Crystal Springs resident Shan Copeland suffers from pseudotumor cerebri, a condition in which pressure inside the skull increases for no obvious reason. Copeland credits Medicaid with saving her life Wochit
Nicole Nichols, a mom with children on the Medicaid-run Children's Health Insurance Program, emails her representatives daily.
CHIP, currently at risk of losing funding in a few months, allows Nichols' family to receive the equipment and care that keeps her daughter Isabella alive. Isabella has type 1 diabetes.
Nichols' request to lawmakers is straightforward.
"I'm asking for (health care) to be affordable. I'm not asking for it to be free."
Nichols volunteers with the Diabetes Foundation of Mississippi and stays in contact with other health care advocates. "Other than that — I don't feel like the Legislature really advocates for us," she said.
Last week, I wrote about health care interests at the Legislature, their high-powered lobbyists and the lawmakers who benefit from those dollars. Since reporting from the Capitol in December, I've noted the lack of input from patients on Medicaid discussions — really a lack of focus on patients in general.
So there was an obvious reaction to the lobbying story: Who 'lobbies' for patients?
Long time civil rights activists Rims and Judy Barber are still staples at the Capitol. They can be spotted at most Medicaid hearings. Rims Barber, who came to Mississippi in 1964, knows just how far the program has come in the last few decades, from insuring roughly 100,000 people to now over 700,000.
But right now, being heard is harder than it was several years ago when there were more Democratic chairmen, Barber said.
"I could walk in and see the chairs of various committees and talk to them. I didn't always get what I wanted, but the doors were always open, and it's a much more closed ship these days," Barber said. "Us who have advocated for the poorest of the poor find ourselves pretty much on the outside."
Nichols isn't poor; her family pulls more than the median household income in Mississippi and pays the mortgage on a nice home in Brandon. But without CHIP, they couldn't afford the thousands of dollars worth of insulin supplies their daughter needs every month.
The Nichols family is a typical Mississippi family: They don't have extra money to donate to political campaigns "to get them to support my cause," Nichols said.
"As pessimistic as it may sound, I don't know how much influence we as advocates for people have in politics until we have money to push around," said Kathryn Rehner, project director at the University of Southern Mississippi-based navigator Mississippi Health Access Collaborative. "That's been the story forever."
Patients don't have lobbyists; they have advocacy groups and associations — many of which "are really just screaming into the void that doesn't listen," Nichols said.
"All we have in our toolbox are the stories and the people," said Oleta Fitzgerald, director of the Children's Defense Fund's Southern Regional Office. "And it's always David and Goliath. But people can overrule money, and that's what we have to keep fighting for."
Mississippi Health Advocacy Program is also working to put a face on Medicaid (some really, really sweet faces) with its campaign #IAmMedicaidMS.
This isn't to say providers, most of which have been jumping up and down about their Medicaid reimbursement rate and their ability to make ends meet, don't ultimately have patients' best interest in mind.
"The medical providers, for the most part, want the best services possible for their patients, but there's also money in medicine," Fitzgerald said. "And, in particular, the big providers, university medical centers, community health centers, whose budgets are dependent upon these same policy makers, in many instances are hesitant to take them on straight up."
Lawmakers are considering several Medicaid changes aimed at helping patients — eliminating the 12-per-year doctor visit cap, increasing the number of prescriptions a patient can get and encouraging the use of 17-hydroxyprogesterone, a drug that can reduce the chance of preterm birth.
Folks who have studied the Medicaid program, like the Medical Care Advisory Committee, are learning that keeping people healthy and providing quality preventative care, will eventually decrease costs in avoided medical expenses.
It seems if it weren't for that predicted dollar savings, patients might not be part of the discussion at all.
Other health news
CPS IS FACING A MULTIMILLION-DOLLAR SHORTFALL of $38.9 million this year. Child Protective Services was separated from the Department of Human Services as its own agency in 2016, which officials say made it harder for them to receive federal funds.
Meanwhile, Medicaid is reporting a projected deficit, $26.4 million, less than the originally anticipated $47.3 million.
GOV. PHIL BRYANT ADDRESSED MEDICAID WORK REQUIREMENTS in his State-of-the-State address Tuesday.
"As you know, I have requested a workforce requirement for able-bodied adults from the Center of Medicaid and Medicare Services. This is not, as some would have you believe, a punitive action aimed at recipients. It will actually help this population reap the rewards of a good job, and one day receive health care coverage from their employer, not the state or federal government," Bryant said.
For more on the work requirement, visit medicaid.ms.gov.
Bryant also said he'd be in favor of delaying the move of Medicaid eligibility functions to the Mississippi Department of Human Services, considering the division just experienced turnover at its highest level. The new interim director, Drew Snyder, took over earlier this month.
MS Pulse: What would happen if we trusted each other?
SEVERAL MEDICAID-RELATED BILLS have been filed so far, many of them long-shots.
Rep. Jarvis Dortch, D-Jackson, Rep. Bryant Clark, D-Pickens, Sen. Derrick Simmons, D-Simmons, and Rep. Omeria Scott, D-Laurel, all filed bills to expand Medicaid, which would help close the gap that leaves many folks without health insurance. These are people who don't get insurance through their jobs, who make too much money to be eligible for Medicaid, but who don't make enough to afford plans through the Marketplace.
Scott also filed bills to: prohibit the face-to-face requirement for Medicaid eligibility redetermination; create an electronic medical records database for Medicaid recipients; require Medicaid patients with obesity to participate in an online obesity program; and require teenage recipients to participate in birth control, abstinence and parenting programs.
MS Pulse: Health insurance and a pile of unread mail
Meanwhile, Sen. Michael Watson, R-Pascagoula, filed a bill to prohibit both the expansion of Medicaid and implementation of the federal Affordable Care Act, which has been the law of the land for eight years.
One bill, filed by Rep. Tracy Arnold, R-Booneville, goes as far as to prohibit the division from continuing to operate any managed care program after July 1, 2019. The state has operated its managed care program, MississippiCAN, since 2011, but lawmakers have questioned whether it has actually achieved its goal of reducing Medicaid costs.
Sen. Terry Burton, R-Newton, introduced a bill to require Medicaid reimburse services provided in school settings to recipients with an IEP.
Rep. Sam Mims, R-McComb, took a stab at addressing provider reimbursement concerns with a bill that would give certain rural hospitals the option to be reimbursed for outpatient services at 101 percent of the Medicare reimbursement rate. (Medicare reimburses at a higher rate than Medicaid.) This would apply to rural hospitals with 50 or fewer licensed beds.
The bill would "provide that outpatient hospital services provided by those hospitals shall not be subject to the five percent reduction in the provider reimbursement rate."
The deadline to file bills is Monday.
A DRAFT MEDICAID TECH BILL proposes giving a pilot project to run part of the state's managed care program to a provider-sponsored health plan (the only one of which in the state is Mississippi True, a group formed by local hospitals and represented by the Mississippi Republican Party Chairman Lucien Smith).
SOME MISSISSIPPI HOSPITALS HAVE EXPERIENCED BED SHORTAGES in their intensive care units recently from increased cases of the flu. The number of folks catching the flu spiked at the end of December, more so than in previous years.
American Medical Response reports there have been 422 calls for flu-like symptoms since October.
THE HEALTH DEPARTMENT IS STRUGGLING to provide TB and HIV services, which is why it has asked for a $3.4 million budget increase this session after receiving deep cuts last year.
Read about the department's difficulties and a breakdown of what it's asking for at clarionledger.com.
More: Health Department asks Legislature to reverse some budget cuts