SirSandra Jordan had worked in public education in Starkville for 24 years when she decided in 2018 to move away.
The youngest of her two kids had left for college on a football scholarship. She was due to retire in a few years. And she wanted to take care of her uncle, who lived with the rest of her family in Carrollton, a 181-person town on the edge of the Delta.
SirSandra Jordan
At the time, Jordan was an administrator in facilities management at Mississippi State University, overseeing the department’s credit cards. Her salary was $36,000. It had been barely enough to cover her expenses when her youngest lived at home, but it was also the most she’d ever made.
Jordan looked for local jobs in Carrollton, but none paid more than $30,000. Rather than take a pay cut, she kept working at MSU, where she’s still employed today.
Most days, Jordan leaves her house around 5 a.m. for the 70-mile, one-way drive. She maintains a modest lifestyle. Her fridge is rarely stocked; she often splits the same meal between lunch and dinner. Since gas is her biggest expense, she sometimes stays in Starkville with friends who cook for her. She’s had to defer car payments and borrow from family.
When money is tight, Jordan, who is diabetic, said she gets “so consumed and overwhelmed with finances that I just forget to take care of my own self.” She puts sticky notes on her bathroom mirror to remind herself to eat.
“With God’s help, I’ve survived and I’ve been able to maintain some type of livable life as a single mom with a son in college in another state,” Jordan said. “But it’s been a struggle, a true struggle for me.”
Jordan’s story is common among the nearly 25,000 people who work at Mississippi’s eight public colleges and universities. Like their K-12 counterparts, higher ed faculty and staff in Mississippi, no matter their institution or rank, are among the lowest-paid in the South, according to the Southern Regional Education Board.
These low salaries are among the lingering effects of the Great Recession, which began years of divestment in higher education by the Legislature. Like the rest of the country, Mississippi slashed its higher ed budget at the height of the financial crisis. But as neighboring states have slowly increased funding for higher ed in the years since, Mississippi’s spending per student continues to drop. To make up the shortfalls, community colleges and universities have increased tuition, but it has not been enough to fund regular across-the-board pay raises.
Year after year, the Institutions of Higher Learning and the Mississippi’s community colleges ask the Legislature to set aside funds for raises. This past session, IHL asked for an additional $29.5 million for a pay raise that would “begin moving faculty salaries to the SREB average.” The community colleges asked for $10 million, enough for a 3% across-the-board raise.
Their requests were granted — sort of.
In the final week of the 2021 legislative session, lawmakers eked out an agreement to set aside $12.5 million in general fund revenue for salary increases for higher education employees — $9.2 million for the public universities, and $3.3 million for the community colleges. This is enough for a 1% across-the-board pay raise, which will go into effect July 1. Campus leaders could grant some employees a 5% raise and others none.
For Jordan, a 1% raise would be about $35 a month.
“Something is better than nothing,” Jordan said. “But it’s effectively nothing. It’s not even a tank of gas for me. It’s really not anything of significance to someone like me.”
The Legislature most recently set aside money for salary increases for higher ed employees last fiscal year. About $874,000 was allocated for pay raises for community college employees, and another $1,951,762 was appropriated for universities that had not received a state-funded raise in the last three years.
Despite these appropriations, real average salaries for higher education employees in Mississippi have actually fallen since the Great Recession.Faculty at Mississippi’s public universities make nearly $1,500 less than they did in 2007, before the Great Recession, according to the SREB.
Community college instructors have experienced an even bigger drop in real average salaries — about $4,100. In years when the Legislature doesn’t allocate additional funds for raises, public universities can draw on their large endowments, pricey tuition fees and deep-pocketed alumni to increase salaries anyway. Community colleges don’t have those kinds of resources, so it’s harder for them to afford raises in years without state funding.
At Southwest Mississippi Community College, increasing employee pay according to the salary schedule has been “a balancing act” without commensurate state funding, said Steven Bishop, the president.
“If we get a cut in the appropriation and no money for a raise, it is very challenging,” to afford raises, Bishop said. “We have to muster up our resources, if you will, to determine if we can develop a raise.”
Some of the factors that influence whether SWMCC can afford a raise by itself in any given year, Bishop said, include revenue from increased enrollment and tuition, and the number of retirees.
“When a person or an employee retires,” Bishop said, “we hire another person. Typically they don’t have as much experience, so they get paid a little less.”
When Renee Moore, the chair of the english department at Mississippi Delta Community College, retires this July, she won’t be replaced. Since the award-winning educator started teaching at MDCC fifteen years ago, she has watched colleagues juggle side jobs, department budgets dwindle, and open positions go unfilled.
After years of state divestment in community colleges, Moore said a 1% raise is “insulting, really, and it’s short-sighted.”
“The Legislature is abdicating, just neglecting its responsibility,” to fund education, she said. “It is basically saying, ‘Here’s a little scrap of money. Do what you can with it.’”
At University of Mississippi, Conor Dowling, an associate professor of political science, said a 1% raise won’t do much for faculty and staff, especially those affected by the coronavirus pandemic. More than a year into the pandemic, many departments had prepared for painful budget cuts. Some adjuncts were told there likely won’t be jobs for them come the fall, said Dowling, who organizes with United Campus Workers, a union affiliated with Communication Workers of America. Several programs cut funding for prospective graduate students, leading some to decline admission to UM in lieu of better-paying schools.
“One percent doesn’t correct for long-standing reductions in state support for higher ed,” Dowling said. “It’s not enough and it’s a little late … especially for those who are rightfully concerned about what the future brings.”
Other UCW members, such as Michael Forster, a professor of social work at University of Southern Mississippi, are concerned the raises may not be equitably distributed among faculty and staff, since campus leadership can choose to forgo an across-the-board raise in order to give some employees a 5% raise and other none. IHL has historically directed university leadership to disburse raises based on merit, market and equity adjustments, and promotions. Forster said he would urge universities to use the funds to bring salaries in line with the cost of living.
“It’s like (lawmakers) don’t want to see anyone getting any money they don’t deserve,” he said. “If you’re breathing and you still have a job, you’re entitled to a cost-of-living increase.”
The kicker for many faculty and staff is that while their pay has stagnated, top administrators have seen their salaries shoot up. In 2019, the presidents of the state’s eight public universities had salaries ranging from $215,000 at Delta State University to $800,000 at Mississippi State University.
Jordan plans to retire as a state employee next year. She will collect a pension on the most money she’s ever made, which is around $42,000. She plans to find another full-time job closer to Carrollton, which she hopes, when combined with her retirement check, will provide her more financial security.
“It’s always unfair,” Jordan said. “The ones who make more always get more. The ones who make less always stay at the bottom.”
The medical marijuana program Mississippi voters approved in November, set to begin in August, hangs in the balance with the state Supreme Court, which heard oral arguments about Initiative 65 on Wednesday.
The arguments have nothing to do with medical marijuana or the program voters enshrined in the state constitution, but on procedural issues — whether Initiative 65’s placement on the ballot through a signature petition was constitutionally proper.
Chief Justice Michael Randolph indicated the nine-judge court would issue an opinion as quickly as possible and, “I know many people are waiting on this.”
“It’s in the judges’ hands now,” said Madison Mayor Mary Hawkins Butler, who filed a Supreme Court challenge to Initiative 65 just days before voters approved it on Nov. 3. “This is one of those defining moments for our state. Maybe we can take care of other antiquated laws that are hindering our progress and our growth.”
Hawkins left the high court’s chambers without taking further media questions Wednesday.
Secretary of State Michael Watson, who took office after the November elections, said “brilliant attorneys” on each side of Butler v. Watson made compelling arguments and regardless the outcome, “we’re all friends, we’re all Mississippians and we’ll move forward.”
Butler argues that the ballot initiative language added to Section 273(3) of the state constitution in 1992 requires proponents to gather signatures evenly from five Mississippi congressional districts — with no more than 1/5, or 20% coming from any single district — to ensure geographic parity.
But Mississippi has had only four congressional districts since the 2000 Census. Butler argues it’s a “mathematical certainty” that of the nearly 106,000 certified voter signatures collected from what are now four districts to put Initiative 65 on the ballot last year, signatures from at least one of the districts surpasses 20%.
Secretary of State Michael Watson speaks with media after oral arguments were presented before the state Supreme Court regarding Initiative 65 on medical marijuana Wednesday morning in Jackson. Credit: Vickie D. King/Mississippi Today
Watson argues that while a panel of federal judges ordered Mississippi to use a four-district map for congressional elections, the Legislature never adopted it in state law and “five congressional districts exist under state law and may be used for anything but congressional elections.” The old districts are still used for appointments to state agencies, boards and commissions. Watson’s lawyers from the attorney general’s office say Watson’s predecessor, now Lt. Gov. Delbert Hosemann, properly certified Initiative 65 petition signatures using the five old districts in state law.
Lawyers on both sides argued Wednesday that “plain language” reading of the passage in the state constitution makes their case.
“(The) language is plain, and a congressional district is the area from where a member of Congress is elected,” said Kaytie M. Pickett, attorney for Butler. “We have four … Ask anybody on the street how many we have, they’ll say four … Qualified elector — those words matter, too … Someone cannot be a qualified elector of the fifth district … a district that does not exist.”
Deputy Attorney General Justin L. Matheny, representing Watson, said a plain reading of the entire ballot initiative section of the constitution makes clear voters have the right to amend the constitution at the ballot box, and the 1/5 petition signature requirement is simply to make sure they are geographically dispersed. Both stipulations were met with Initiative 65, Matheny told justices. He said the section also prohibits the Legislature from doing anything to impair voters’ rights to a ballot initiative.
Justices noted that state congressional districts have changed and will continue to change with population shifts. Matheny said this shows the intent of constitutional framers was not to have the initiative right nullified by a change in congressional districts.
“We don’t think the intent was to set up something impossible,” Matheny said.
Justice Kenny Griffis said he understood the Legislature in the 1990s was reluctant to allow voters to approve a ballot initiative process and did so “kicking and screaming.” He questioned whether some of the wording had the “intent of defeating the ability of people to change the constitution.”
Chief Justice Randolph’s questioning of Matheny was at times pointed and sharp.
Chief Justice Michael Randolph poses a question during oral arguments regarding Initiative 65 on medical marijuana Wednesday morning in Jackson. Credit: Vickie D. King/Mississippi Today
“You want me to go to a statute in order to interpret the constitution?” Randolph told Matheny. “I’ve got a problem with that … The dictionary says a congressional district is a part of a state from which a member of the U.S. House of Representatives is elected … If the words are clear, everybody in this room including you agrees we have four congressional districts. Why go anywhere else? What license do we have to go past the plain language, outside of that?”
Justices Robert Chamberlin and James Maxwell II questioned Pickett why the Legislature and voters would have adopted a constitutional amendment thinking it would be subject to Census changes.
“Your position is the Legislature adopted this with the understanding it could be impossible to meet in 10 years or less?” Chamberlin said.
Maxwell said: “So if we lose a federal representative, through federal law, it means our citizens don’t have the means to change our state constitution? Somehow those two things are related?”
Justice Josiah Coleman noted the state statute with five congressional districts “has never been declared unconstitutional, we’ve never been asked to declare it so.” Pickett responded that “a statute cannot change the plain meaning of the constitution.”
Justice Dawn Beam at the outset of the hearing noted her children were watching a livestream of the proceedings, “and I want to make clear, it is totally irrelevant what this court thinks about or how we voted on Initiative 65” but the court will make its decision on constitutional issues. Medical marijuana was barely mentioned during Wednesday’s hearing.
Attorney Kaytie Pickett before the Mississippi Supreme Court during oral arguments challenging ballot Initiative 65 on medical marijuana Wednesday morning in Jackson. Credit: Vickie D. King/Mississippi Today
Justices James Kitchens and Leslie King did not ask any questions of either side during Wednesday’s arguments.
Some legal and political observers have questioned whether an adverse ruling on Initiative 65 could open other ballot initiatives from the last 20 years, such as limits on eminent domain and voter ID requirements, to being challenged and overturned.
Watson said he believes that is not a concern because the “doctrine of laches” barring unreasonable delays in legal challenges would prevent such issues. He said laches should also have prevented Butler’s challenge of Initiative 65 just days before the Nov. 3 election.
But Watson said he is concerned about current and future initiatives, and noted that “three or four are to the point of gathering signatures now” amid uncertainty until, and maybe after, the court rules.
It would appear a ruling totally accepting Butler’s arguments would nullify voters’ rights to ballot initiatives until the Legislature and voters changed both the constitution and state law.
Angie Calhoun of Puckett, one of the leaders of the citizen-led drive for medical marijuana in Mississippi, attended Wednesday’s high court hearing and had signed on as an amicus, or friend of the court, on Watson’s side. Calhoun is the mother of a son who suffered medical problems she said could have been treated with marijuana. Her son, now an adult, eventually moved out of state so he could use medical marijuana.
“I believe our justices will do what’s right an uphold the will of the voters,” Calhoun said. “… I feel like our Legislature obviously has failed us.”
After lawmakers failed for years to approve use of medical marijuana despite a groundswell of public support, voters took matters in hand in November with Initiative 65. The Legislature tried this session to pass a “backstop” or alternative medical marijuana program should the Supreme Court strike down the one voters pass, but the legislation was killed after much debate. Initiative 65 supporters viewed it as a legislative move to usurp the will of voters.
With less than a week before Gov. Tate Reeves must approve the education budget passed by lawmakers this year, a merit pay program he supports was not funded this year as a result of the COVID-19 pandemic.
The School Recognition Program, which provides bonuses for public school teachers in high-performing schools and those that improve their students’ achievement, went unfunded this year by the Legislature. And with less than a week before Reeves must sign or veto the state’s education budget, it is unclear whether he will push back.
Last year, Reeves partially vetoed the education budget because it did not fund the School Recognition Program, which he championed dating back to his time as lieutenant governor. Lawmakers overrode Reeves’ veto but also passed a separate bill for $28 million for the School Recognition Program.
Sen. Dennis DeBar, chairman of the Senate Education Committee, said the program went unfunded this year after state testing was canceled last year due to the COVID-19 pandemic. The program awards bonuses to educators based on schools’ accountability ratings, which are based partly on students’ performance on state tests. Without year-over-year test results, bonuses would prove difficult to award.
Reeves’ office did not respond to Mississippi Today’s questions about whether he would sign or veto the education bill.
Schools will also keep their previous accountability ratings for the 2020-2021 school year after the State Board of Education decided testing would take place this year to get a sense of where students are academically, but no new accountability grades would be issued. That means the program likely won’t be funded next year either.
The Legislature created the program in 2014. It financially rewards schools and teachers for student performance and improved letter grades in annual accountability ratings, which are based partly on students’ performance on state tests.
Teachers in A-rated schools or those that improve from a ‘F’ to ‘D,’ or ‘D’ to ‘C,’ receive $100 per student, and teachers at ‘B’ rated schools receive $75 per student.
Supporters of the program, including Reeves, say it incentivizes educators to work harder to raise student performance. But critics say it exacerbates inequity among wealthy and cash-strapped school districts. There are also concerns about a lack of guidelines in how to distribute the funds and who is eligible for them.
“I think it’s a program that needs some work, as far as ensuring some of the kinks that are in it are worked out,” said DeBar.
In this episode of Mississippi Stories, restauranteur and author Robert St. John sits down with Mississippi Today Editor-At-Large Marshall Ramsey to discuss St. John’s long career in the restaurant business. With the COVID-19 pandemic hitting local independent restaurants particularly hard, St. John shares how it has affected both his businesses and his charity Extra Table (which won a 2021 GIVE Award for its efforts to feed food-challenged Mississippians during the pandemic.) St. John also talked about his partnership with watercolorist Wyatt Waters and how their friendship has produced numerous books, trips and a television show. St. John also discusses his new projects in Fondren, a neighborhood of Jackson, Mississippi. Also, St. John breaks down the legislation to help independent restaurants, which St. John proclaims as the keystones of a community.
Madison Mayor Mary Hawkins Butler on Oct. 26 filed a challenge to ballot Initiative 65 on medical marijuana, saying it was not properly before voters (who passed it) in November per the state constitution.
The state Supreme Court on Wednesday will hear oral arguments in the legal battle between Butler and Secretary of State Michael Watson, with many people and groups signing on with one side or the other as “amicus” or friendly participants.
What’s the argument?
Butler argues that the ballot initiative language added to Section 273 of the state constitution in 1992 requires proponents to gather signatures evenly from five Mississippi congressional districts — with no more than 1/5, or 20% coming from any single district. Problem is, Mississippi has had only four congressional districts since the 2000 Census showed it lost population. Therefore, Butler argues, it’s a “mathematical certainty” that of the nearly 106,000 certified voter signatures collected from what are now four districts to put Initiative 65 on the ballot last year, signatures from at least one of the districts surpasses 20%.
Butler’s lawyers also note that there have been at least seven unsuccessful attempts in the Legislature to address the issue, and that other parts of the constitution either refer to congressional districts “as now existing” or referring to their makeup at a specific date.
Amicus filings by the American and Mississippi Medical Associations argue that justices should strike down the initiative and let lawmakers make any necessary changes and “decline the invitation for the court to fix the one-fifth error.” They also said the court should consider that legalized cannabis is bad medicine for the state.
What’s the other side’s argument?
Watson argues that while a panel of federal judges ordered Mississippi to use a four-district map for congressional elections, the Legislature never adopted it and “five congressional districts exist under state law and may be used for anything but congressional elections.” Watson’s lawyers from the attorney general’s office say Watson’s predecessor, now Lt. Gov. Delbert Hosemann, properly certified Initiative 65 petition signatures using the five districts in state law.
Watson said a plain reading of the constitution’s text “means our state’s five current congressional districts established by state law, not the four districts for federal congressional elections existing only by way of a federal court’s injunction,” otherwise getting an initiative on a ballot would be impossible. Shy of that, Watson argues, the court should consider that the intent of Section 273, passed by the Legislature and voters, was to allow citizen ballot initiatives.
And besides, Watson’s lawyers said, the “doctrine of laches” barring unreasonable delays in legal challenges should thwart Butler’s challenge, since she filed it just days before the Nov. 3 election where Initiative 65 passed.
Watson said the political or health arguments about medical marijuana and Initiative 65 should not be part of the high court’s consideration.
Supporters of Initiative 65, including two mothers of children suffering from medical conditions that could be treated with medical cannabis and numerous other citizens and medical doctors, have signed on as amicus interested parties.
Opponents signing on include the medical associations, Mississippi State Department of Health, state Sheriffs’ Association, the Mississippi Municipal League and several state lawmakers.
What’s next?
It’s unclear when the court might rule after hearing oral arguments on Wednesday. In the meantime, Initiative 65’s medical marijuana program is part of the state constitution. The state Health Department has been working to meet a July 1 deadline under Initiative 65 to publish its final rules and regulations governing medical marijuana in Mississippi.
Both the state auditor and Mississippi attorney general are investigating whether Centene Corp., as a provider of Medicaid drug services, failed to disclose discounts on pharmacy services, inflated dispensing fees and received reimbursements for amounts already paid.
Ohio Attorney General Dave Yost made similar allegations in a lawsuit. “Corporate greed has led Centene and its wholly owned subsidiaries to fleece taxpayers out of millions,” he said. “Centene has broken trust with the state of Ohio, and I intend to hold this company accountable for its deceptive practices.”
Asked about these allegations in Mississippi, a Centene spokesman told MCIR, “In our viewpoint, these claims are unfounded, and Envolve (a wholly obtained subsidiary) will aggressively defend the integrity of the pharmacy services it has provided. Envolve Pharmacy Services saved millions of dollars for taxpayers when compared to market-based pharmaceutical pricing. We look forward to answering any questions from our governmental partners regarding this issue. Our company is committed to the highest levels of quality and transparency.”
Between 2016 and 2020, the Mississippi Medicaid program paid Centene more than $1.1 billion for pharmacy services.
Rep. Becky Curry, R-Brookhaven Credit: Gil Ford Photography
State Sen. Becky Currie, R-Brookhaven, said if Centene is “cheating in the pharmacy area, what else are they doing? We don’t know because we’ve never bothered to look.”
Medicaid patients are covered under MississippiCAN, a plan that lets patients pick from three for-profit managed care companies: Molina Healthcare (a new entry), UnitedHealthcare Community Plan and Magnolia Health, a subsidiary of Centene, which in 2020 took in more than $111 billion, nearly double its total revenue from two years earlier.
These companies promise to reduce medical costs by promoting better health care among patients.
Credit: Bethany Atkinson
So what do the numbers show?
In 2015-2016, Magnolia received overall scores of 1.5 in prevention and 2 in treatment (on a scale of 1 to 5), according to the Health Insurance Plan Ratings issued by the National Committee for Quality Assurance, a nonprofit that uses surveys and data to measure health care quality.
Four years later, prevention inched up to 2, while treatment stayed the same at 2. Scores of 2 and lower are considered “lower performance.”
Magnolia did improve in consumer satisfaction from 3 to 4.5. The scores of 4 and higher are considered “higher performance.”
In areas broken down by categories, the company received a score of 5 for dental visits and avoiding opioids at high dosage and a 4 for eye exams and asthma control. But the score was 1 for childhood and adolescent immunizations as well as heart disease, a 1.5 for children and adolescent well care and a 2 for diabetes treatment.
In 2015-2016, UnitedHealthcare received a 1.5 score each in prevention and treatment. Four years later, those scores improved slightly to 2.5 in prevention and 2 in treatment. During that same time, consumer satisfaction fell slightly from 3.5 to 3.
UnitedHealthcare scored a 5 for dental visits and asthma control, and a 4 for prenatal checkups, for continued follow-up after diagnosis for attention deficit disorder and “getting care quickly.”
The company received a host of 1s that included childhood immunizations, blood pressure control, glucose control, statin therapy for diabetes, statin therapy for cardiovascular disease and getting patients to adhere to depression medication.
There are no scores so far for Molina, according to the website.
Asked about these low scores, UnitedHealthcare spokeswoman Sara Belfry responded, “We are working to ensure our members receive the care we expect, and 85% of our primary care physicians are in value-based contracting agreements that reward those who achieve improved quality of care results. We also provide clinical guidance and collaborate with providers to develop innovative programs to close member/patient gaps in care and help providers improve quality measures.”
Belfry said the quality scores for UnitedHealthcare had actually improved 60% since 2012. That’s when the company’s scores were even lower.
“We continue to make investments in communities across Mississippi to improve public health,” she said.
A spokesperson for Magnolia Health said the company “is committed to ensuring our members have access to high-quality healthcare, and we partner with providers to offer comprehensive healthcare services with a focus on positive outcomes for our members. Magnolia continues to develop new and innovative programs to treat the whole person and focus on each individual’s unique needs.
“Routine well-child care and vaccinations have declined dramatically during the COVID-19 pandemic, as parents avoid medical services to mitigate the transmission of the coronavirus. While Magnolia Health recognizes the health concerns of the community, it encourages parents to continue to schedule checkup appointments and get early vaccinations for young children to protect against preventable diseases.”
Richard Roberson, vice president, Mississippi Hospital Association
Taxpayers should be concerned about how their millions are being spent by these companies, said Richard Roberson, general counsel for the Mississippi Hospital Association, which has competed for a managed care contract. “If public school test scores were that low, legislators would have a fit about high administrative costs for poor classroom performance.”
Matt Westerfield, a spokesman for the state’s Division of Medicaid, said they look at these health insurance plan ratings “the way we look at Hospital Quality Star Ratings – they are instructive but not the complete picture. While we see room for improvement, we are encouraged that (these) ratings have improved over time, and that one plan’s consumer satisfaction score is among the highest in the country.”
He said, since Drew Snyder took over as executive director in 2018, the department has “focused more on quality rather than quantity.”
A year later, the department introduced two initiatives to improve that quality, the first of which could impose financial penalties, Westerfield said. Magnolia avoided a financial penalty, but UnitedHealthcare and Molina did not.
The second initiative, the Quality Incentive Payment Program, uses supplemental funds to improve the quality of care and health of those covered by Medicaid, he said. “Payments are linked to potentially preventable hospital readmission rates.”
The Division of Medicaid, he said, is also working with stakeholders to improve its Managed Care Quality Strategy, which was last updated in 2018.
Currie wonders how much managed care is taking place. She said she has seen Medicaid patients show up repeatedly in the emergency room, but has yet to hear a MississippiCAN company calling one of these patients to schedule follow-up appointments.
Currie, a member of the House Medicaid Committee, called for a full audit of the companies. “We are giving them full rein of Mississippi taxpayers’ money without checks and balances,” she said. “Are legislators finally going to look at this and realize that we can do better?”
New legislation requires more stringent reviews or audits of these companies, but stops short of specifics.
Currie warned that an audit would mean nothing if experts in Medicaid aren’t involved. “It’s a monster to understand,” she said.
In 2016, the Legislature authorized the examination of the performance of the managed care companies. The report concluded that in 54 out of 68 categories, Magnolia and United failed to meet or only partially met requirements.
That report by Navigant Consulting cited widely varying numbers, questioning the validity of some Medicaid data. In May 2016, Magnolia reported that 22% of patients had follow-up visits within 30 days of hospitalization, but in June that figure was 62%. In July 2016, UnitedHealthcare reported 0.8% of patients and a month later reported 1.98%.
The Navigant report concluded by recommending that lawmakers order an in-depth study to evaluate the cost of the MississippiCAN program.
In its 120-page response, Mississippi’s Medicaid officials disputed many of Navigant’s findings, saying they had already provided such an evaluation to the Legislature. A report for the agency by Myers and Stauffer concluded that MississippiCAN had saved the state $286 million between 2011 and 2017.
During that same time, the auditor’s office determined that more than $616,000 in “improper payments” had been made to these managed care companies, and Mississippi’s Medicaid officials agreed.
In 2015, Mississippi Hospital Association offered to provide a nonprofit competitor, Mississippi True, to the for-profit managed care companies. The governor signed a law that enabled such provider-sponsored health plans to operate, but Mississippi True failed to score high enough to make the cut, Medicaid officials said.
Three years later, the House voted for language to allow a limited pilot for Mississippi True, but that part of the bill died in the Senate.
Currie wondered why leaders never gave Mississippi True a chance, saying she believed it was “cheaper and better, and I’m all for cheaper and better.”
The pandemic has devastated many businesses, but the revenue for Magnolia’s parent, Centene, skyrocketed past $111 billion in 2020. In its second quarter report, the company acknowledged it had profited “from lower medical utilization as a result of the COVID-19 pandemic.”
In recent years, Centene has been buying up health-related companies. The St. Louis-based company now ranks among the nation’s 10 biggest healthcare corporations.
Centene is filling campaign coffers
Centene remains a Wall Street darling, ranking 42 on the Fortune 500, and is alsoone of the governor’s big donors. He has received more than $200,000 from the corporation, plus another $5,000 from Centene’s top brass, including CEO Michael Neidorff, who brags that his company serves 1 in every 15 Americans, “maintaining our leadership in government-sponsored healthcare.”
Reeves is hardly alone. Centene gave $43,000 to 10 Mississippi lawmakers through its political action committee, $20,000 to the Republican Party of Mississippi and $10,000 to the Democratic Party of Mississippi, according to OpenSecrets.org.
Centene Management Co.’s LLC gave then-Lt. Gov. Tate Reeves one large $50,000 donation, making the company the largest donor in 2017. The LLC also gave $25,000 to House Speaker Philip Gunn and $10,000 to Secretary of State Delbert Hosemann.
On the national front, Centene helped finance Donald Trump’s 2016 presidential inauguration and contributed $41,458 to his 2020 race, according to OpenSecrets.org. Centene was even more generous with Democratic candidate Joe Biden, who received $289,401.
Centene has given more than $12 million in contributions to politicians across the U.S. over the past 21 years, according to FollowTheMoney.org. Nearly $7.3 million has gone to Republican candidates, nearly $3.5 million has gone to Democratic candidates, and another $1.5 million has gone to candidates whose parties weren’t designated.
So far, 38 states have expanded Medicaid, many of them creating their own version, including Republican-led Indiana when Mike Pence was governor.
Mississippi should follow their lead, Currie said. “As a nurse of over 40 years, my whole life has been to take care of the sick and poor, and we are doing a terrible job of that.”
Even states that have balked before at Medicaid expansion before are now considering it, including Wyoming, where the state House has passed an expansion bill.
Mississippi health care officialssay the money is desperately needed. Since 2014, five of Mississippi’s rural hospitals have closed, and more than half are now at risk of immediate closure.
“I am very concerned about access to health care in rural parts in Mississippi,” Gov. Tate Reeves told MCIR. “I think it’s critically important that we focus our conversation around not only affordability but accessibility to rural facilities around Mississippi.”
Asked if these rural hospitals would have been better off if Medicaid had expanded, Reeves replied that he didn’t believe Medicaid expansion “was the right thing for Mississippi.”
A 2016 study by the National Center for Health Statistics showed that more than twice as many people living in states that haven’t expanded Medicaid failed to get care they needed because of the costs.
A study released last year by Vanderbilt University School of Medicine and Harvard Medical School showed that Medicaid expansion slowed rates of health decline in Southern states that approved expansion.
“It helped people maintain their health so that they didn’t fall off the cliff,” said co-author Dr. John Graves. “It helped move people out of poor states of health or kept them from declining into poor health.”
In this year’s legislative session, Mississippi lawmakers failed to take up a bill that promised to take the state off the hook for its share of Medicaid. Called MississippiCares, it would pay for the state’s share through a combination of hospital taxes and monthly patient premiums.
Credit: Bethany Atkinson
“I wanted MississippiCares badly,” Currie said. “Who doesn’t want to hire a Mississippi company with Mississippi employees?”
She would like to see those in power to sit down at a table and examine how to improve health care access. “If you won’t bother to sit down and look at this,” she said, “that’s going to be your legacy.”
Insurance Commissioner Mike Chaney believes there is a better plan besides MississippiCARES.
His office was looking to buy an insurance policy that would cover those added under Medicaid expansion. But when he checked last week into a possible waiver from the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services, he said officials told him they couldn’t do anything without a request from the Legislature.
The Kaiser Family Foundation is predicting that if Mississippi continues to reject Medicaid expansion, it would leave $24 billion on the table, he said. “That’s over almost five times what our annual budget is for the state.”
Expanding Medicaid would add at least $1 billion a year to the state’s coffers. The new $1.9 trillion COVID-19 relief legislation, signed by President Biden, has made expansion even more enticing. For the next two years, the state would only have to pay a 5% share instead of 10%.
Despite that offer, Reeves continues to reject Medicaid expansion. He calls it “Obamacare expansion” and insists that “the people have spoken on the issue” by voting for him.
Hob Bryan, chairman of the Senate Public Health and Welfare Committee, said babbling opposition to “Obamacare” does nothing to keep rural hospitals open or to improve health care access for the needy.
Mississippi is turning its back on billions that “could alleviate human suffering,” said the Democrat from Amory. “Does it matter if people are sick and dying? All we care about is holding down the Medicaid budget.”
Beyond health, Mississippi lawmakers should note that local hospitals are often the largest employers in rural communities, Currie said. “Look at it as economic development.”
Centene drew scrutiny in Ohio
Mississippi and other states began taking a closer look at Centene after The Columbus Dispatch in Ohio reported in 2018 that that state’s taxpayers might be paying twice for the same Medicaid drug services.
HealthPlan Data Solutions determined the pharmacy middlemen in Ohio were raking off up to $186 million a year above the industry’s standard profit margin. Ohio taxpayers were paying three to six times as much to process prescription drugs for the poor and disabled as the industry standard, according to its report.
Ohio wasn’t the only state with issues.
In 2019, Arkansas told Centene officials they had to refund more than $12 million after collecting too much in premiums. According to the Centers for Medicare and Medicaid Services, Centene collected $983 million in premiums for its plans covering Arkansas Works enrollees and other consumers in the state from 2016-18, but spent just $756 million of that on medical care and other health-related expenses.
In Mississippi, the state auditor’s office began digging into the pharmacy allegations against Centene in the summer of 2019, according to a letter obtained by MCIR. Asked about this, the auditor’s office confirmed it was indeed investigating the matter on behalf of taxpayers.
Mississippi Attorney General Lynn Fitch’s office is also investigating the matter. “We are still early in our investigation,” said Colby Jordan, director of communications, “so we cannot release details yet, but it is similar to the Ohio case.”
The Ridgeland law firm of Liston & Deas, which is working with the Ohio attorney general’s office, is representing Mississippi in the matter and declined to comment.
“It’s never been about what’s good for Mississippi,” Currie said. “Our hospitals are struggling. If nothing changes, our healthcare system is going to break.”
Mississippi Today reporters Anna Wolfe and Michelle Liu and a team of collaborators won the 2021 Goldsmith Prize for Investigative Reporting, considered the top investigative journalism award in the nation.
Their investigation, reported for Mississippi Today and The Marshall Project, exposed Mississippi’s practice of forcing individuals convicted of low-level felony offenses to work off their fines and other court debts at low-wage jobs during the day while they are confined in locked facilities at night until the debts are paid.
The reporting beat out several other Goldsmith Prize finalists including Politico, Reuters, Tampa Bay Times, Indianapolis Star and AL.com.
The investigation was a collaboration between The Marshall Project and Mississippi Today, and was also published by the USA Today Network, the Clarion-Ledger, the Mississippi Center for Investigative Reporting, and Mississippi Public Broadcasting. Data analysis was provided by The Marshall Project’s Andrew R. Calderon. Leslie Eaton of The Marshall Project and R.L. Nave of Mississippi Today edited the project. Liu, who was a reporter for Mississippi Today between 2018 and 2020, now works for The Associated Press.
This is the fourth national award the investigation has won. In March 2020, the project won the John Jay College/Harry Frank Guggenheim awards for Excellence in Criminal Justice Reporting. In February 2020, the reporting won the Sidney Award. In September 2020, it won the Online News Association’s Al Neuharth Innovation in Investigative Journalism Award.
COVID-19 vaccination efforts in the United States were slowed by an unexpected hurdle on Tuesday after federal health agencies recommended a pause in the use of Johnson & Johnson’s single-dose coronavirus vaccine after six recipients developed an extremely rare blood clot.
“We are recommending a pause in the use of this vaccine out of an abundance of caution,” Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention, said in a joint statement. “Right now, these adverse events appear to be extremely rare.”
Health officials have said that the pause is only expected to last a few days. In response, state health departments across the country, including in Mississippi, have either instructed or advised health providers to halt the use of the vaccine while the blood clotting issue is investigated. The pharmacy giants CVS and Walgreens have also said that they will stop administering the Johnson & Johnson vaccine and will reschedule the appointments of affected patients as soon as possible.
Mississippi State Health Officer Dr. Thomas Dobbs tweeted Tuesday morning that the Mississippi State Department of Health is instructing vaccine providers in the state to refrain from using the Johnson & Johnson vaccine until more guidance is available from federal health agencies.
MSDH is instructing all physicians, clinics and hospitals to refrain from using Johnson and Johnson until additional guidance available from CDC/FDA https://t.co/2O3jMhiVHg
Dobbs also told the nearly 42,000 Mississippians who have received the Johnson & Johnson vaccine not to worry, noting that the window of risk for developing the rare blood clot after receiving the vaccine appears short, and the likelihood of it happening at all is very slim.
During a press briefing on Tuesday, State Epidemiologist, Dr. Paul Byers, said that MSDH will work with vaccine providers that have received Johnson & Johnson shipments to replace those doses with Pfizer or Moderna doses if needed.
All six patients known to have developed the rare blood clot, known as cerebral venous sinus thrombosis, were women between the ages of 18 and 48 and developed the clotting within two weeks of vaccination. One of the six has died from the illness, and another has been hospitalized in critical condition.
The CDC will hold a meeting of its Advisory Committee on Immunization Practices (ACIP) on Wednesday to further review these cases and assess whether they were caused by an immune system response triggered by the vaccine. The FDA will review these findings alongside their own investigation to determine the future status of the vaccine’s Emergency Use Authorization.
Treating the type of blood clot observed in these cases is another area of concern, as it might be dangerous to administer the drug commonly used to treat blood clots. Dobbs said that the federal review of this issue was important “in part, to ensure that the health care provider community is aware of the potential for these adverse events and can plan for proper recognition and management due to the unique treatment required with this type of blood clot.”
Nearly seven million people in the U.S. have received the Johnson & Johnson vaccine, according to CDC data. This represents only a tiny fraction of the more than 187 million doses of COVID-19 vaccines that have been administered across the country.
The U.S. Supreme Court has refused to act on Attorney General Lynn Fitch’s motion to pause a lawsuit filed on behalf of African American parents saying the state violated federal law by spending less on majority-Black schools than majority-white ones.
Will Bardwell, an attorney for the Southern Poverty Law Center, which filed the lawsuit on behalf of Black Mississippi parents, said the ruling denying Fitch’s request “almost certainly means that the Supreme Court isn’t going to take the case, at least for now, which clears the way for us to move forward in district court.”
Colby Jordan, a spokesperson for the Attorney General’s office, said of last week’s decision by the Supreme Court: “We are in the process of reviewing our options.”
Fitch was asking the nation’s highest court to halt any advancement of the lawsuit in district court while her office had time to file an appeal of a narrow ruling of the 5th Circuit Court of Appeals saying the case could move forward. Samuel Alito, one of the Supreme Court’s more conservative justices, acting on behalf of the entire panel, rejected Fitch’s request last week.
What is at issue in the unique case is whether the state is in violation of the Mississippi Readmission Act of 1870 that was passed by the U.S. Congress after the Civil War. As a condition of readmission, the federal act, in part, prohibited Mississippi from making changes to its laws that lessened the guarantee of an equal or uniform school system. Bardwell said the language placed in the state Constitution recognizing the state’s commitment to public education has been watered down through the years, especially as state leaders strived at times in the state’s history to have separate school systems based on the students’ race.
Bardwell said the goal of the lawsuit is “to re-establish Mississippi’s obligation to maintaining a uniform school system and to hold the state accountable for not upholding that obligation.”
The lawsuit by the SLPC cited what it said were numerous examples where African American students still receive an inferior education in Mississippi. For instance, in the 2015-16 school year, of the 19 F-rated school districts, 13 had a Black enrollment of more than 95%, and all had enrollment of African Americans of at least 85%.
In its motion to dismiss the case, Fitch argued, “At the end of the day, it should go without saying that education is of the utmost importance to all of the state defendants and the state’s citizenry. And, of course there is always room for improvement in this area in the state of Mississippi. But the tactics utilized by the SPLC in this lawsuit are not, and could not be, the answer.”
All states have clauses in their constitutions establishing their public education commitment.
Mississippi’s 1868 Constitution states: “As the stability of a republican form of government depends mainly upon the intelligence and virtue of the people, it shall be the duty of the Legislature to encourage, by all suitable means, the promotion of intellectual, scientific, moral and agricultural improvement, by establishing a uniform system of free public schools, by taxation or otherwise, for all children between the ages of five and twenty-one years, and shall, as soon as practicable, establish schools of higher grade.”
The state’s current Constitution, enacted in 1890, weakened that commitment by among other things removing the word “uniform” and adding a new section, mandating separate schools for “children of the white and colored races.”
That language establishing separate education system based on race was not removed from the Constitution until 1978. Even with that removal, the lawsuit contends the state’s current constitutional commitment to public education is much weaker than it was in the 1868 Constitition when Mississippi was re-admitted to the Union.
U.S. District Judge Henry T. Wingate of the Southern District of Mississippi is scheduled to hear the case.
