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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.

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.

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.”

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 also one 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 officials say 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.

Arkansas, which did expand Medicaid, has seen only one rural hospital close. That state has seen a 30% reduction in the costs of uncompensated care.

In contrast, 52 rural hospitals closed in surrounding states over the past decade, according to the Arkansas Center for Health Improvement.

“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.

“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.”

This report was produced in partnership with the Community Foundation for Mississippi’s local news collaborative, which is independently funded in part by Microsoft Corp. The collaborative includes the Clarion Ledger, the Jackson Advocate, Jackson State University, Mississippi Center for Investigative Reporting, Mississippi Public Broadcasting and Mississippi Today.

Researcher Vilas Annavarapu contributed to this report.

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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: Want out of Jail? First You Have To Take a Fast-Food Job

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.

The post Mississippi Today investigation into modern-day debtors prisons wins 2021 Goldsmith Prize appeared first on Mississippi Today.

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. 

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.

MAP: Where Mississippians can get the COVID-19 vaccine 

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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.

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Mississippi women who have given birth will likely continue to receive Medicaid health care coverage until at least the end of 2021 even after legislation recently died that would have extended the coverage.

During the 2021 Mississippi legislative session, Senate leadership attempted to place in state law a requirement that postpartum coverage would be expanded from 60 days to 12 months for mostly low-income women. That coverage is particularly important in Mississippi, the poorest state in the nation with high rates of infant and maternal mortality.

The Senate tried to include the postpartum coverage expansion in the Medicaid bill passed during the 2021 session designed to make various technical amendments to the complex federal-state health care program. The House rejected that proposal.

But Matt Westerfield, a spokesperson for Mississippi’s Division of Medicaid, told Mississippi Today that federal emergency orders “will likely” keep the coverage in place through 2021.

“Because of the federal Families First Coronavirus Response Act enacted in March 2020, Medicaid recipients, including pregnant women, are receiving continuous Medicaid coverage for the duration of the federal public health emergency,” Westerfield said. “The Biden administration has informed states that the federal COVID-19 public health emergency will likely remain in place for the entirety of 2021.”

When the legislation failed this year, House leaders pointed out that the coverage would remain in effect because of the federal health care emergency status. House Speaker Philip Gunn contended that adding the postpartum expansion to the Medicaid technical amendments bill was not allowed under legislative rules.

“The code section that involved that was not in the bill and it was subject to a point of order,” Gunn said, adding, “there was an individual who had informed us he was going to raise the point of order.”

When asked if expanding the postpartum coverage should be considered in the 2022 session, Gunn said, “I don’t know if Medicaid is the answer to that, but certainly we are concerned… We will probably be looking at ways to address that. Expansion may or may not be a way to address that. It is just something we need to look at.”

Mississippi has the highest infant morality rate in the nation with 9.07 deaths per 1,000 births, according to the U.S. Centers for Disease Control and Prevention. Mississippi also has the 19th-highest maternal mortality rate at 20.8 deaths per 100,000 births, according to a study released by USA Today in 2019.

Lt. Gov. Delbert Hosemann has said that the Senate will be studying issues surrounding health care access and outcomes in the coming months.

Twelve states, including Mississippi, have not expanded Medicaid as is allowed under federal law to provide health care coverage for primarily the working poor. With Medicaid expansion, presumably poor women who give birth would have continuous coverage as long as they are in lower income levels. The Medicaid expansion would not entitle people who qualify to any additional funds, but instead would make them eligible for health care coverage.

There have been proposals that would mandate any Medicaid expansion in Mississippi to include a minimal co-pay for health care for people covered by the expansion.

While pregnant women in Mississippi are now receiving the continuous Medicaid coverage, the state is receiving extra funds from the federal government to pay for it. Under the March 2020 Families First Coronavirus Response Act, the federal government is providing a matching rate of near 85% for Mississippi Medicaid recipients. In other words, for each dollar of health care provided through Medicaid, the federal government is paying almost 85 cents and the state is paying the remainder.

In addition, under the more recent American Rescue Plan, the federal government would provide incentives of about $600 million for Mississippi over a two years to expand Medicaid to cover primarily the working poor. Thus far, state leaders, including Gunn and Gov Tate Reeves, have rejected the incentive package. Hosemann has indicated that all avenues of improving health care access, including for postpartum coverage, will be studied this summer.

In the meantime, the Mississippi Hospital Association voted last week to back a ballot initiative that would ask voters to approve expanding Medicaid in the state. Supporters of that effort believe they can start gathering signatures by May 1, 2021, and that the question could be placed on a statewide ballot by 2022.

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The National Collegiate Athletic Association Board of Governors said it may ban future championships — including college baseball and softball regionals — in Mississippi and other states that have passed legislation barring transgender athletes from competing on teams that align with their gender identity.

The NCAA decision resembles one they made in June 2020, when Mississippi lawmakers were considering whether to change the state flag, the last in the nation containing the Confederate battle emblem. Many believe that decision from the NCAA — a more definitive ruling than the one made this week — helped spur lawmakers to change the flag.

“Inclusion and fairness can coexist for all student-athletes, including transgender athletes, at all levels of sport,” the NCAA board said in a statement on Monday. “Our clear expectation as the Association’s top governing body is that all student-athletes will be treated with dignity and respect. We are committed to ensuring that NCAA championships are open for all who earn the right to compete in them.”

In a rare public ceremony on March 11, Gov. Tate Reeves signed a bill that bans transgender girls and women at public schools and colleges from playing on sports teams that align with their gender identity. The bill is set to become law on July 1.

Neither Reeves nor any legislator that supported the bill could cite any example of a transgender athlete competing with their cisgender classmates in Mississippi. 

Though Mississippi was the first to do so in 2021, it is far from the only state taking up the issue. Lawmakers in the neighboring states of Arkansas and Tennessee have passed similar bills this year. Last year, Idaho passed a similar bill. A federal judge kept that law from going into effect as hearings continue. According to the American Civil Liberties Union, more than 30 state legislatures are considering bills that would target transgender athletes. 

In June 2020, the NCAA banned Mississippi from hosting tournaments until lawmakers changed the state flag. That economic pressure, put on lawmakers by many business leaders, played a considerable role in getting the legislature to adopt a new flag early this year.

READ MORE: ‘Denying humanity’: Advocates discuss law that bans trans athletes from female sports teams

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Former Gov. Ronnie Musgrove used to say the most important item addressed each legislative session is the budget because it establishes the priorities of the state.

For decades, that priority in terms of where the most state funds are spent has been public education. While arguments can be made that Mississippi could be spending a modest amount more of existing funds on education than say on public safety or other entities, the real issue is not the share of state revenue spent on public education, but that Mississippi’s limited tax base does not cover all the needs of the state.

During the 2021 session, legislators found themselves in an enviable and somewhat unusual situation in that by Mississippi standards the state coffers were flush — well, relatively flush.

Based on that situation, legislators passed a state-support or general fund budget that totaled $6.56 billion or $249.6 (almost 4%) above the amount budgeted the previous year.

“The main highlight would be the budget …,” House Speaker Philip Gunn said when talking about the recently completed 2021 session. “Obviously, revenue continues to be good. This allows us to fund all state agencies. It actually has allowed us to restore the cuts made last year.”

Last year, in the midst of COVID-19 and fearing what the pandemic would mean for the state economy, legislators cut most state budgets. The overall cut was $125 million or almost 2%. But the impact on the state economy and especially on revenue collections has not been as negative as once feared.

While there have been recent downticks in the state economy in terms of job losses, most economist believe that the outlook for the coming year is bright. Revenue collections through February are 9.5% or $338 million above the amount collected through the same period last year.

Gunn cited “good conservative, budgeting practices” over time for what he described as the budget highlight achieved during the 2021 session.

Truth be known, legislators might have had a little help in reaching that budget highlight, and it came via government spending, not conservative policies.

Economists cite the multiple federal stimulus packages passed to address the pandemic for fueling the Mississippi economy and revenue collections. After all, the average Mississippian has received at least $3,200 in direct payments from the federal government. And thanks to enhanced federal unemployment payments, many Mississippi workers who lost their jobs during the pandemic most likely were making more money than when employed in the state with the second-lowest per capita income.

“We attribute much of this (economic) performance to the federal transfers,” economist Corey Miller of the University Research Center wrote back in September, even before the latest two rounds of stimulus were passed by Congress.

It should be noted that legislators did use a significant portion of that additional revenue to invest in that priority of education. According to figures compiled by the staff of the Legislative Budget Committee, funding for kindergarten through 12th grade education was increased almost $72 million or about 2.8%. When lottery revenue is added, the total additional funding for public education will be about $102 million.

In addition, funding for the eight public universities was increased $47.6 million, or 7%, and funding for the 15 community colleges was increased $16.7 million, or 7.9%.

Nearly every agency garnered additional funding when compared to the amount they received last year. Modest pay raises of about $1,000 a year were provided to teachers. Enough funds were appropriated to provide pay raises of 3% to most state employees and 1% for community college and public university faculty and staff. It should be pointed out not all state employees and university staff will receive those raises.

Importantly, the Legislature provided the funds to cover the increase in costs in the state health insurance plans to ensure the premiums paid by state employees and teachers would not go up. If the Legislature had not covered the increased costs, state employees and teachers would have had to, resulting in a reduction in their take home pay.

Another one of the big-ticket items in the state budget — Medicaid — was essentially funded at the same level as last year, about $900 million. The level funding was made possible, in large part, because the federal government, through the COVID-19 relief packages, is picking up more of the costs for the states’ Medicaid programs — another example where the work of Mississippi legislators was made easier by the largess of the federal government.

Despite all that, when the dust clears, Mississippi still will be near the bottom in funding of teacher, state employee, university faculty pay and in many other areas.

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I’m so old I remember when Secretary of States supported voting. Read the story behind the cartoon here.

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