Nettleton - 47 days before the election, Tate Reeves unveiled a desperate election year stunt to try to cover for his failed healthcare record that has left 220,000 working Mississippians without affordable healthcare and hospitals across the state laying off employees, slashing essential services, and closing down altogether.

Here are just some of the flaws in the non-stop critical coverage of Reeves’ campaign stunt:

• Tate Reeves is rewarding the 16 hospitals that left the Mississippi Hospital Association earlier this year after the organization endorsed Brandon Presley with 42 percent of the benefit, while 96 hospitals including smaller, rural hospitals are left with scraps.

• The Chief Financial Officer at Winston Medical Center in Louisville called the plan “a slap in the face to most all of the small rural hospitals around the state.”

• Reeves’ plan does nothing to help workingMississippians get affordable healthcare.

• Hospitals will have to pay “$178 million in taxes for Mississippi Hospital Access Program payments”

On day one as governor, Brandon Presley will expand Medicaid so that 220,000 working Mississippians can get the healthcare they need and rural hospitals can stay open.

Read more about what Mississippians are reading below:

Mississippi Today: Brandon Presley again vows to expand Medicaid as Gov. Tate Reeves reiterates opposition
Devna Bose 
September 28, 2023

Days after Republican Gov. Tate Reeves doubled down on his stance against Medicaid expansion, Democratic gubernatorial candidate Brandon Presley promised Jones County voters he’d pass the policy on his first day in office.

The state’s health care crisis has remained one of the major issues of the governor’s race. As hospitals struggle financially and Mississippi leads the nation in uninsured residents, the top gubernatorial candidates are debating the merits of Medicaid expansion, a federal-state program that would provide health care coverage to an estimated 300,000 poor, working Mississippians and help hospitals cover costs.

Presley, who appeared at a legislative forum in Laurel on Wednesday hosted by Rep. Omeria Scott, placed the blame for the state’s health care problems squarely on the governor’s shoulders and repeatedly vowed to expand Medicaid.

“Now there’s one reason Tate Reeves is not for expanding Medicaid,” Presley said. “It’s because a Democratic president passed the Affordable Care Act, and what a silly, small way to be. Let me tell you about me: If Donald Trump had passed the Affordable Care Act and 230,000 people in this state would benefit, I’d be for it in five seconds because it’s not about the politics. It’s about the people.”

Mississippi is one of just 10 states that have not expanded Medicaid, an option under former President Barack Obama’s 2010 Affordable Care Act. Experts say the state could receive about $1 billion a year for expansion, and it would go a long way to stemming Mississippi’s health care crisis. One report puts nearly a half of rural hospitals at risk of closing — many of them are losing millions caring for people who are uninsured.

Reeves reiterated his opposition to Medicaid expansion at a press conference last week announcing a hospital funding plan, repeatedly incorrectly calling it “welfare” and suggesting the health care crisis would be aided if more people joined the workforce in Mississippi.

But supporters of Medicaid expansion say it’s for people who are already working but don’t have jobs that provide them with private health insurance.

Just last week — less than two months before the election — Reeves announced a complex scheme to draw down more federal money for hospitals in lieu of expanding Medicaid. While his plan, which hasn’t been approved by the federal government yet, would put more money in some hospitals’ pockets, it won’t insure more Mississippians. 

That means under Reeves’ plan, uninsured people in Mississippi will largely have to continue to rely on emergency rooms for their medical care and forgo preventative care. 

At the forum on Wednesday, Presley reminded attendees of Reeves’ plan and who it benefits.

“Remember that Tate Reeves has shown us who he is. Don’t forget it,” he said. “With your help on Nov. 7, we’re gonna tell Tate Reeves his party’s over.

Presley also drew contrasts between his background and Reeves’ at the Wednesday event.

“I understand what it’s like to come home and have your lights and your water cut off,” he said. “Tate Reeves doesn’t understand families like ours exist. He was born with a silver spoon in his mouth. I have been where working people in Mississippi are. It’s one of the reasons that I support and will take action on day one to expand Medicaid.”

The proclamation garnered shouts and applause from the hundred constituents before him, including Samella Walker. 

Walker, a lifelong resident of Laurel, is a three-time cancer survivor who knows intimately the importance of health insurance. She’s been attending Scott’s forum since its inception decades ago. This year, however, she said the energy was different. 

“Something has got to be done,” Walker said, shaking her head. “The party is over, and it’s time for a change.” 

SuperTalk: Not all hospitals are winners under new plan from Tate Reeves, CFO says 
Caleb Salers
September 26, 2023

Mississippi Governor Tate Reeves last week announced what he called “sweeping Medicaid reimbursement reforms” that are anticipated to generate an estimated $689 million for hospitals throughout the state. However, one medical official is saying the proposal is not a victory for all hospitals.

Reeves, joined by Mississippi Division of Medicaid (MDOM) Executive Director Drew Snyder and eight hospital executives, introduced the following on Thursday:

The Mississippi Hospital Access Program will provide direct payments to hospitals serving patients in the Mississippi Medicaid managed care delivery system. With these direct payments, hospitals would be reimbursed at the same rate compensated by private insurance, which has been considered the federal ceiling for Medicaid reimbursements in managed care.

The second initiative will supplement Medicaid base payments for hospitals by reimbursing inpatient and outpatient hospital services at rates in the upper payment limit. Hospitals will pay more to cover the costs of bed taxes and uninsured patients but will be reimbursed at a much higher rate than what they put in.

Matt Woodward, the chief financial officer at Winston Medical Center in Louisville, told SuperTalk Mississippi News that the initiatives will do nothing more than validate claims that the Republican governor has failed Mississippi’s healthcare industry, specifically small and rural hospitals.

“Healthcare is largely considered by most in the industry as a complete failure by the Reeves administration – most notably, rural healthcare. The announcement of Governor Reeves’ Medicaid reimbursement reform on September 21 did very little to change that,” Woodward said. “In fact, it was a slap in the face to most all of the small rural hospitals around the state.”

As part of the proposal from Reeves, 42 percent of the funds ($291 million) will be dispersed among 16 hospitals. The other 58 percent ($398 million) will be distributed among 95 hospitals, most of which are small or in rural areas. That would equal out to $18.19 million per hospital in the first category and $4.19 million per hospital in the second.

Politics is seen as the primary factor in the decision to allocate a lion’s share of the money to certain hospitals over others. Seven of the eight hospital administrators standing behind Reeves during Thursday’s press conference belonged to institutions that left the MHA earlier this year.

While politicos speculate that the alleged favoritism shown toward those who withdrew their MHA membership stems from a $250,000 donation a political action committee associated with the organization made to Democratic gubernatorial candidate Brandon Presley, Woodward argues that the financial contribution to Reeves’ challenger is irrelevant.

Instead, Woodward views it as an attempt by larger systems to remove the “little man” from the table of decision-makers — especially with recently ousted MHA president Tim Moore consistently advocating for all hospitals during his tenure.

The first step in the process of gaining further influence and minimizing small hospitals’ role in these decisions, according to Woodward, was to circumvent Moore. Moore had reportedly worked on similar solutions as the one presented by Reeves, but the difference was that Moore’s plan put small and large hospitals on an equal playing field.

“Tim was an advocate for all hospitals in Mississippi. And it is a damn shame how the Reeves political machine chewed him up and spit him out,” Woodward said.

“What they won’t tell you is that Tim and MHA worked on these kinds of solutions with Medicaid for the last several years. Unfortunately, nothing ever came of that because the large facilities felt like the small rural facilities were getting too much of a voice, hence the split of the large facilities from MHA. It had nothing to do with the donation to Brandon Presley.”

All in all, the announcement that larger hospitals would be the overwhelming beneficiaries of the money came as no shock to Woodward.

He pointed to last November when the MDOM introduced an amendment to the SFY 2023 Mississippi Hospital Access Program that would allocate an estimated $450 million to hospitals, with those with a lower average commercial rate expected to receive the bulk of the funds. In the amendment, rural hospitals were placed in a higher tier than urban ones and were projected to benefit more from the apportionment.

Come February, MDOM officials notified hospital administrators that they had overstated the available funding by $400 million without showing industry leaders where the initial calculation went wrong, according to Woodward.

Woodward asserts that the decision to move away from the amendment, especially after receiving no explanation, could have been controlled by larger hospitals in cahoots with Reeves.

“We never received any detail showing the initial calculation or the corrected calculation – only a notification that ‘we messed up.’ They said that our commercial rate was not as low as they had projected,” Woodward recounted. “My worry is that this is another case of the large facilities and systems seeing this and knowing it would not benefit them as much and going behind closed doors to get this amendment squashed.”

Though, on paper, the governor’s initiatives, if approved by Centers for Medicare and Medicaid Services, will provide monetary relief to medical facilities across Mississippi, Woodward and other healthcare leaders continue to argue that Medicaid expansion would be a huge piece of the puzzle when it comes to solving the ongoing crisis.

Woodward would also like to see a rural access payment as another means of funding operations as nearly half of Mississipp’s rural hospitals are in danger of closing.

At the time of publication, Governor Tate Reeves had not responded to a request for comment from SuperTalk Mississippi News.

Mississippi Today: Experts say Gov. Tate Reeves' plan will help hospitals, but not uninsured Mississippians
Devna Bose 
September 25, 2023

Gov. Tate Reeves, after months of inaction, has unveiled a plan he says will turn Mississippi’s health care crisis around. 

However, even some health care experts were stumped by how the Governor’s proposed reforms will work. 

The plan, which Reeves announced at a press conference Thursday while flanked by state health care leaders, is essentially a complex scheme to increase extra payments hospitals get for treating patients on Medicaid — and notably doesn’t include Medicaid expansion.

Some Mississippi leaders say Reeves’ ideas aren’t even that new. It’s not certain they’ll be approved, either.

The announcement comes less than two months before Election Day, and after his opponent in the gubernatorial race, Democrat Brandon Presley, has repeatedly stated his intention to expand Medicaid if elected and largely campaigned on the state’s hospital crisis.

Two things were clear at the conference: Reeves claims the changes would put a much-needed $700 million in hospitals’ pockets, and he does not plan to expand Medicaid.

Everything else, however, was not as easy to understand.

The plan relies on two major changes that bolster supplemental payments to hospitals for the care they provide to people with Medicaid. Supplemental payments are extra payments hospitals receive to offset low Medicaid reimbursement rates or uncompensated care, which is money hospitals lose caring for patients who are uninsured and can’t pay their hospital bill. Medicaid is a federal-state program that provides health coverage to millions of people in the U.S., including low-income adults, children, pregnant women, elderly adults and people with disabilities. The income requirement for people in Mississippi to qualify is extremely stringent. 

The first is a change to the Mississippi Hospital Access Program, which typically pays hospitals for the gap between payments for services rendered for Medicaid managed care patients (which are usually lower) and Medicare patients (which are usually slightly higher). Under the proposed changes, hospitals will instead be paid for the gap between Medicaid patients and people insured by commercial plans, which tend to reimburse at higher rates. 

The state Division of Medicaid was granted a similar change to the program in March for outpatient services, resulting in $40.2 million for hospitals. However, Medicaid officials had expected it to generate an additional $450 million. But because Mississippi’s average commercial rate is so low, the payout was much less. 

What’s not clear is how, in Reeves’ plan, the average commercial rate results in nearly triple what hospitals typically get for these payments — going from a total of $562 million to $1.522 billion. Reeves didn’t say at the press conference what average commercial rate was actually being used (whether a state, regional or national rate).

When asked what had changed since the spring regarding these rates, Medicaid Executive Director Drew Snyder did not directly answer the question. 

“I think the difference is, we got the right people in the room … sometimes it makes sense to get a second opinion,” he said before stepping back in line on stage.

The second initiative modifies the Upper Payment Limit Supplemental Payments, which are aimed at also increasing payments for hospitals that receive low payments from Medicaid. This program will yield an increase of an additional $137 million in fiscal year 2024, according to Reeves. 

State leaders did something similar earlier this year after the Mississippi Hospital Access Program projections came in much lower than originally expected, said Tim Moore, former leader of the state hospital association. It resulted in an extra one-time payment of $137 million.

The supplemental payment programs are meant to reduce disparities in insurance payments and the cost of caring for uninsured people. By changing them, the state is drawing down more federal money because of our state’s high Federal Medical Assistance Percentage match, which is the highest in the country at 77.27% because of our state’s high poverty rate. Hospitals have to put up more in “bed taxes” for the state portion, and then the federal government matches. 

In other words, if a Medicaid patient receives a service at a Mississippi hospital that costs $100, the hospital is reimbursed $77.27 from federal funds. The remaining $22.73 must be paid by the state – that $22.73 comes from the hospitals themselves in the form of a tax. 

Harold Miller, leader of the Center for Healthcare Quality and Payment Reform described it this way: “When the state is paying for a Medicaid service, the state has to find the state share — that 23% — somewhere. They have to find that money, and ordinarily they would have to tax the taxpayers to do that.” Instead, Mississippi asks the hospitals for that money, he said. 

In short, hospitals will have to pay $178 million in taxes for Mississippi Hospital Access Program payments to go up by $960 million, Upper Payment Limit payments will yield $137 million and disproportionate share hospital payments — which make up the difference for hospitals that lose money on serving a significant population of Medicaid-insured and uninsured people — will decrease by $230 million because the other payments are bridging the gap. The net gain for hospitals will be $689 million total. 

Experts agree this plan will keep hospitals open for longer. Even if it’s unclear how the expected payments will increase, it’s still a significant amount of money — money that hospitals have been asking for for a long time. However, critics say it’s not ensuring more people receive health care.  

According to federal data, Mississippi has the highest uninsured rate of people aged 18-64 in the country, as of September. About one in every six Mississippians is uninsured. 

Emergency rooms by law cannot turn down people, regardless of their insurance status, who come for care — but doctors’ offices can and so can pharmacies. That means people who are uninsured in Mississippi, one of the unhealthiest states in the nation, cannot receive preventative care or medications that they need. They generally must rely on the emergency room for their health care needs. 

“People typically need a lot more care than care in a hospital, and a lot of that care is preventive care… outpatient care,” said Adam Searing, an associate professor at Georgetown University’s McCourt School of Public Policy’s Center for Children and Families whose work focuses on Medicaid. “If you get cancer and you need prescriptions and drugs and outpatient care from a team of specialists, this has nothing to do with that. So, the key differences, this is an issue about the finances of hospitals. 

“And Medicaid expansion is about financial security for families.”

Reeves said a little over $689 million will go to the state’s hospitals under this plan. 

And although he said Thursday the money would benefit all hospitals, it appears larger hospitals will benefit most, even though most agree that small rural hospitals are the facilities feeling the strain of the health care crisis most acutely. 

Additionally, nearly half of the money — 45% or about $309 million — will go to hospitals that have left the state hospital association in recent months. In the spring, after the Mississippi Hospital Association’s PAC made a $250,000 donation to Presley, several hospitals left the organization.

Most of those hospitals’ leaders stood behind Reeves as he announced his plan Thursday.

Reeves said at the press conference this plan has been in the works for four to five months. 

According to Tim Moore, former head of the state hospital association, and another state leader, that’s not true. 

A year ago, Moore learned of similar measures in Louisiana and brought the idea to state leaders. Lt. Governor Delbert Hosemann recently told Mississippi Today that hospital payment initiatives were discussed by stakeholders last year, but the Division of Medicaid told his office that those changes weren’t possible.

Reeves repeated at the conference that the changes would come at no cost to taxpayers, though he noted Snyder and his division employees are paid by state tax dollars. 

That’s mostly true — taxpayers will likely not feel the brunt of this big tax increase for hospitals,  according to one expert. Even if hospital charges increase, it should be eaten by the insurance companies and services for people who are uninsured will continue to go uncompensated and be claimed as charity care.

The plan is being submitted to the Centers for Medicaid and Medicare Services for approval. Snyder estimated at the conference that the state would likely hear from the federal government within two to three months. If it’s approved, it would be retroactively effective beginning July 1, 2023. 

It’s hard to say what the likelihood of approval is, though several other states have passed similar Medicaid reforms intended to draw down more federal dollars. 

One expert said it was unlikely that Mississippi state leaders announced the plan without expecting CMS approval, and historically, the agency has erred on the side of keeping hospitals open — even if it comes at the cost of forgoing expansion.

Medicaid expansion has long been pointed to as a solution to the state’s worsening hospital crisis. Republican state leadership – Reeves most prominently – has staunchly opposed the policy adoption, despite support from a majority of Mississippians. 

At the press conference Thursday, Reeves repeatedly incorrectly referred to the program as “welfare,” and claimed the solution to the issue was putting more people in the workforce. He said if more people are added to Medicaid’s rolls, hospitals will keep losing money because Medicaid payments are so low. 

That’s better than losing money on people who are uninsured, said Adam Searing, the associate professor whose work focuses on Medicaid.

“These are two disconnected things,” he said. “Reimbursement rates for hospitals and expanding Medicaid are completely separate issues.”

While hospital leaders agree that these policy reforms will make a huge difference for many hospitals in the state, it still might not be enough to single handedly solve the crisis. In other states, such as Louisiana, similar policy reforms work in tandem with Medicaid expansion to create a holistically supported health care system. 

The way Moore sees it, the state is putting up $170 million for a $700 million net gain, when with expansion, it could put up $100 million for a $1 billion reward. 

States that have not expanded Medicaid have been offered a financial incentive to do so — an estimated $600 million in federal funds over two years. 

And, despite more hospitals that will probably be able to stay open as a result of these reforms, uninsured Mississippians still won’t have health care. That means they will have to continue to rely on emergency rooms for their medical care — the most expensive place to receive health care — and uncompensated care costs will continue. 

Searing said these reforms “improve the financial bottom line for some hospitals” and keep them open longer, but people are still going without health coverage. 

“You’re really not solving the problem,” he said. “You’re just putting a Band-Aid on one aspect of it.”

American Independent: Gov. Tate Reeves' Medicaid plan will help campaign donors but not uninsured Mississippians
Josh Israel 
September 26, 2023

 Republican Mississippi Gov. Tate Reeves is still refusing to opt in to the Affordable Care Act’s Medicaid expansion, which would provide health insurance to an estimated 230,000 uninsured adults in the state.

Instead, on Sept. 21, Reeves announced plans to boost Medicaid reimbursements to hospitals by hundreds of millions of dollars, directly benefiting his own donors.

The first-term governor is running for reelection and will face Democratic state Public Service Commissioner Brandon Presley in the Nov. 7 election. Several of the hospitals that will benefit most from this plan and their top executives have contributed to Reeves’ campaigns.

According to the Mississippi State Department of Health, hospitals would receive $690 million more in Medicaid funds under his plan if it is approved by the federal Centers for Medicare & Medicaid Services. Rural hospitals in the state have been struggling financially under Reeves, and dozens face possible closure.

Merit Health’s River Oaks Hospital would see a $17,501,586 increase in payments from Medicaid. While its CEO Sam Dean does not appear to have personally donated to the governor’s campaign, his hospital gave Reeves $5,000 in December 2022.

Memorial Hospital in Gulfport would stand to gain $9,048,381. Its president and CEO, Kent Nicaud, has donated more than $100,000 to Reeves over the course of his political career, including $41,000 in 2022, according to a Mississippi Today report. Nicaud also hosted a December 2020 fundraising event for Reeves. Reeves appointed Nicaud to the Mississippi Gaming Commission in March 2023 and approved a $7 million appropriation in 2022 for his hospital while vetoing $50 million for the University of Mississippi Medical Center.

The North Mississippi Medical Center would receive $33,456,940. President and CEO Shane Spees gave Reeves $1,000 in August 2022. 

In total, the three hospitals would benefit by close to $60 million from the proposal.

According to Jackson television station WLBT, Reeves introduced all three CEOs at his press conference announcing the increase as part of a group of supportive medical professionals. “The plan that I’m announcing today is a result of the hard work of the folks standing behind me,” he said. “Over the last four to five months, we’ve worked to put together a proposal that we believe can have a real impact on Mississippi hospitals. I’m thankful for their public service.”

A Reeves spokesperson did not immediately respond to an inquiry for this story.

Two of the other medical professionals in attendance to support Reeves’ plan, John Davis and Drew Snyder, are appointees to his administration.

Presley, Reeves’ opponent, has called for immediate Medicaid expansion to cover lower-income individuals, which would be 90% paid for by the federal government. “Not expanding Medicaid is one of the dumbest decisions that this state has ever made,” he reportedly said at a September campaign event.

Reeves was asked at the event why the state has still not expanded Medicaid coverage.

“The expansion of Obamacare, while [it] certainly adds a significant number of people to the welfare rolls, does not have the kind of financial impact that some of you in the room and some people across the state think that it will have,” he told reporters, according to an ABC News report, falsely claiming that the health insurance program was welfare.

Experts told Mississippi Today that Reeves’ plan will help hospitals but do little to help patients.

“People typically need a lot more care than care in a hospital, and a lot of that care is preventive care… outpatient care,” Adam Searing, an associate professor at the Georgetown University McCourt School of Public Policy Center for Children and Families, told the outlet. “So, the key difference [i]s, this is an issue about the finances of hospitals. And Medicaid expansion is about financial security for families.”

Searing said Reeves’ plan would “improve the financial bottom line for some hospitals,” but warned, “You’re really not solving the problem. You’re just putting a Band-Aid on one aspect of it.”

The Mississippi Democratic Party issued a statement panning Reeves’ proposal.

“This is an election year hail mary that we can see straight through, and Mississippians will still suffer,” state Rep. John Hines said in the statement. “We can not play politics with the health of our people. We must expand Medicaid and end this healthcare crisis once and for all.”

Mississippi Public Broadcasting: Critics say Reeves' hospital plan doesn't help patients
Will Stribling 
September 25, 2023

Governor Tate Reeves says he has a plan to address the state's hospital crisis, but some advocates for health care access are criticizing the plan as being good for hospitals, but not patients.

Reeves' proposals to overhaul the state's Medicaid reimbursement formula will provide a financial boon for hospitals if they work as intended, but will do nothing to help the hundreds of thousands of Mississippians who would have access to health coverage through Medicaid expansion.

Dr. John Gaudet is a former pediatrician who led an effort to pass Medicaid expansion through the ballot initiative process before it was overturned.

"As a physician, my focus really is less on the business aspects of running a hospital and more on the health care of patients that are going to that hospital," Guadet said. "I think we need to maintain our focus on the patient."

Reeves plan includes increasing the "bed taxes" that hospitals pay to allow more federal dollars to come into the state. This would, in theory, increase Medicaid reimbursement rates more in line with those of private insurers and result in additional $689 million in revenue for hospitals.

Reeves has said the state should focus on getting people into better paying jobs that provide health coverage and calls Medicaid "welfare." Gaudet says this characterization of the program as a handout is not true.

"Many of the people who would benefit from Medicaid expansion are already working," Gaudet said. "They're just working in jobs that don't provide health insurance coverage, which is actually becoming more and more common...  we have to remember that these are our neighbors and our family members and friends."

Mississippi is one of just ten states that haven't expanded Medicaid and doing so would bring in an additional $1 billion in federal funding each year.

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