A nonprofit backed by the Mississippi Hospital Association plans next week to kick off its petition drive to put Medicaid expansion before voters on the 2022 midterm ballot, hoping to override a recalcitrant Legislature and put expansion in the state constitution.
Healthcare for Mississippi next week will hold two yet-to-be announced press conferences — one in central Mississippi and one in the north — announcing the drive and naming numerous other groups that are supporting the campaign.
Tim Moore, president of MHA and a founder of Healthcare for Mississippi, said the nonprofit has inked contracts with two Mississippi companies to gather petition signatures and is “getting print materials ready, lining up speakers for next week’s opening and there will be an educational campaign starting relatively quickly.”
“I’ve been amazed at the number of people who have called, and the other groups asking how to get involved and who to give money to,” Moore said. “We’re not going to name them until next week, but we have a wide assortment of groups that are involved in this. I think the numbers are growing even faster than we expected.”
Medicaid expansion through the federal Affordable Care Act has brought heated — and most often partisan — debate in Mississippi, the poorest state in the union. Mississippi, despite its dependence otherwise on federal money, is one of just 12 states that has refused to expand Medicaid, leaving hundreds of thousands of “working poor,” uninsured Mississippians without health coverage and rejecting at least $1 billion a year in federal funds to provide it.
Proponents estimate that expanding Medicaid would provide coverage for at least 200,000 working poor Mississippians, in addition to the roughly 750,000 poor pregnant women, children, elderly and disabled people already on Medicaid.
Most of the state’s Republican leadership, starting with former Gov. Phil Bryant, have opposed expansion, saying they don’t want to help expand “Obamacare” and don’t trust the federal government to continue footing most of the bill. Meanwhile, Mississippi’s hospitals — especially smaller rural ones — say they are awash in red ink from providing millions of dollars of care each year to uninsured and unhealthy people. Hospitals pitched a plan to lawmakers to cover the state’s share of expansion with taxes on hospitals and fees for new Medicaid enrollees, to no avail.
Now, Moore said, he believes voters should take matters in hand through the state’s ballot initiative process. He believes, in part based on polling, that the push will have bipartisan support among voters.
“What do you do after a decade of waiting for the Legislature and leadership to do something and it hasn’t happened?” Moore said. “Do you wait another decade? … This shouldn’t be political. We are talking about working Mississippians who can’t afford coverage, and that shouldn’t be political at all.
“Certainly, there will be significant support from the Democratic side, but I think there is more and more support on the Republican side as well. Too many Republicans have told me, off to the side, ‘It’s time. It’s time to do something.’”
Moore and others have said expanding Medicaid by constitutional amendment is not the preferred path, and he noted that lawmakers still could tackle the issue themselves in next year’s legislative session starting in January. But should the petition drive successfully net about 106,000 signatures by October, the issue would still be on the 2022 ballot.
“(Lawmakers) can take action, not take action, come up with an alternative and put it on the ballot as well,” Moore said. “I would be tickled to death if they moved forward in January of next year… but they would have to address it early.”
Lt. Gov. Delbert Hosemann has said he’s open to discussion on the issue, one of few state Republican politicians to say so.
But House Speaker Philip Gunn has remained steadfastly opposed.
Neither Gunn nor Hosemann immediately responded to requests for comment on the ballot initiative drive kickoff coming next week.
Gov. Tate Reeves has also reiterated his opposition to Medicaid expansion, and the ballot initiative campaign is likely to face opposition from other conservative corners.
Jameson Taylor, with the conservative Mississippi Center for Public Policy, recently wrote that “Medicaid expansion is bad for Mississippi.” He said that while Medicaid is an insurance program, “Medicaid is also a welfare program. This is the root of the problem for Medicaid.”
“… Unlike TANF (cash welfare) and other welfare programs, Medicaid is an open-ended entitlement,” Taylor wrote. “… In order for Medicaid to work better, two things have to happen. First, Medicaid needs to begin operating like other welfare programs. This means enrollment is going to have to be limited. (Which also means expanding Medicaid to able-bodied, working-age adults is a very bad idea if your goal is to provide healthcare to those who really need it.)”
But health care, racial justice and other advocates of expansion say it would help impoverished Mississippi tackle one of the global and persistent problems that keeps it on the bottom: the unhealthiness of its people. The ACA expansion would provide health coverage for people making up to 138% of the federal poverty level, or about $17,600 a year for an individual.
Proponents say the expansion would also have pragmatic financial benefits for the state economy and state government budget. Besides helping hospitals cover the $600 million a year and rising they have to eat in uncompensated care for uninsured people, expansion would create thousands of jobs and improve the state health care industry overall.
The proposed Initiative 76 addresses some of this in its language, noting that the state would draw down at least $907 million in new federal funding in fiscal 2023, with the state share being about $99 million.
“However, an estimated 82% of these costs — or $80 million — would be offset by reductions in other state health care spending as a direct result of Medicaid expansion and the remainder more than offset by new tax revenue generated by productivity gains,” the proposed measure reads. “For example, in SFY 2023 Mississippi would save an estimated $51 million on currently eligible Medicaid enrollees, such as low-income pregnant women, becoming eligible for enhanced federal funding. The state would also save an estimated $29 million by accessing federal funding for hospital care for incarcerated individuals and mental health and substance use disorder treatment that currently is funded entirely by the state.”
It also says that, “Further, the infusion of new federal funding into Mississippi’s economy is projected to generate over $95 million in new state and local tax revenues each year. This would more than offset the remainins tate costs of expansion and result in a net benefit to the state budget of over $76 million.”
Besides the ACA covering 90% of the cost of expansion with federal dollars, the American Rescue Plan recently passed by Congress would further increase the federal share of the cost of traditional Medicaid for two years for any of the 12 holdout states that agree to expand the program.
The Medicaid expansion ballot initiative — and other pending ones including early voting and the state flag — face an uncertain future with a pending state Supreme Court decision. The high court has heard a constitutional challenge to the medical marijuana program voters approved in November through a ballot initiative.
The court is expected to rule soon whether the initiative was constitutionally flawed because the state’s initiative language says petition signatures must be equally gathered from the state’s five congressional districts. But Mississippi has had only four congressional districts since the 2000 census, and state lawmakers neglected to address the issue.
Moore said the Medicaid expansion initiative drive is trying to take that into account, and will try to collect enough signatures to be able to meet the thresholds for either four or five districts.
However, the Supreme Court’s ruling could also halt the state’s ballot initiative process, at least until lawmakers and voters rework state law and constitutional language.
Following a string of alarming events in the Holmes County Consolidated School District, the Mississippi Department of Education is conducting an investigation and has appointed a financial adviser to oversee the district.
But the appointment of the financial adviser has already stirred up controversy in the district, which has been rated as failing every year since 2016.
The state department approved Shaquita Burke, the former chief financial officer of Vicksburg Warren School District, to serve as the financial adviser. When Burke was in Vicksburg, a 2019 audit not only revealed a host of problems with Vicksburg Warren’s finances but also pointed to possible “fraud, waste and abuse” on her part.
A spokeswoman for the Mississippi Department of Education said the position was advertised, and Burke applied and met the qualifications.
But before the state department appointed Burke as financial adviser, the Holmes County school board rejected Interim Superintendent Benjamin Torrey’s recommendation to hire Burke as chief financial officer for the district. That district-level position is currently vacant, according to Holmes County school board President Louise Lewis Winters, and the superintendent has not brought forth any other candidates for the position.
Winters said after the board voted not to hire Burke, she was surprised to hear last week that the state appointed Burke to serve as the district’s financial adviser.
“The board had no knowledge of this person or anything, so when we did get knowledge, you know, we decided to vote it down because of information that came forth,” said Winters of the board’s decision not to hire Burke.
At the same time the financial adviser is working to set the district’s finances straight, the state education department is also conducting an on-site investigative audit of the district, according to an April 22 letter from State Superintendent of Education Carey Wright to the district’s interim superintendent. The audit is to determine whether the district is complying with accreditation standards and state and federal laws.
Investigative audits are done following a formal complaint, which is not made public. The department has conducted comprehensive audits for five districts in the past five years, including Holmes County.
The audit revealed 25 total findings, including that taxpayers footed the bill for a “B.Y.O.B., adults only” party that cost $4,200, and that the former superintendent was paid $170,000 annually even though minutes from the board meeting show the board approved a salary of $10,000 less.
A separate financial audit also revealed additional weaknesses, which then triggered the requirement for the Mississippi Department of Education to appoint a financial adviser to oversee the district.
The department may conduct these unannounced audits at any time following a formal complaint made to the Commission on Accreditation. According to Shella Head, president of the newly formed community engagement council in the district and parent of four former students, she believes there were multiple complaints made to MDE about events in the district.
This is in addition to the fact the district has received an ‘F’ rating for six years straight. Head, an active member in the community who has been involved with the school district for more than 25 years in various roles, says the state of the district is “stressful and heartbreaking” right now. She also said she’s been sounding the alarm about problems in the schools for years now and wonders why the state is just now stepping in.
“We have people from outside looking in it, and, to me, it appears (they think) that nobody in the county wants a quality education for the kids, when that’s so far from the truth,” she said. “The last couple years … we literally had people, including in the community, that were screaming and throwing red flags up and saying ‘Hey, something is going wrong, we need some help.’”
At the end of its audit, the department will produce a corrective action plan for the district and can recommend the district’s accreditation status be downgraded to either probation, withdrawal of accreditation or state of emergency. A determination of a state of emergency, which triggers a state takeover of the district, must be approved by the State Board of Education before being sent to the governor.
Torrey, who has acted as the interim superintendent for the district since January, reassured board members at their April 22 meeting the district is “putting processes in place to make sure we are in compliance” with accreditation standards and state and federal laws.
“Those that we aren’t in compliance with, we will continue to work to be in compliance with,” he said.
A second round of severe weather in three days is tearing through Mississippi on Tuesday, spawning tornadoes and heavy rains that have damaged property but caused no reported injuries.
Both a tornado watch and flash flood watch is in effect for much of the state Tuesday. On Tuesday morning, several people posted videos and photos of what appeared to be a tornado crossing Highway 49 near the Piney Woods School in Rankin County.
Tornado crossing US 49 at the Piney Woods campus earlier this morning, near the Simpson/Rankin line. Still working to confirm more damage reports. #mswx@wlbt ?@Fox40News? ?@NWSJacksonMS?
— Patrick Ellis WLBT (@PatrickEllisWx) May 4, 2021
Our severe threat has increased with a Moderate Risk now in place for the southern half of the area.
Widespread damaging winds gusts up to 80 MPH continues to be our main concern (especially for areas near and south of I-20), but hail and a few tornadoes are also possible. #mswxhttps://t.co/LgWlRRasF9
Tuesday’s severe weather outbreak follows a Sunday outbreak that spawned several tornadoes and damaged property but caused no reported injuries.
Officials from the National Weather Service in Jackson have deployed teams across central Mississippi to confirm tornado reports and assess damages.
One tornado touched down in Pontotoc County late Sunday night. The storm caused damage in Calhoun City and Tupelo, knocking down trees, ripping off roofs and blocking roads with downed power lines.
Damage has been reported in the City of Tupelo. Emergency crews are currently assessing the degree of damage. Please do…
Another tornado was spotted in southern Hinds County around Byram before making its way into southwest Rankin County. On Sunday evening, another tornado touched down in Yazoo County, damaging homes over a several-mile stretch.
Mississippi’s contract with Centene, an insurance company state officials are currently investigating over suspicions it overcharges taxpayers to boost its profits, is set to expire at the end of June, providing an opportunity for the state to end business with the company.
But the Mississippi Division of Medicaid, an agency under the governor’s office, expects to extend the contract for another year without issuing a new bid, agency spokesperson Matt Westerfield told Mississippi Today last Wednesday.
Centene, parent company to Magnolia Health, is one of three insurance companies the state pays to provide health coverage to the state’s most vulnerable residents, mostly children of poor families. Meanwhile, the insurer has been filling the campaign coffers of Mississippi officials for years and is one of Gov. Tate Reeves’ largest donors, contributing as large as $50,000 at a time to his campaign for a total of more than $200,000.
In the managed care program, called MississippiCAN, the state pays the insurers an up-front, per-member rate every month to cover about 485,000 recipients, as opposed to the state paying health care providers and pharmacies their fees and prices directly. About 64% of Medicaid recipients are in managed care and the rest — typically the more medically fragile patients — have fee-for-service Medicaid.
Centene pulls millions in taxpayer dollars for its role as middleman, and the state auditor and state attorney general are now investigating whether it used deceptive practices within its pharmacy benefits, the Northeast Mississippi Daily Journal first reported in March. Officials say the investigation resembles a lawsuit in Ohio, in which state officials allege Centene inflated drug dispensing fees, hid the true cost of pharmacy services and double-dipped its reimbursement.
A Magnolia Health spokesperson told Mississippi Today that the claims are unfounded and that the company has actually saved taxpayers millions of dollars. A written statement said Magnolia expects to return about $75 million to Mississippi “as a result of lower utilization brought on by COVID-19.”
“Recent criticisms and inaccuracies have been largely driven by parties with a longstanding agenda against Medicaid Managed Care,” the Magnolia statement reads.
Often when a state contract ends, the corresponding agency issues a Request for Proposals, or RFP. Vendors respond and the state awards a new contract based on how they score the proposals.
The Division of Medicaid typically takes its direction from the governor, but Westerfield said the agency believes it can extend its contract with Magnolia for another year “on its own” as long as it has approval from the Public Procurement Review Board.
Reeves’ office did not respond to Mississippi Today’s questions regarding the governor’s support for a contract extension.
The original three-year contract, which began in 2017 and was extended last year, is set to expire at the end of June, but contains an optional renewal through 2022. The Medicaid tech bill lawmakers passed this year also allows for an one-year emergency extension on the contract. Either would allow Magnolia to continue receiving millions from the state, even as the investigation continues.
“We as taxpayers deserve better than we’re getting,” said state Rep. Becky Currie, R-Brookhaven. “We need to let the RFP run its course in September (sic) just like it always does. I just believe that putting it off a year is just going to give Centene time to sweep things under the rug.”
Officials expect the investigation to conclude as early as this summer.
Investigators are focusing on the actions of Centene’s pharmacy benefit managers, third-party companies that manage pharmacy benefits for insurers. Magnolia paid its PBMs, extra middlemen that pharmacists have long bemoaned, more than $1.1 billion from 2016 to 2020, according to data the Medicaid division provided Mississippi Today.
The Mississippi Legislature addressed PBMs in 2018 when it prohibited the companies from including “gag clauses” in their contracts with pharmacies. These provisions had prevented pharmacists from telling patients cheaper ways to pay for their medication, such as if their copay is higher than the cash price of the drug.
When State Auditor Shad White took office later that year, his first announcement was that his office had found $600,000 worth of improper Medicaid payments to managed care companies. The office’s ongoing investigation into Centene began not long after; it sought help from a local firm in April of 2019, Daily Journal reported.
The lawsuit in Ohio is ongoing; Centene argues it adhered to its contract and followed state law. The Ohio attorney general Dave Yost alleged Centene’s “corporate greed” led its Ohio subsidiary to inflate costs through its pharmacy benefit managers.
“So why would we extend their contract?” Currie said. “Do we want to have a company with such corporate greed taking care of the most vulnerable people in our state? The sickest, fragile people in our state. I mean, it’s a no-brainer for me. We don’t want that.”
Correction: A previous version of this story misstated which month the Medicaid contract is set to expire.
Mississippi is poised to have its biggest spike in economic growth since 2008, according to the latest forecast report by the state economist. But that expected surge doesn’t mean the state’s economy will keep growing.
“The forecast shows that 2021 looks to be a rebound year,” said Corey Miller, state economist with the University Research Center. “We’re not seeing much growth beyond that. We are seeing Mississippi return to a trend of slow growth.”
Mississippi’s gross domestic product is expected to rise by 2.8% in 2021, the report says. Since the Great Recession, the state hasn’t seen annual growth of more than 1%.
“For this second quarter of 2021, our forecast has improved quite a bit,” Miller said. “A lot of that has to do with federal stimulus in the form of the American Rescue Plan and the increase of the number of people being vaccinated for COVID-19.”
The outlook report says consumer spending in the U.S. and Mississippi is expected to continue to grow as more Americans are vaccinated. The number of jobs in the state are also expected to grow by 1.8 year this year, which would be the largest annual increase since 1998.
Those additions are largely making up for losses that had been caused by the pandemic.
Mississippi’s unemployment rate was 6.3% in March, up from 6.1% the month before. The national rate for March was 6%.
“I think recovery has been rather uneven,” Miller said. “We still have quite a few people in the service industry, accommodations and food service, who are still unemployed.”
Mississippi added 3,400 jobs in March, 2,500 of which were in the professional business services sectors. That sector covers a large swath of workers and fields from law to accounting.
The overall jobs number is down 3% compared to a year ago, according to Miller.
“That’s not good, but compared to a lot of the country it’s not too bad,” Miller said.
Big industries in Mississippi, like agriculture and manufacturing, weren’t largely affected by the pandemic. Those sectors make up a bigger chunk of the Mississippi workforce than they do in other states.
Whatever gains anticipated for the year are expected to even out by the start of the new year. The forecast report shows that the number of Mississippi workers on payroll jobs is expected to remain stagnant for the next four years.
Meanwhile, that same number is expected to grow 1.3% each year for the country as a whole until 2025.
Two key state education boards may not have enough members to carry out their duties, and Gov. Tate Reeves, who is responsible for filling most of the vacancies, still hasn’t said when he might make the necessary appointments.
The Board of Trustees of State Institutions of Higher Learning starting Friday will have just eight members — exactly enough for a quorum. The Board of Education currently has five members — exactly enough for a quorum. This means that the state’s top education boards cannot legally meet if one member is absent or has to recuse themselves, which is a regular occurrence on both boards.
Reeves has made no public comments on when he will name appointments for the vacancies. Because he did not make the appointments before the end of the 2021 legislative session, there are questions of whether he can make the appointments without calling a special session of the Mississippi Senate.
The Constitution mandates that the Senate confirmthe appointments to both boards. And legal opinions and documents from legislative committees seem to suggest that Reeves will have to call a special session to confirm his appointments or wait for the Senate toreconvene for the 2022 regular session, which starts in January.
The terms of four members of the Board of Trustees of State Institutions of Higher Learning, which oversees the state’s eight public universities, will expire on May 7, leaving the panel with just enough members to constitute a quorum under the board’s guidelines.
Reeves’ office did not respond to questions from Mississippi Today on when he might fill the four college board seats.
“The bottom line is, Friday night at 12:01, the four trustees in our class roll off the board, and our nine-year term is over,” said Ford Dye of Oxford, the former chair of the IHL Board.
It will be difficult for the IHL Board to function with only eight members. On any issue where a member recuses themselves — which occurs nearly every meeting — the board will not have enough votes to make a decision.
In addition to the issues with the 12-member IHL Board, the nine-member state Education Board has been operating with only five members. Under that panel’s guidelines, five members constitute a quorum. A meeting in November had to be canceled because of a lack of a quorum.
Two of the vacancies on the Education Board are the governor’s responsibility to fill, while Lt. Gov. Delbert Hosemann and Speaker Philip Gunn each have one seat to fill.
To further complicate matters, the term of Northern District Education Board member Karen Elam is set to expire this June. That post also is a gubernatorial appointee.
Education Board Chair Rosemary Aultman of Clinton said both she and state Superintendent of Education Carey Wright have inquired about the vacancies.
“We have not heard anything specifically other than an appointment was forthcoming,” she said of conversations with Reeves.
Aultman said Gunn also has assured her thathe is working to fill his appointment.
“I’ve spoken with him (Gunn) about that, and he indicated that he was very much aware of it and he had two candidates he was looking at and would be making a decision soon … but it is encouraging that he is working on it,” Aultman said.
Leah Rupp, a spokesperson for Hosemann, said the lieutenant governor also is interviewing potential candidates for the Board of Education seat he is responsible for filling.
In March, legal experts told Mississippi Today there is a question of whether the appointees could begin serving prior to the next legislative session, which could be either a special session called by the governor or the 2022 regular session.
The attorney general, in a 1977 opinion, seemed to support the argument that for regularly scheduled vacancies, the governor must make the appointments in the session before the vacancy occurs or wait until the next session. The opinion stated when a “term is about to expire and will expire by limitation before the next session of the Senate, the governor should nominate a person to fill the vacancy,” and “if he fails to do so, he cannot make a valid appointment to fill such a vacancy in the vacation of the Senate.” If the governor tried to do so, it “would be to limit and abridge the right of the Senate to advise and consent to the appointment.”
A 2015 document compiled by the Legislature’s Performance Evaluation and Expenditure Review Committee reaches essentially the same conclusion.
The PEER report said state law “requires” that the governor make the appointment in the session before any regularly scheduled vacancy set to occur within nine months of the legislative session. But the report goes on the say that in many instances, the governor has appointed someone after the session ended and that appointee began serving prior to being considered by the Senate in the next regular session.
“This practice is in direct contravention of” state law, the PEER report concluded.
A Mississippi Today analysis of previous appointments found that former governors Phil Bryant and Haley Barbour submitted their college board appointments to the Senate in the session before the appointees’ tenures began. Former Gov. Ronnie Musgrove made some college board appointments after the session ended, and they began serving before they were confirmed by the Senate.
In 1996, former Gov. Kirk Fordice made four college board appointments who were rejected by a Senate subcommittee in the regular session prior to when their terms were scheduled to begin. Fordice, arguing that the four had not been rejected because they were not considered by the full Senate Universities and Colleges Committee, called a special session, where they were then rejected by the full committee. Fordice later called a special session prior to the start of the next regular session where four new appointees were confirmed.
