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Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project. Read more about the project by clicking here.

While running for governor in 2019, then-Lt. Gov. Tate Reeves was quizzed at a Capitol Press Corps luncheon whether his opposition to expanding Medicaid coverage to working-poor Mississippians was softening.

“I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I am opposed to Obamacare expansion in Mississippi. I don’t know how many ways I can explain this to y’all,” Reeves said.

Reeves’ fellow Republican House Speaker Philip Gunn has frequently given equally deep and erudite explanations of his steadfast opposition to accepting $1 billion a year in federal money to help the working poor and Mississippi’s distressed hospitals.

“From what I know about it, we cannot afford it,” Gunn said tersely to questions as the 2021 legislative session ended, obviously not wanting to discuss the issue further.

For more than a decade, despite most other states expanding Medicaid and despite hospitals, doctors, economists and experts saying it would be a net benefit to the poorest, sickest, most uninsured and most federally dependent state in the country, most of Mississippi’s top elected leaders have refused the offer.

As some hospitals across the state close their doors and others struggle on the brink of collapse — even as the state budget sees record gains from other federal spending — Mississippi leaders’ recalcitrance growingly appears more political than pragmatic.

Reeves and Gunn, who can block expansion from their posts, remain steadfast in their opposition. Republican Lt. Gov. Delbert Hosemann has said he’s open to the idea, as are a small but growing number of legislative Republicans. But Hosemann avoids even saying the words “Medicaid expansion” and hasn’t pressed his colleagues on full expansion. He has, unsuccessfully, pushed for expanding postpartum Medicaid coverage for mothers.

Q&A: What is Medicaid expansion, really?

Notably, all three top leaders declined interviews or comments for this story. Medicaid expansion hasn’t gotten a real hearing with the Legislature in years, even as the federal government has tried to sweeten the deal and counter arguments against expansion.

At times, including recently, some state leaders have said they would instead prefer people to have good jobs that provide private insurance. But this has proved elusive, with Mississippi seeing slow job growth, the lowest median income in the nation and among the highest rates of uninsured people.

Mississippi Today compiled a list of the main arguments against Medicaid expansion that opponents have given over the last decade, with counterpoints from proponents:

We can’t afford it/it will tank the state budget

“I don’t see Medicaid expansion as something that is beneficial to the state of Mississippi,” Gunn said in 2021. “I just don’t think the taxpayers can afford it. That is what it boils down to is the taxpayers. It is their money. I just don’t have the taxpayers calling saying we want you to raise taxes so we can expand Medicaid.”

So far, Medicaid expansion hasn’t tanked any states’ budgets, nor have any been forced to raise taxes to cover ACA Medicaid expansion.

Numerous studies, including those by Mississippi’s state economists, say the state — including government coffers — would see a net economic benefit, including growth in GDP and population and the creation of thousands of jobs.

Studies in Arkansas, Kentucky, Louisiana, Michigan, Montana and Virginia showed the states saw a net reduction of more than 4% in spending on their traditional Medicaid programs after expansion. Louisiana’s Medicaid expansion in 2016 brought a 33% reduction in uncompensated care costs for hospitals, including a 55% reduction for rural hospitals.

READ MORE: Here’s what experts say about expanding Medicaid in Mississippi

The federal government will quit paying its share

“For us to enter into an expansion program would be a fool’s errand,” then-Gov. Phil Bryant said in 2014. “I mean, here we would be saying to 300,000 Mississippians, ‘We’re going to provide Medicaid coverage to you,’ and then the federal government through Congress or through the Senate, would do away with or alter the Affordable Care Act, and then we have no way to pay that.”

But the Affordable Care Act, including Medicaid expansion, has survived through three presidents, including Republican Donald Trump who wanted to do away with it, and through multiple congresses, including two under Republican control of both chambers. It has survived numerous court challenges (Mississippi has joined in at least a couple of those).

Mississippi leaders made the same argument to postpone adopting the Medicaid program when it was created in the 1960s. It was one of the last states to do so, in 1969. Arguments that the feds would stop funding it and leave Mississippi in the lurch have proved erroneous, and the Magnolia State has enjoyed the highest rate of federal reimbursement for its existing Medicaid program for many years.

It’s subsidizing people who won’t work/it’s more welfare

“We believe all able-bodied folks ought to get off the couch and go to work,” state Agriculture Commissioner Andy Gipson, a longtime former lawmaker, said at the Neshoba County Fair in July, mirroring comments many other leaders have made over years. “This is why we oppose Medicaid expansion.”

By its definition, covering people who make up to 138% of poverty level income, Medicaid expansion is aimed at helping the working poor.

“These are people that are working,” said Tim Moore, president of the Mississippi Hospital Association. “By definition, to be at 138% above poverty, you have to have income from somewhere. In fact these are people that are often working multiple jobs, but still don’t have the discretionary income to afford the high cost of premiums.”

“Medicaid expansion is not about putting people on the welfare rolls,” state Insurance Commissioner Mike Chaney said last year. “This is about expanding health care availability to the poor, the disabled, the folks that fall through the cracks, that are not able to get on the Affordable Care Act.”

READ MORE: How Medicaid expansion could have saved Tim’s leg and changed his life

It would drive up private insurance costs, especially if hospitals help pay for expansion

“If hospitals are going to pay for it, that means that your cost when you go to the hospital is going to go up,” Reeves said during a 2019 gubernatorial election debate, referring to Mississippi hospitals offering to pay the state’s share of expansion. “If you have private insurance, that means that your insurance rates are going to go up.”

Others over the years have warned that expansion in general would drive up private insurance premiums.

But driving down uncompensated care costs for Mississippi hospitals, which has hovered around $600 million a year (lowered temporarily a bit recently because of federal COVID-19 relief money) would allow hospitals to lower prices, Moore said. One recent study said expansion would cut Mississippi hospitals’ uncompensated care by an average of $251.6 million a year from 2020-2030. The same study projects private premiums paid each year would also fall by $52.6 million over the same period.

“Treating people with no coverage forces the costs onto everyone else,” Moore said. “Plus, if people have coverage, they get care in a more timely, more efficient manner. You have less chronic problems, less higher-cost problems.”

As for hospitals paying the state’s share of expansion, as MHA proposed with the MS Cares plan in 2019, Moore said that’s a moot point now, because Mississippi hospitals are struggling so bad financially now that they couldn’t afford to do it.

Medicaid is broken, full of fraud and provides poor health outcomes

When Mississippi lawmakers in 2017 passed an act aimed at preventing fraud in Medicaid and welfare, one concern cited during debate was that there were dead people on Medicaid rolls.

“Are you talking about dead people on the rolls of Medicaid?” one lawmaker asked then-Senate Medicaid Chairman Brice Wiggins, R-Pascagoula. He responded: “I am talking about everybody, yes. It doesn’t matter if it is dead people. It doesn’t matter if it is people double dipping. They need to be following the law.”

Medicaid doesn’t provide money to beneficiaries. It provides health care, and money goes to providers. As several lawmakers pointed out at the time, it would be hard for dead people to be receiving health care.

Many, including some state politicians, appear to conflate Medicaid with “welfare.” Medicaid is a state-federal health insurance program that, in Mississippi currently, is available only to the disabled, elderly poor people, poor pregnant women and poor children. An able-bodied adult cannot simply be poor and qualify for Medicaid.

Mississippi has been plagued with fraud, corruption or misspending in Medicaid, welfare and other government programs. But this has been mostly committed by politicians, bureaucrats, business people, or large corporations. Beneficiary fraud in all these programs would appear to be a smaller problem.

It is true that Mississippi Medicaid beneficiaries have very poor health outcomes. But given that a large portion of qualifying beneficiaries are very sickly and poor to begin with, this would appear self-fulfilling prophecy. The aim of expansion is to cover the healthier, working poor and provide more preventive care.

“If you start early and provide health care, the outcome is better,” Moore said. “If you put off treating a condition, it gets worse. Diabetes is an example. You have an individual that doesn’t have health care coverage and they have neuropathy but put off treatment. They get a hole in the foot that gets infected. Then they lose a leg. Or they lose eyesight or have renal failure. Then all of a sudden they have a disability and can’t work, and they have to be taken care of. But we could have prevented it, and we could have managed the cost much better.”

The post Who’s opposed to Mississippi Medicaid expansion and why? appeared first on Mississippi Today.

Note: This article was published in partnership with The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system. Sign up for their newsletters, and follow them on Twitter, Instagram and Facebook.

Mississippi’s state auditor on Monday demanded a private prison operator pay nearly $2 million after the company improperly billed the state for thousands of prison guard shifts that were never actually worked.

State Auditor Shad White announced the demand — the result of an inquiry his office launched in late 2020, following an investigation by The Marshall Project that revealed the company’s ghost workers practice.

White’s audit found that Management & Training Corporation, the country’s third-largest private prison company, did not notify or credit Mississippi’s Department of Corrections when staffing at a prison run by MTC fell below minimum requirements, as agreed to in their contract. The auditor is demanding about $1.4 million for unfilled shifts between 2017 and 2020, and just under $600,000 in interest and recovery costs. White called it one of the largest demands issued during his four years in office.

“We look forward to a swift recovery of these funds,” White said in a press release. MTC has 30 days to make payment, the auditor’s office said, or the case will be referred to the state’s attorney general.

MTC spokesman David Martinson declined to answer questions Monday. In a statement, he wrote the company has paid vacancy penalties under the terms of the contract, and that the auditor’s demands are inconsistent with the contract. He did not elaborate.

The Marshall Project investigation showed how MTC collected millions of dollars in Mississippi by routinely charging the corrections department for vacant security positions the company was required to fill. The practice illustrated a perverse financial incentive unique to private prisons: While fewer workers meant more danger for staff and incarcerated people, it created more profit for MTC.

The news investigation highlighted the experience of Correctional Officer Darrell Adams, who was nearly killed in 2019 when he was attacked by a prisoner during an overnight shift where Adams was doing the work of eight officers in four different buildings.

Adams worked at the Marshall County Correctional Facility, near the Tennessee border, where the state’s audit found that MTC billed for 12,000 unfilled mandatory shifts in the four-year

period. MTC operated two other Mississippi prisons during the same period, but the auditor’s demand letter only addressed the Marshall County prison.

The Marshall Project also exposed a ghost worker problem at the two other MTC prisons. Using monthly invoices and data on vacant positions, the news organization estimated that between 2013 and 2019, the state paid MTC about $7 million combined for no-show workers at the Wilkinson County Correctional Facility, south of Natchez, and the East Mississippi Correctional Facility, near Meridian.

When asked Monday if payment would be sought from MTC for ghost workers at those other facilities, a spokesperson for the state auditor’s office wrote, “Our work is not over.”

The Marshall Project’s investigation in 2020 was published in partnership with The Clarion-Ledger, Mississippi Today and The Mississippi Center for Investigative Reporting.

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A Jackson-based conservative think-tank filed a lawsuit Monday that aims to clear up a bizarre legal conundrum in Mississippi: that abortion is technically both legal and illegal at the same time.

The Mississippi Center for Public Policy filed a lawsuit Monday in an attempt to get the state Supreme Court to reverse its 1998 ruling that said the Mississippi Constitution provides a right to an abortion.

That decades-old ruling — Pro Choice Mississippi v. Fordice — has been in conflict with two new state laws that took effect this summer after the U.S. Supreme overturned Roe v. Wade, which had previously established a national right to an abortion.

After the U.S. Supreme Court decision in late June overturning Roe v. Wade, two Mississippi laws went into effect. One banned all abortions except in cases of rape and when the life of the mother was in jeopardy. A second law banned all abortions except for cases of medical emergency.

But officials at Mississippi Center for Public Policy say those two laws are in conflict with the state Supreme Court ruling that said the state constitution provides a right to an abortion. The center’s lawsuit attempts to ensure the two new laws that restrict abortion are not negated by the 1998 Pro Choice Mississippi v. Fordice ruling.

“This legal uncertainty has placed Mississippi physicians in an impossible ‘Catch-22,’” said the center’s news release. “…Whether elective abortions are ‘lawful’ in Mississippi depends on whether the Mississippi Supreme Court’s opinion in Fordice is still valid.”

READ MORE: Mississippi, where abortion is technically both legal and illegal at the same time

The U.S. Supreme Court ruling overturning Roe v. Wade came in a case brought by Mississippi and argued by the office of state Attorney General Lynn Fitch. The landmark case — Dobbs v. Jackson Women Health Organization — resulted in the state’s only abortion clinic closing.

“In the Dobbs case, Mississippi secured a major victory for human rights and the rule of law,” said Aaron Rice, director of the Mississippi Justice Institute, which is the legal arm of the Mississippi Center for Public Policy. “Now it’s time to finish the job and protect the right to life in the state that took Roe down.”

The case was filed in Hinds County Chancery Court. The press release said it will be up to the state Supreme Court to ultimately rule on whether to reverse the ruling providing a right to an abortion in the Mississippi Constitution.

Right after the U.S. Supreme Court decision, Jackson Women’s Health Organization, then providing abortion services in Jackson, took legal action in Hinds County Chancery Court trying to block the enactment of the laws banning abortion in Mississippi. The Mississippi Center for Justice, arguing on behalf of the Jackson Women’s Health Organization, said that the state laws banning abortions would not trump the Mississippi Supreme Court ruling saying that the Constitution provided a right to an abortion.

READ MORE: Supreme Court rejects plea for quick ruling on effort to stop abortion ban

In an unusual ruling in early July, Chancery Judge Debbra Halford of Meadville, appointed to hear the case by the state Supreme Court, refused to block the laws banning abortions. One of her primary reasons for not blocking the laws is because she predicted the current state Supreme Court would reverse the ruling providing a right to abortion in the Mississippi Constitution.

The Mississippi Center for Justice appealed to the Supreme Court. But the state’s highest court refused to take up the case on an expedited schedule. During the uncertainty, Jackson Women’s Health Organization closed and the Mississippi Center for Justice dropped the appeal.

Now the conservative leaning Mississippi Center for Public Policy is trying to renew the case.

“We will review this lawsuit and consider whether we should intervene,” said Rob McDuff, an attorney with the Mississippi Center for Justice that represented the Jackson Women’s Health Organization.

The Mississippi Justice Institute has brought the lawsuit on behalf of the American Association of Pro-Life Obstetricians and Gynecologists, according to the news release.

The post Abortion is technically both legal and illegal in Mississippi. New lawsuit asks Supreme Court to clarify appeared first on Mississippi Today.

In this episode of Mississippi Stories, Mississippi Today Editor-At-Large Marshall Ramsey sits down with Janet Parker from Innovate Mississippi. Janet serves as the director of Business Development and marketing at Innovate Mississippi. She oversees all marketing, public relations, and corporate fundraising functions with the ultimate goal of working with partner organizations and companies to grow Mississippi’s innovation ecosystem — and the state economy.

She is a Mississippian by choice, heralding originally from Illinois. In her past life, she was vice president of public relations for Maris, West & Baker Advertising and a business consultant and communications coach working with Fortune 500 clients in the U.S., Canada and Trinidad.

If she looks familiar, she was the host of the Emmy-Award winning TV show, “Mississippi Outdoors” on MPB and has appeared on TV commercials, radio ads and print promotions. She also had an 11-year career as an award-winning pharmaceutical sales representative. In 2012, she was named one of the Business Women in Mississippi by the “Mississippi Business Journal”.

The post Mississippi Stories: Janet Parker appeared first on Mississippi Today.

The theme for the 2022 Restoration Summit, held every November at the Mississippi Coast Coliseum in Biloxi, was “purposeful restoration.”

“We’re not doing random acts of restoration,” said Chris Wells, executive director at the Mississippi Department of Environmental Quality.

In watching the state’s years-long effort to spend the roughly $2 billion provided to it from the Deepwater Horizon oil spill in 2010, stakeholders in the past have criticized Mississippi for not having a centralized game plan. Others questioned the state’s commitment to one of it’s purported top goals: improving water quality.

On Thursday evening, Wells addressed the former criticism head on while the state announced $65 million in new project spending between the RESTORE Act funds and the National Fish and Wildlife Foundation (NFWF)..

“A lot of these projects seem disjointed, they’re not independent of each other, though,” he said of the state’s efforts thus far. “We do try to piece this puzzle together. We know what’s good for water quality is good for oysters and vice versa, building marsh habitat and leveraging different projects against each other, being able to take a holistic approach to things.”

One example MDEQ presented is the $50 million Hancock County Living Shoreline: Hoping to improve shipping infrastructure, the state dredged sediment from the channel at Port Bienville, and then used the sediment to rebuild 46 acres of new marsh to Heron Bay. MDEQ is planning to add more marsh to the area with dredged sediment from Bayou Caddy.

Similarly, MDEQ pointed to a group of projects in Bay St. Louis, including a 20-acre non-harvestable reef the Nature Conservancy built with the long-term goal of repopulating local oysters. The state also built in the bay a 1,600-foot line of breakwaters comprised of concrete rings, which give oysters a place to grow and helps reduce erosion.

The state, which has currently obligated $809.8 million of the $2 billion it’s set to receive, will continue to receive funds from the BP settlement until 2031.

A lot of the state’s environmental projects, such as rebuilding marsh and improving water quality, are long-term efforts that have taken longer to receive funds, while many of the state’s completed projects so far — such as an aquarium in Gulfport and a science center in Pearlington — are aimed at economic restoration.

In the last year, according to the state’s project tracker, the project seeing the most money in spending has been improving the runway at the Trent Lott International Airport in Moss Point, with $4.2 million in expenditures from 2021 to 2022. Other projects that saw large amounts of spending in the last year include:

• Infrastructure improvements at Port Bienville: $3.7 million
• Constructing living shorelines and reefs: $2.5 million
• Water quality improvement through upgrading storm water and wastewater systems: $2 million
• Using dredged materials to restore marsh: $1.3 million

New project spending announced Thursday between the RESTORE Act funds and the National Fish and Wildlife Foundation (NFWF):

RESTORE projects (Direct component, Bucket 1):

• Lowery Island Restoration ($4.4 million) — create a marina and mixed-use district.
• Pearl River Community College Hancock Aviation Aerospace Workforce Academy ($2.09 million) — purchase equipment to support the establishment of PRCC Aerospace Workforce Academy.
• The Kiln Utility District and Fire District Water and Sewer Expansion Project ($3 million) — expand water and sewer to support increased development.
• Highway 609 Washington Street Gateway Phase II ($5.5 million) — construct pedestrian friendly features including sidewalks, crosswalks, and landscaped median under Phase II from Old Fort Bayou to Highway 90.
• Trent Lott International Airport North Apron Expansion ($2.4 million) — expand the north apron of the Trent Lott International Airport.
• Magnificent Mile: I-10 Highwqy 63 Corridor Improvement ($5.5 million) — investment in road infrastructure to alleviate traffic congestion and encourage development.
• Gulfport-Biloxi International Airport Secondary Runway Extension ($2.2 million) — funding will expand the secondary runway.
• Port Bienville Railroad Intermodal Expansion ($3.3 million) — construction of a 7-track classification yard and the addition of a truck-to-rail intermodal facility expansion.

RESTORE projects (Spill impact component, Bucket 3):

• Jones Park Expansion Parking Areas ($1.65 million) — expand parking areas at Jones Park.
• Walter Anderson Museum of Art Creative Complex ($1.2 million) — provide funding for facility construction and new program implementation.
• Mississippi Gulf Coast Community College Workforce Training ($4.95 million) — development of curricula and workforce development program designed to meet job market needs.
• Health Professions for our Community (HEALP): Health Professions Center of Excellence ($6.6 million) — project will focus on developing a Health Professionals Center of Excellence.
• Marina at Front Beach ($5.5 million) — funding to convert derelict shrimp processing plant to marina and event center.
• Institute of Marine Mammal Studies Outreach and Ecotourism ($875,000) — enhance and expand ecotourism around Gulf Coast marine resources.
• St. Stanislaus and Ocean Springs Environmental Education ($566,500) — enhance environmental science programs related to marine ecosystem education.

NFWF:

• Wolf River headwaters acquisition ($15,103,000) — acquire approximately 14,000 acres along the Wolf River south of Highway 53 to help improve water quality and quantity.
• Gulf Islands National Seashore ($1,578,000) — continue invasive species removal and control work out on the Gulf Islands National Seashore with the National Park Service.

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OCEAN SPRINGS — Amber Granger, 38, took her first health care job more than two decades ago as a nursing assistant.

She went back to school to be a lab technician, then moved into management. She dreamed of becoming a nurse but she couldn’t give up her income – or take on anymore student debt – for nursing school.

Her career aspirations sat on hold until the Singing River Healthcare Academy gave her the nudge she needed. The new academy is the state’s first-ever medical apprenticeship program.

The academy is part of the Singing River Health System’s – and state and local leadership’s – answer to the major staffing shortages plaguing the state’s health care system.

“If I can advance my career, continue to work, and provide for my family then why not apply?” said Granger, a Gulfport resident. “I got the call that I was accepted and it was surreal until my first day of school.”

Now Granger is on her way to become a licensed practical nurse. She’s in a cohort of 15 in the fledgling academy, which won’t have a dedicated homebase until a new complex is constructed. The program allows students to train for a host of much-needed health care jobs without charge and while getting paid for on-the-job training.

On Thursday, Gov. Tate Reeves gathered with hospital leaders to break ground on the academy’s planned four-story building. The new training center will be a short drive from Singing River’s Ocean Springs hospital campus on Bienville Boulevard.

“This transformative program is going to have a huge impact on the Mississippi Gulf Coast,” Reeves said during Thursday’s celebration. “And, quite frankly, it’s going to have a huge impact on the entire state of Mississippi.”

Singing River CEO Tiffany Murdock said the program projects to have 1,000 students in the fall of 2024. She plans to more than quadruple that annual count once the academy’s building is open to students.

Reeves said the academy fits the state’s overall approach to strengthening the economy through workforce development by ensuring Mississippians have access to training for the state’s most in-demand and high-paying positions.

“This academy will strengthen the pipeline of health care professionals in Mississippi,” he said, “and will help entice people to live, learn and work right here on the Mississippi Gulf Coast.”

Lauren Fernandez, a 33-year-old Ocean Springs resident, is one of the program’s recent graduates. The former Army medic is now a surgical technologist. She aids surgeons from a procedure’s start to finish.

“I had gotten out of health care for a while,” Fernandez said, “and I debated going back for surgical tech school. But then I saw the apprenticeship program and I was like, ‘This is meant to be.’”

In addition to practical nurses and surgical technologists, the program also trains nursing assistants, medical assistants, and phlebotomists.

Hospitals have been facing staffing shortages since before the pandemic, but the issues peaked as the worst of COVID-19 dragged on. Nurses left the field altogether, took on less-stressful nursing jobs outside a hospital setting, or became contracted travel nurses for higher pay.

Mississippi hospitals reported about 3,000 total nursing vacancies at the end of 2021, according to a survey by the Mississippi Hospital Association.

“I can’t be 2,500 people,” Granger said, referring to the state’s massive nursing shortages, “but I can fill the gap of one.”

The post Singing River breaks ground on Mississippi’s first medical apprenticeship facility appeared first on Mississippi Today.

Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project. Read more about the project by clicking here.

Perhaps no other federal-state policy has been studied and debated more than Medicaid expansion per the federal Affordable Care Act, including its potential impact on Mississippi — one of just 12 states that has not expanded the program.

A Kaiser Family Foundation report notes there have been more than 400 studies on the topic nationwide. And in Mississippi, the poorest and unhealthiest state in the nation, numerous studies have focused on what expansion would mean. A majority project net positive benefits economically, health-wise or both.

READ MORE: What is Medicaid expansion, really? Answers to common questions.

Expansion would mean someone making $18,754 a year (138% of the poverty level) would be eligible for health care coverage through the federal-state program. The federal government would pay 90% of the costs for those covered, with the state paying 10%.

When Medicaid expansion began Jan. 1, 2014, the federal government paid 100% of the costs, stepped down to 90% over years. Mississippi missed out on the larger matching rates from the federal government.

But under the recent American Rescue Plan, the 12 states that have not expanded Medicaid have been offered a financial incentive to do so. That equates to more than $700 million for Mississippi, and more recent studies have factored in those incentives.

The studies on Medicaid expansion in Mississippi

• Mississippi University Research Center/IHL, 2021: This analysis of the fiscal and economic impact of expansion was authored by state Economist Corey Miller and senior Economist Sondra Collins. It found expansion would add about 230,000 adults to Mississippi’s Medicaid rolls between 2022 and 2027. It would produce an average of 11,000 new jobs a year during that time and provide an additional $44 million a year to the state general fund.

The study found that expansion would increase the state’s gross domestic product by more than $700 million a year over five years, increase personal income between $539 million and $812 during the same period and increase the state’s population between 3,300 and 11,500 annually over the same period.

• Commonwealth Fund study, 2021: The study estimates expansion would cost the state $956 million over five years, while generating $1.2 billion in savings for a net gain to state coffers of $212 million. The study estimates expansion would provide coverage for about 230,000 adults.

• Urban Institute/Robert Wood Johnson Foundation national study, 2020: This was a study of the impact of expansion on the then 15 states that had not expanded Medicaid. The study projected that expansion in Mississippi would bring an increase of 207,000 enrollees and an increase in state Medicaid costs of $177 million a year, but did not attempt to calculate any increased revenues or savings.

• Perryman Group study of Mississippi Cares plan, 2019: This was a study of the Mississippi Hospital Association’s “Mississippi Cares” alternative expansion plan. MHA proposed creating a public-private partnership, expanding eligibility to adults earning up to 138% of the poverty level, but imposing a $20 a month premium on enrollees and a $100 copay for non-emergency use of hospital emergency rooms. Hospitals would cover remaining state costs. The Perryman study projected the plan would create an additional 36,000 jobs a year on average for the first 11 years and provide an increase in state tax revenue, a decrease in private insurance premiums and a reduction in uncompensated care costs of $252 million a year. The plan also included a requirement that unemployed beneficiaries enroll in job training or education programs.

• University of Alabama Birmingham study for Mississippi Health Advocacy Program, 2013: This study, by UAB’s Department of Health Care Organization and policy, modeled the impact of expansion on enrollment, state and federal costs, employment and state tax revenue from 2014 to 2020. It projected expansion would result in 212,362 more enrollees by 2020, would generate 19,318 additional jobs in 2020, with $200 million in additional state and local tax revenue. It projected an overall state budget savings of $34 million in 2020 and projected expansion would produce $2 billion in economic activity annually.

• Kaiser Foundation/Urban Institute national study, 2012: This study projected the effect of expansion on costs and enrollment nationally and by state from 2013 to 2022. The study projected expansion in Mississippi would cost the state about $1 billion for the period, and result in an additional 231,000 enrollees. The study listed the additional costs without estimates of any savings or increases in tax revenues.

• Mississippi University Research Center/IHL, 2012: This study projected the impact of expansion on Medicaid costs, enrollment, and net economic impact on the state budget from 2014-2025. The study used three scenarios, high, medium and low participation, predicting that high participation of an additional 310,000 enrollees was most likely. It predicted the state’s cost of expansion would be about $118 million by 2020, but that expansion would create about 9,000 new jobs a year and have a net positive impact on the state budget of nearly $65 million by 2020.

• Milliman Inc. study, 2010, 2012: The Mississippi Division of Medicaid contracted this analysis of Mississippi Medicaid’s budget exposure to the ACA from fiscal 2011-2020, and it was updated in 2012 and is still referred to frequently by opponents of expansion. The report modeled three scenarios – low, moderate and high enrollee increases and said moderate or low scenarios were most likely. The report projected under the moderate scenario that 243,000 additional adults and 67,000 more children would enroll and the state share of Medicaid costs would increase by $1.26 billion over the time period, including costs for current and additional enrollees. It estimated that by fiscal 2020, the state would see increased costs of $280 million a year.

The 2012 report modeled enrollment and costs from fiscal 2014-2020 under various scenarios. Under the higher enrollment scenario, it estimated expansion would cost the state $155 million a year by 2020. It focused on the Medicaid budget and did not estimate any cost offsets from other programs or from additional tax revenue.

The post Here’s what experts say about expanding Medicaid in Mississippi appeared first on Mississippi Today.

The Mississippi State Board of Education on Thursday approved a multi-million dollar contract to a company whose vice president chaired the state board until last spring.

The board voted 5-2 to approve the contract to the PATH Company to administer a loan program established by the Legislature earlier this year. The contract will pay up to $3.6 million over a four-year period, providing $1.2 million in the first year. Two members of the company’s leadership have ties to state government: Senior Vice President of Business Development Jason Dean is the former chair of the State Board of Education, and Co-Founder and Principal Nathan Wells is the former chief of staff to Speaker of the House Phillip Gunn. 

The Educational Facilities Revolving Loan Fund makes money available to school districts as a zero-interest loan for repairs and renovations of existing school buildings and new construction for pre-K programs or career and technical education facilities. In its first year of operation, the Legislature allocated $40 million to the revolving loan fund. 

The company will be responsible for reviewing the construction plans of districts to ensure that they are “critical infrastructure improvements” and adhere to building codes, as state law requires, and for tracking the repayment of the loans. 

When asked by Mississippi Today about the possible conflict of interest with Dean’s employment, the Mississippi Department of Education pointed to the Public Procurement Review Board manual, which establishes that former membership to a board is only considered a conflict of interest if it has been less than one year since the former member exited the board. Dean left the board in April 2021. 

Dean told Mississippi Today the contract was awarded through a public competition that numerous other construction management companies could have applied to, but did not.

“Obviously, I know people that are on the State Board of Education,” Dean told Mississippi Today. “I did not contact them and use any personal relationship at any point to influence the decision. I wanted it to be awarded to us objectively based on merits.”   

Bill Jacobs, a state board member, questioned spending such a large amount for reviewing construction plans and financial record keeping, and asked why PATH Company was overseeing the loan repayment program instead of an accounting firm or similar financial entity. 

Felicia Gavin, chief of operations for the Mississippi Department of Education, said the law creating the program allows no more than 3% of the funds to be spent on administrative costs, which the contract adheres to. Gavin also said that while the PATH Company was the only group to apply for this contract, the proposal met all the criteria, including their financial management abilities. On the company’s website, its work is described as “help(s) entities utilize technology to create better efficiencies in the areas of energy, water, and/or operations.” 

Dean added that PATH has internal financial managers, and the company stated in its proposal that it plans to bring in an additional accounting firm to assist in the financial management of the loans.  

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