a failure of financial responsibility under the Department’s regulations,” according to an Aug. 4 letter the federal education department sent to Gov. Tate Reeves, the IHL commissioner, and the presidents and financial aid directors of the eight public universities.
For the next five years, when Mississippi universities seek to cover tuition with federal financial aid dollars — everything from Pell Grants to student loans — they will be required to first provide certain documentation. Typically, universities are able to draw down federal funds in advance.
This creates an administrative headache because universities rely on federal financial aid to cover a significant chunk of tuition, and Mississippi is no exception. About two-thirds of full-time undergraduate freshmen at the public universities receive federal financial aid like the Pell Grant, according to the most recently available federal data.
“It’s a much bigger concern for small private colleges that are really tight on cash, but for a public system that has some money it’s much more of a slap on the wrist,” said Robert Kelchen, a professor of higher education finance at the University of Tennessee, Knoxville.
The more significant penalty is that IHL will also be required to submit any new academic programs for a full review by its accreditor, the Southern Association of Colleges and Schools Commission on Colleges, before the Board of Trustees can approve.
Sometimes universities need to extend credit lines or shift funds in response to heightened cash monitoring, but Kim Gallaspy, an IHL spokesperson, wrote in an email that the agency won’t need to do that. Reeves’ office did not respond to questions by press time.
To date, IHL has not publicly announced the stricter status, even though it was in place before the start of the fall semester. Just last week, some of the universities started notifying faculty and staff about it at meetings and via internal email.
Gallaspy wrote the reason for the delay was IHL’s third-party auditor, the national accountancy firm CliftonLarsonAllen LLP, needed more time to perform additional audits after discovering that “some institutions had inaccurately classified federal program funds,” including major programs. Gallaspy did not specify which institutions.
“To be clear, although the funds were misclassified there were no findings from our auditor which indicate that federal funds were inappropriately spent,” she wrote.
This resulted in IHL submitting its audited financial statements on June 14 of this year when they were due on March 31, according to the letter.
The letter asked IHL to upload information to an online portal if the agency believes it did not err in submitting its audited financial statements late.It’s unclear if IHL did that, though Gallaspy wrote the agency is working to appeal the decision.
“We have also required written corrective action plans to be submitted,” Gallaspy write. “These corrective action plans will be tested for effectiveness by the Board’s Office of Internal Audit. Ineffective corrective actions will warrant further corrective measures by the Board.”
It’s not unusual for universities to be sanctioned in this way by the U.S. Department of Education, according to Inside Higher Ed.
IHL will be joining six other universities in Mississippi that are under heightened cash monitoring as of June 2023, including Belhaven University, Coahoma Community College and Traxler’s School of Hair, a for-profit college in Jackson.
Students applauded, cried and jumped with excitement at the news that Mississippi’s first charter high school was approved Monday afternoon.
The school, Clarksdale Collegiate Prep, has been approved to open in the Clarksdale Municipal School District in the fall of 2025. It is an expansion of Clarksdale Collegiate Public, a K-8 public school already operational in the school district.
Two groups applied this year to open charter high schools in Mississippi, and Clarksdale Collegiate Prep was the only finalist. About 35 students and school employees came to Jackson today to watch the Charter School Authorizer Board vote on the proposal, which had been approved by an outside evaluator and passed unanimously.
Charter schools are free public schools that do not report to a school board like traditional public schools. Instead, they are governed by the Mississippi Charter School Authorizer Board, which oversees the application process to open a new charter school. They have more flexibility for teachers and administrators when it comes to student instruction, and are funded by local school districts based on enrollment.
Charter schools can apply directly to the authorizer board if they’re planning to open in a D or F district. If an operator wants to open in an A, B, or C district, they need to get approval from the local school board. Clarksdale Collegiate Prep will be opening in the Clarksdale Municipal School District, which is currently F-rated.
This is Clarksdale Collegiate’s second year applying to open a high school after having their application denied last year. Amanda Johnson, the executive director of the Clarksdale Collegiate schools, told Mississippi Today that she believed the school succeeded this time because they were two years out from opening instead of three, which allowed them to be more detailed in their application.
In her comments to the board asking them to approve the proposal, Johnson talked about her school’s commitment to the success of its students.
“We’re here in order to make sure we’re fulfilling the promise that we made to scholars back in 2017-18,” she said. “We told (families) we were putting their child on a path to go to and through college. So opening up a high school, even though it’s hard, even though it’s expensive, we believe that work is worthy and that our scholars and the scholars of the Delta deserve the absolute best.”
When the vote came up on the agenda, board member Jennifer Whitter said it gave her great joy to make a motion to approve the school.
Students began celebrating immediately after the vote was announced. Johnson said her students have been invested in this application process and have provided input at points, particularly the students who were present as they will be the first graduating class of the high school.
Johnson said her next steps include announcing the location of the high school to parents and the community, fleshing out the academic plans, and looking at merging the contracts for each school into one in order to reduce duplicates in reporting. Currently, each charter school in Mississippi is categorized by the state as its own school district, but the Authorizer Board is considering a process to allow schools run by the same operator to come under one contract.
Gov. Tate Reeves, after months of inaction, has unveiled a plan he says will turn Mississippi’s health care crisis around.
However, even some health care experts were stumped by how the Governor’s proposed reforms will work.
The plan, which Reeves announced at a press conference Thursday while flanked by state health care leaders, is essentially a complex scheme to increase extra payments hospitals get for treating patients on Medicaid — and notably doesn’t include Medicaid expansion.
Some Mississippi leaders say Reeves’ ideas aren’t even that new. It’s not certain they’ll be approved, either.
The announcement comes less than two months before Election Day, and after his opponent in the gubernatorial race, Democrat Brandon Presley, has repeatedly stated his intention to expand Medicaid if elected and largely campaigned on the state’s hospital crisis.
Two things were clear at the conference: Reeves claims the changes would put a much-needed $700 million in hospitals’ pockets, and he does not plan to expand Medicaid.
Everything else, however, was not as easy to understand.
How will Gov. Reeves’ plan work?
The plan relies on two major changes that bolster supplemental payments to hospitals for the care they provide to people with Medicaid. Supplemental payments are extra payments hospitals receive to offset low Medicaid reimbursement rates or uncompensated care, which is money hospitals lose caring for patients who are uninsured and can’t pay their hospital bill. Medicaid is a federal-state program that provides health coverage to millions of people in the U.S., including low-income adults, children, pregnant women, elderly adults and people with disabilities. The income requirement for people in Mississippi to qualify is extremely stringent.
The first is a change to the Mississippi Hospital Access Program, which typically pays hospitals for the gap between payments for services rendered for Medicaid managed care patients (which are usually lower) and Medicare patients (which are usually slightly higher). Under the proposed changes, hospitals will instead be paid for the gap between Medicaid patients and people insured by commercial plans, which tend to reimburse at higher rates.
The state Division of Medicaid was granted a similar change to the program in March for outpatient services, resulting in $40.2 million for hospitals. However, Medicaid officials had expected it to generate an additional $450 million. But because Mississippi’s average commercial rate is so low, the payout was much less.
What’s not clear is how, in Reeves’ plan, the average commercial rate results in nearly triple what hospitals typically get for these payments — going from a total of $562 million to $1.522 billion. Reeves didn’t say at the press conference what average commercial rate was actually being used (whether a state, regional or national rate).
Drew Snyder, Mississippi Division of Medicaid executive director, answers questions from the media after Gov. Tate Reeves announced his plans for a series of Medicaid reimbursement reforms during a press conference at the Walter Sillers Building in Jackson, Miss., on Thursday, September 21, 2023. Credit: Eric Shelton/Mississippi Today
When asked what had changed since the spring regarding these rates, Medicaid Executive Director Drew Snyder did not directly answer the question.
“I think the difference is, we got the right people in the room … sometimes it makes sense to get a second opinion,” he said before stepping back in line on stage.
The second initiative modifies the Upper Payment Limit Supplemental Payments, which are aimed at also increasing payments for hospitals that receive low payments from Medicaid. This program will yield an increase of an additional $137 million in fiscal year 2024, according to Reeves.
State leaders did something similar earlier this year after the Mississippi Hospital Access Program projections came in much lower than originally expected, said Tim Moore, former leader of the state hospital association. It resulted in an extra one-time payment of $137 million.
The supplemental payment programs are meant to reduce disparities in insurance payments and the cost of caring for uninsured people. By changing them, the state is drawing down more federal money because of our state’s high Federal Medical Assistance Percentage match, which is the highest in the country at 77.27% because of our state’s high poverty rate. Hospitals have to put up more in “bed taxes” for the state portion, and then the federal government matches.
In other words, if a Medicaid patient receives a service at a Mississippi hospital that costs $100, the hospital is reimbursed $77.27 from federal funds. The remaining $22.73 must be paid by the state – that $22.73 comes from the hospitals themselves in the form of a tax.
Harold Miller, leader of the Center for Healthcare Quality and Payment Reform described it this way: “When the state is paying for a Medicaid service, the state has to find the state share — that 23% — somewhere. They have to find that money, and ordinarily they would have to tax the taxpayers to do that.” Instead, Mississippi asks the hospitals for that money, he said.
In short, hospitals will have to pay $178 million in taxes for Mississippi Hospital Access Program payments to go up by $960 million, Upper Payment Limit payments will yield $137 millionand disproportionate share hospital payments — which make up the difference for hospitals that lose money on serving a significant population of Medicaid-insured and uninsured people — will decrease by $230 million because the other payments are bridging the gap. The net gain for hospitals will be $689 million total.
Who will the plan help?
Experts agree this plan will keep hospitals open for longer. Even if it’s unclear how the expected payments will increase, it’s still a significant amount of money — money that hospitals have been asking for for a long time. However, critics say it’s not ensuring more people receive health care.
According to federal data, Mississippi has the highest uninsured rate of people aged 18-64 in the country, as of September. About one in every six Mississippians is uninsured.
Emergency rooms by law cannot turn down people, regardless of their insurance status, who come for care — but doctors’ offices can and so can pharmacies. That means people who are uninsured in Mississippi, one of the unhealthiest states in the nation, cannot receive preventative care or medications that they need. They generally must rely on the emergency room for their health care needs.
“People typically need a lot more care than care in a hospital, and a lot of that care is preventive care… outpatient care,” said Adam Searing, an associate professor at Georgetown University’s McCourt School of Public Policy’s Center for Children and Families whose work focuses on Medicaid. “If you get cancer and you need prescriptions and drugs and outpatient care from a team of specialists, this has nothing to do with that. So, the key differences, this is an issue about the finances of hospitals.
“And Medicaid expansion is about financial security for families.”
How much money is it bringing to hospitals?
Reeves said a little over $689 million will go to the state’s hospitals under this plan.
And although he said Thursday the money would benefit all hospitals, it appears larger hospitals will benefit most, even though most agree that small rural hospitals are the facilities feeling the strain of the health care crisis most acutely.
Additionally, nearly half of the money — 45% or about $309 million — will go to hospitals that have left the state hospital association in recent months. In the spring, after the Mississippi Hospital Association’s PAC made a $250,000 donation to Presley, several hospitals left the organization.
Most of those hospitals’ leaders stood behind Reeves as he announced his plan Thursday.
Is this a new plan?
Reeves said at the press conference this plan has been in the works for four to five months.
According to Tim Moore, former head of the state hospital association, and another state leader, that’s not true.
A year ago, Moore learned of similar measures in Louisiana and brought the idea to state leaders. Lt. Governor Delbert Hosemann recently told Mississippi Today that hospital payment initiatives were discussed by stakeholders last year, but the Division of Medicaid told his office that those changes weren’t possible.
Will it cost the taxpayers anything?
Reeves repeated at the conference that the changes would come at no cost to taxpayers, though he noted Snyder and his division employees are paid by state tax dollars.
That’s mostly true — taxpayers will likely not feel the brunt of this big tax increase for hospitals, according to one expert. Even if hospital charges increase, it should be eaten by the insurance companies and services for people who are uninsured will continue to go uncompensated and be claimed as charity care.
Is it final?
The planis being submitted tothe Centers for Medicaid and Medicare Services for approval. Snyder estimated at the conference that the state would likely hear from the federal government within two to three months. If it’s approved, it would be retroactively effective beginning July 1, 2023.
It’s hard to say what the likelihood of approval is, though several other states have passed similar Medicaid reforms intended to draw down more federal dollars.
One expert said it was unlikely that Mississippi state leaders announced the plan without expecting CMS approval, and historically, the agency has erred on the side of keeping hospitals open — even if it comes at the cost of forgoing expansion.
How is this different from Medicaid expansion?
Medicaid expansion has long been pointed to as a solution to the state’s worsening hospital crisis. Republican state leadership – Reeves most prominently – has staunchly opposed the policy adoption, despite support from a majority of Mississippians.
At the press conference Thursday, Reeves repeatedly incorrectly referred to the program as “welfare,” and claimed the solution to the issue was putting more people in the workforce. He said if more people are added to Medicaid’s rolls, hospitals will keep losing money because Medicaid payments are so low.
That’s better than losing money on people who are uninsured, said Adam Searing, the associate professor whose work focuses on Medicaid.
“These are two disconnected things,” he said. “Reimbursement rates for hospitals and expanding Medicaid are completely separate issues.”
While hospital leaders agree that these policy reforms will make a huge difference for many hospitals in the state, it still might not be enough to single handedly solve the crisis. In other states, such as Louisiana, similar policy reforms work in tandem with Medicaid expansion to create a holistically supported health care system.
The way Moore sees it, the state is putting up $170 million for a $700 million net gain, when with expansion, it could put up $100 million for a $1 billion reward.
States that have not expanded Medicaid have been offered a financial incentive to do so — an estimated $600 million in federal funds over two years.
And, despite more hospitals that will probably be able to stay open as a result of these reforms, uninsured Mississippians still won’t have health care. That means they will have to continue to rely on emergency rooms for their medical care — the most expensive place to receive health care — and uncompensated care costs will continue.
Searing said these reforms “improve the financial bottom line for some hospitals” and keep them open longer, but people are still going without health coverage.
“You’re really not solving the problem,” he said. “You’re just putting a Band-Aid on one aspect of it.”
In this edition of Mississippi Stories, Mississippi Today Editor-at-Large Marshall Ramsey sits down with Stacey Trenteseaux, Executive Director of Opera Mississippi and a fantastic soprano opera singer.
Stacey talks about how she discovered her talent, her professional journey and tells about Opera Mississippi, the 9th longest continuously performing opera company in the United States.
Check out this week’s Marshall’s Mississippi newsletter and see a cartoon I drew about this very topic — during the Fordice/Musgrove years! Nothing is new under the sun.
Buoyed by a series of tweets from State Auditor Shad White belittling certain liberal arts degrees as “garbage,” “useless” and “indoctrination factories,” a recent report from his office calls for Mississippi to change how it funds higher education by stripping public money from programs that don’t support the state’s economy in favor of those that do.
But in an interview Friday afternoon, two days after the report was released, White said he could not think of any lawmakers who had reached out to him about setting up a committee — the report’s central recommendation — to study revamping higher education funding in Mississippi.
“I’m wracking my brain,” he said. “Not a ton (have reached out) because it’s just been out for two or three days.”
White said he expects some inquiries but his guess is that hard copies of the report, which were prepped for a number of powerful elected officials — the governor, the lieutenant governor, the speaker of the house and members of key legislative committees — haven’t arrived in the mail yet.
The state auditor’s office does not have policy-making power, so for now, White is reliant on champion lawmakers to turn his recommendations into reality.
“I’m trying to think if a legislator has texted or called me,” White said. “I don’t recall any right offhand that specifically mentioned the report.”
The eight-page report is part of a yearlong effort by the auditor’s office to propose solutions to Mississippi’s intractable “brain drain,” the phenomenon in which college-educated people leave the state for better-paying opportunities elsewhere, in effect subsidizing the economy’s of nearby states.
If Mississippi could retain just a few more graduates seeking highly paid jobs like engineering, the report said it would be a multimillion-dollar boon to the economy.
“State appropriations should focus on the degree programs our state’s economy values most,” the report states. “Otherwise, taxpayers will face the repercussions of an inadequate workforce and a declining population.”
The brain drain is an issue that has concerned lawmakers across the political spectrum and, in recent years, led to bipartisan proposals in Mississippi to incentivize graduates to go into crucial fields, like teaching and nursing, that are experiencing dire shortages.
State agencies already have some policies that take this into account. The Institutions of Higher Learning, which oversees public universities in Mississippi, evaluates programs based on the state’s workforce needs. The state’s community colleges are trying to expand workforce development programs.
What White is proposing goes further. Though he is not advocating for “abolishing” certain degrees, White said it’s not enough to simply let the market guide Mississippi college students to degrees that lead to higher-paying jobs — which, by and large, is what’s already happening.
Rather, state government intervention is necessary to ensure taxpayers are seeing a return on investment in higher education, White said.
“What I’m suggesting is that we take a hard look at how we’re spending money, and we add more money to those programs of study,” he said, “by … taking those dollars away from programs of study that aren’t economically beneficial to taxpayers.”
Toren Ballard, an education policy analyst at Mississippi First, said it’s important to understand that taxpayers are not really footing the bill for the state’s universities. This year, state appropriations comprised just 21.5% of IHL’s operating budget.
As state funding for higher education has plummeted since 2000, the cost of tuition has ballooned, putting the onus on Mississippians to pay for college, leading them to choose career paths that help them afford it, Ballard said. That’s one reason he thinks the report’s recommendation is largely unnecessary, though he hopes it could lead to more funding for higher education.
“I think we’re not giving enough credit to individual student decision making here,” Ballard said.
Al Rankins, the IHL commissioner, seemed to agree. In a statement, he said it would “appear more productive” to address Mississippi’s brain drain by creating more career opportunities.
“University students are adults who choose their majors based on their interests and career aspirations,” he said. “After graduating some choose to pursue opportunities in other states for a myriad of reasons outside of the control of our universities.”
White said that when he was choosing his undergraduate major — political science and economics from the University of Mississippi — that he wished he had access to data showing what he could expect to make when he graduates.
“If I had to think it over again, I would rethink majoring in political science,” he said.
So what degree programs does Mississippi’s economy value most, according to the auditor? The report begins with a graph that measures value as a trade-off between the median income a graduate can expect to make and the likelihood they will stay in Mississippi.
The state auditor said that based on the findings the report, he would rethink majoring in political science. Credit: Courtesy Office of the State Auditor
In the top-left corner of the graph are higher-paid graduates who are more likely to leave, like business and engineering degrees. The top-right corner shows higher-paid graduates who were very likely to stay, including health professions and teachers. “All other degree types” are largely in the middle.
Right now, the report says, the state funds all those degrees at the same amount, even though some degrees cost more to offer.
Ballard noted the report did not consider graduates who go directly to law school or medical school, potentially lowering the median income of majors like sociology that the auditor denigrated online.
“That’s why engineering degrees look particularly good here,” he said.
White said the goal of the report — and his social media posts — was not to be comprehensive but to “initiate a conversation around this question.”
But that doesn’t mean he’s taking back anything he wrote.
“I’m defending it,” he said. “I’m telling you that we have to address these ideas in a way that is plain and clear, and if you shroud it in technocratic jargon, nobody will care.”
Republican Gov. Tate Reeves said he’ll have debates — plural — with his Democratic challenger Brandon Presley, but those haven’t been agreed to or scheduled yet as the clock ticks down to the Nov. 7 election.
“Our team is working with their team,” Reeves said at a press conference on Thursday. “I have been pretty busy … I am letting the campaign team work on that. But I am sure we are going to have debates. We have always had debates.”
Presley has accepted debate invitations from WJTV in Jackson and stations across the state owned by Gray Television. On the campaign stump, he has accused Reeves of “hiding out” and dodging debates.
“He doesn’t want to debate,” Presley said last week. “… He won’t even show up in his own TV commercials to talk to the people of Mississippi. So, I highly doubt he’s going to have the guts to stand toe-to-toe with me in a debate. His ads that he’s running are bald-faced lies, and he doesn’t have the guts to stand on a stage and look me in the face and say these lies and so he won’t agree to any debates.”
Reeves’ count on Thursday portends any debates would be spicy, should they come to fruition.
“I’ll be honest with you, I look forward to getting on the stage with that individual, who seems to have a really hard time telling the truth,” Reeves said. “It doesn’t matter the topic, he has a pretty easy time lying … I give him credit, he’s a really talented politician — that is to say he’s willing to lie about anything. He’s willing to stand in any room and say what he thinks they want to hear, and then he goes to the next room and says something exactly opposite based upon what he believes their views are.”
Conventional wisdom is debates would be most likely to help a challenger such as Presley, trailing the incumbent in campaign cash and name recognition.
Every Mississippi gubernatorial election since at least 1987, with the exception of one, has seen candidate debates, in most cases multiple debates. In 2015, incumbent Gov. Phil Bryant did not debate his Democratic opponent Robert Gray.
As Gov. Tate Reeves announced his plan to save Mississippi’s rural hospitals, the state hospital association’s longtime leader prepared for his last day at the organization.
Tim Moore, who’s led the Mississippi Hospital Association for a decade, confirmed to Mississippi Today that the board fired him. His last day in his current position is today. He will stay on in another capacity to help with the transition until Nov. 30.
“The board made a decision to execute a unilateral separation that’s in my employment contract,” Moore said when reached by phone. He declined to say when the decision was made but said he has known about it “for some time.”
The Mississippi Hospital Association’s Board of Governors released a statement Friday at noon about Moore’s termination.
“The Board is grateful for Mr. Moore’s service over the past 10 years,” it reads. “The Board will immediately begin a search for a new President and CEO to lead the MHA. MHA will continue its mission of serving its members in the promotion of excellence in health through education, public information, advocacy, and service.”
The decision comes months after a handful of hospitals cut ties with the Mississippi Hospital Association following a $250,000 donation from the group’s political action committee to Reeves’ opponent in the gubernatorial race, Democrat Brandon Presley.
It was the PAC’s largest donation in history.
Moore, who led both the organization and its PAC, was criticized harshly in the weeks that followed the decision, though he maintained he was acting out the wishes of the association and its directors.
The hospitals that left the organization included the state’s largest public hospital, the University of Mississippi Medical Center. UMMC’s leaders, Dr. LouAnn Woodward, vice chancellor for health affairs and medical school dean, and Dr. Alan Jones, associate vice chancellor for clinical affairs, stood at the governor’s right hand as he announced his plan at a press conference Thursday, along with almost all of the leaders of the hospitals that previously left the association.
The only health care leader on stage whose health care facility had not left the organization was Gregg Gibbes, CEO of South Central Regional Medical Center.
On stage, Reeves said the health care leaders had approached him a few months ago after the “conversation had devolved around health care in Mississippi.”
Moore said the governor had a “huge impact” on the hospitals’ decisions to leave the organization. He did not offer any further details.
“My concern is not for me — I’m fine,” he said. “But I’m afraid we’ve got a lot of hospitals that are not going to get the representation that they need because people will not stand up for them, and that’s going to be a problem. That’s going to affect health care in the state of Mississippi.
“I wish the best for the hospital association and the membership,” he added.
The Mississippi Hospital Association, a member of the American Hospital Association, represents the interests of Mississippi’s hospitals and advocates for health care policy change, including Medicaid expansion. They also offer services to member hospitals, like a health information exchange program and educational courses. According to its website, the MHA comprises over 100 hospitals, health care systems and other providers, as well as over 50,000 employees.
None of those hospitals, as of today, has rejoined the organization.
While a search is ongoing for a new leader, Kim Hoover, the chief operating officer, will maintain operations of the organization.
