Local Mississippi election officials have changed at least 54 precincts across 24 counties since the March 2024 primaries. But not all of those changes are reflected in SEMS, the statewide database that the online polling place locator tool draws from. At least 20 precincts have incorrect information in the system.

The post Mississippi Counties Change 54 Voting Precincts, But Incorrect Information May Send Some Voters to the Wrong Place on Election Day appeared first on Mississippi Free Press.

A federal indictment accuses a Mississippi law enforcement officer of striking a man with the handgrip of a Taser and kicking him in the head while he was handcuffed to a bench. Simpson County Sheriff’s Department Deputy Adrian Durr is charged with deprivation of civil rights under color of law.

The post Simpson County Sheriff’s Deputy Kicked Handcuffed Man in the Head, Federal Indictment Alleges appeared first on Mississippi Free Press.

Mississippi consistently ranks in the top five in the nation for its rates of antipsychotic drugging in nursing homes, data from the federal government shows. 

More than one in five nursing home residents in the United States is given powerful and mind-altering antipsychotic drugs. That’s more than 10 times the rate of the general population – despite the fact that the conditions antipsychotics treat do not become more common with age. 

In Mississippi, that goes up to one in four residents. 

“The national average tells us that there are still a large number of older residents who are inappropriately being prescribed antipsychotics,” explained Dr. Michael Wasserman, a geriatrician and former CEO of the largest nursing home chain in California. 

“The Mississippi numbers can not rationally be explained,” continued Wasserman, who has served on several panels for the federal government and was a lead delegate in the 2005 White House Conference on Aging. “They are egregious.”

The state long-term care ombudsman, Lisa Smith, declined to comment for this story.

Hank Rainer, who has worked in the nursing home industry in Mississippi as a licensed certified social worker for 40 years, said the problem is two-fold: Nursing homes not being equipped to care for large populations of mentally ill adults, as well as misdiagnosing behavioral symptoms of dementia as psychosis. 

Both result in drugging the problem away with medications like antipsychotics, he said. 

Antipsychotics are a special class of psychotropics designed to treat psychoses accompanied by hallucinations and paranoia, such as schizophrenia. They have also been found to be helpful in treating certain symptoms of Tourette syndrome and Huntington’s disease, two neurological diseases. All of these conditions are predominantly diagnosed in early adulthood.

The drugs come with a “black box warning,” the highest safety-related warning the Food and Drug Administration doles out, that cautions against using them in individuals with dementia. The risks of using them in patients with Alzheimer’s and other forms of dementia include death.

Yet more than a decade after a federal initiative to curb antipsychotic drugging in nursing homes began, 94% of nursing homes in Mississippi – the state with the highest rate of deaths from Alzheimer’s disease – had antipsychotic drug rates in the double digits.

Long-term care advocates and industry experts have long said that the exponentially higher number of nursing home residents on these drugs – 21% in the country and 26% in the state – is indicative of a deeper and darker problem: the substandard way America cares for its elders. 

“If the nursing homes don’t have enough staff, they try to keep people quiet, so they give them sedatives or antipsychotics,” said gerontologist and nursing home expert Charlene Harrington. 

And the problem, she emphasized, isn’t going away. 

“Over the last 20 years we’ve had more and more corporations involved and bigger and bigger chains, and 70% are for-profit, and they’re really not in it to provide health care,” Harrington said. “… It’s a way to make money. And that’s been allowed because the state doesn’t have the money to set up their own facilities.”

‘It’s just not right to give someone a drug they don’t need’

On a late Thursday morning in August, Ritchie Anne Keller, director of nursing at Vicksburg Convalescent Center, pointed out a resident falling asleep on one of the couches on the second floor of the nursing home.

The resident, who nurses said was previously lively and would comment on the color of Keller’s scrubs every day, had just gotten back from another clinical inpatient setting where she was put on a slew of new drugs – including antipsychotics. 

One or more of them may be working, Keller explained, but the nursing staff would need to eliminate the drugs and then reintroduce them, if needed, to find the path of least medication. 

“How do you know which ones are helping her,” Keller asked, “when you got 10 of them?”

The home, which boasts the second-lowest rate of antipsychotic drug use in the state, is led by two women who have worked there for decades.

Keller has been at the nursing home since 1994 and entered her current position in 2004. Vicksburg Convalescent’s administrator, Amy Brown, has been at the home for over 20 years. 

Low turnover and high staffing levels are two of the main reasons the home has been able to keep such a low rate of antipsychotic drug use, according to Keller. These two measures allow staff to be rigorous about meeting individual needs and addressing behavioral issues through non-medicated intervention when possible, she explained.

Keller said she often sees the effects of unnecessary drugging, and it happens because facilities don’t take the time to get to the root cause of a behavior. 

“We see (residents) go to the hospital, they may be combative because they have a UTI or something, and (the hospital staff) automatically put them on antipsychotics,” she said.

Urinary tract infections in older adults can cause delirium and exacerbate dementia.

It’s important to note, said Wasserman, that Vicksburg and other Mississippi nursing homes with the lowest rates are not at zero. Medicine is always a judgment call, he argued, which is why incentivizing nursing homes to bring their rates down to 0% or even 2% could be harmful. 

Schizophrenia is the only mental illness CMS will not penalize nursing home facilities for treating with antipsychotics in its quality care ratings. However, there are other FDA-approved uses, like bipolar disorder. 

“As a physician, a geriatrician, I have to use my clinical judgment on what I think is going to help a patient,” Wasserman said. “And sometimes, that clinical judgment might actually have me using an antipsychotic in the case of someone who doesn’t have a traditional, FDA-approved diagnosis.”

In order to allow doctors the freedom to prescribe these drugs to individuals for whom they can drastically improve quality of life, Wasserman says the percentage of residents on antipsychotics can have some flexibility, but averages should stay in the single digits. 

When 20 to 30% of nursing home residents are on these drugs, that means a large portion of residents are on them unnecessarily, putting them at risk of deadly side effects, Wasserman explained. 

“But also, it’s just not right to give someone a drug they don’t need,” he said.

Experts have long said that staffing is one of the strongest predictors in quality of care – including freedom from unnecessary medication – which makes a recent federal action requiring a minimum staffing level for nursing homes a big deal. 

The Biden administration finalized the first-ever national minimum staffing rule for nursing homes in April. The requirements will be phased in over two to three years for non-rural facilities and three to five years for rural facilities.  

In Mississippi, all but two of the 200 skilled nursing facilities – those licensed to provide medical care from registered nurses – would need to increase staffing levels under the standards, according to data analyzed by Mississippi Today, USA TODAY and Big Local News at Stanford University. 

Even Vicksburg Convalescent Center, which has a five-star rating on CMS’ Care Compare site and staffs “much above average,” will need to increase its staffing under the new regulations.

Mississippi homes with the highest antipsychotic rates

The six nursing homes with the highest antipsychotic rates in the state include three state-run nursing homes that share staff – including psychiatrists and licensed certified social workers – with the state psychiatric hospital, as well as three private, for-profit nursing homes in the Delta. 

The three Delta nursing homes are Ruleville Nursing and Rehabilitation Center in Ruleville, Oak Grove Retirement Home in Duncan, and Cleveland Nursing and Rehabilitation Center in Cleveland. All have percentages of schizophrenic residents between 26 and 43%, according to CMS data.

Ruleville, a for-profit nursing home, had the highest rates of antipsychotic drugging in the state at 84% the last quarter of 2023. Slightly more than a third – or 39% – of the home’s residents had a schizophrenia diagnosis, and nearly half are 30-64 years old. 

New York-based Donald Denz and Norbert Bennett own both Ruleville Nursing and Rehabilitation Center and Cleveland Nursing and Rehabilitation Center.

CMS rated the Ruleville facility as one out of five stars – or “much below average” –  partly due to its rates of antipsychotic drugging. 

But G. Taylor Wilson, an attorney for the nursing home, cited the facility’s high percentages of depression, bipolar and non-schizophrenic psychoses as the reason for its high rate of antipsychotic drug use, and said that all medications are a result of a physician or psychiatric nurse practitioner’s order. 

While CMS has identified high antipsychotic drug rates as indicative of potential overmedication, Ruleville appears to be an exception, though it’s not clear why it accepts so many mentally ill residents or why its residents skew younger.  

It is unclear what, if any, special training Ruleville staff has in caring for people with mental illness. Wilson did say the home contracts with a group specializing in psychiatric services and sends residents to inpatient and outpatient psychiatric facilities when needed.

There is no special designation or training required by the state for homes that have high populations of schizophrenic people or residents with other mental illnesses. Nursing homes must conduct a pre-admission screening to ensure they have the services needed for each admitted resident, according to the Health Department.    

An official with the State Health Department, which licenses and oversees nursing homes, said there are more private nursing homes that care for people with mental illness now because of a decrease in state-run mental health services and facilities.

Agency officials pointed specifically to the closure of two nursing homes run by the Department of Mental Health after the Legislature slashed millions from the agency’s budget two years in a row.

“Due to the lack of options for many individuals who suffer from mental illness, Mississippi is fortunate that we have facilities willing to care for them,” said State Health Department Assistant Senior Deputy Melissa Parker in an emailed statement to Mississippi Today.  

However, the Health Department cited Ruleville Nursing and Rehabilitation Center in May after a resident was allegedly killed by his roommate.  

The resident who allegedly killed his roommate had several mental health diagnoses, according to the report. The state agency said that the facility for months neglected to provide “appropriate person-centered behavioral interventions” to him, and that this negligence caused the resident’s death and placed other residents in danger. 

Wilson, the attorney for Ruleville, said his clients disagree with the state agency’s findings.

“The supposed conclusions reached by the (state agency) regarding Ruleville’s practices are not fact; they are allegations which Ruleville strongly disputes,” he said.

Oversight of nursing homes is limited

In 2011, U.S. Inspector General Daniel Levinson said “government, taxpayers, nursing home residents, as well as their families and caregivers should be outraged – and seek solutions” in a brief following an investigative report that kickstarted the movement against overprescription of antipsychotics in nursing homes.

“It was pretty striking,” said Richard Mollot, executive director of the Long Term Care Community Coalition, a nonprofit advocacy group dedicated to improving the lives of elderly and disabled people in residential facilities. “The Office of the Inspector General … They’re pretty conservative people. They don’t just come out and say that the public should be outraged by something.”

That landmark report showed that 88% of Medicare claims for atypical antipsychotics – the primary class of antipsychotics used today – were for residents diagnosed with dementia. The black box warning cautioning against use in elderly residents with dementia was introduced six years earlier in 2005.

But the problem persists today – and experts cite lack of oversight as one of the leading causes. 

“CMS has had that whole initiative to try to reduce antipsychotics, and it’s been 10 years, and basically, they’ve had no impact,” Harrington said. “Partly because they’re just not enforcing it. Surveyors are not giving citations … So, the practice just goes on.”

In Mississippi, 52 nursing homes were cited 55 times in the last five years for failing to keep elderly residents free of unnecessary psychotropics, according to State Health Department data. 

Barring specific complaints of abuse, nursing homes are generally inspected once a year, according to the State Health Department. In Mississippi, 54% of nursing home state surveyor positions were vacant in 2022, and 44% of the working surveyors had less than two years of experience. 

During an inspection, a sample group usually consisting of three to five residents is chosen based on selection from surveyors and the computer system. That means if a nursing home is cited for a deficiency affecting one resident, that’s one resident out of the sample group – not one resident in the entire facility. 

The state cited Bedford Care Center of Marion in 2019 for unnecessarily administering antipsychotics. The inspection report reveals that four months after a resident was admitted to the facility, he was prescribed an antipsychotic for “dementia with behaviors.”

The resident’s wife said her husband started sleeping 20 hours a day after starting the medication, according to the inspection report, yet the nursing home continued to administer the drug at the same dose for six months. 

CMS mandates that facilities attempt to reduce dose reductions for residents on psychotropic drugs and incorporate behavioral interventions in an effort to discontinue these drugs, unless clinically contraindicated. 

The facility did not respond to a request for comment from Mississippi Today. 

In another instance, Ocean Springs Health and Rehabilitation Center was cited in 2019 after the facility’s physician failed to decrease three residents’ medications as a pharmacy consultant had recommended. The inspection report says there was no documentation as to why. 

Officials with the nursing home did not respond to a request for comment from Mississippi Today. 

These two incidents – and all citations for this deficiency in the last five years – were cited as “level 2,” meaning “no actual harm” as defined by federal guidelines. Facilities are not fined for these citations, and their quality care score is only minimally impacted.  

“If they don’t say there’s harm, then they can’t give a fine,” Harrington said. “And even when they do give fines, they’re usually so low they have no effect. A $3,000 fine is just the cost of doing business. They don’t pay any attention to it.”

“Level 3” and “Level 4” are mostly used in extreme and unlikely situations, explained Angela Carpenter, director of long-term care at the State Health Department.

“For example,” she said, a Level 4 would be “if a person was placed on Haldol (an antipsychotic), he began having seizures, they still continued to give him the Haldol, they didn’t do a dose reduction, and the person ended up dying of a heart attack with seizures when they didn’t have a seizure disorder.”

“Actual harm” is supposed to also include psychosocial harm, according to federal guidelines, but Carpenter said psychosocial harm “can be very difficult to prove,” as it involves going back to the facility and doing multiple interviews to figure out what the individual was like before the drugs – not to mention many symptoms are attributed to the cognitive decline associated with the aging process instead of being seen as possible symptoms of medication. 

Experts say the bar for “harm” is far too high.

“And that sends a message that ‘Well, you know, we gave them a drug that changes the way their brain works, and we did it unnecessarily, but you know, no harm’ – and that’s where I think the regulators really don’t have a good understanding of what is actually happening here,” said Tony Chicotel, an elder attorney in California.

‘Looking at the person as a whole’: More humane solutions

Hank Rainer, a licensed certified social worker, has worked in Mississippi nursing homes for decades. Nursing homes contract with him to train social services staff in how best to support residents and connect them with services they need. 

Rainer believes there are several solutions to mitigating the state’s high rates of antipsychotic drugs. Those include training more physicians in geriatrics, increasing residents’ access to psychiatrists and licensed certified social workers, and creating more memory care units that care for people with dementia. 

The nation is currently facing a severe shortage of geriatricians, with roughly one geriatrician for every 10,000 older patients. The American Geriatrics Society estimates one geriatrician can care for about 700 patients. 

Because it’s rare for a nursing home to contract with a psychiatrist, most residents are prescribed medication – including for mental health disorders – by a nurse practitioner or family medicine doctor, neither of which have extensive training in psychiatry or geriatrics.  

Rainer also said having more licensed certified social workers in nursing homes would better equip homes to address residents’ issues holistically.

“LCSWs are best suited to help manage behaviors in nursing homes and other settings, as they look at the person as a whole,” he said. “They don’t just carve out and treat a disease. They look at the person’s illness and behaviors in regard to the impact of environmental, social and economic influences as well as the physical illness.”

That’s not to say, he added, that some residents might not benefit most from pharmacological interventions in tandem with behavioral interventions. 

Finally, creating more memory care units that have the infrastructure to care for dementia behaviors with non-medicated intervention is especially important, Rainer said, given the fact that antipsychotics not only do not treat dementia, but also pose a number of health risks to this population. 

Dementia behaviors are often mistaken for psychosis, Rainer said, and having trained staff capable of making the distinction can be lifesaving. He gave an example of an 85-year-old woman with dementia who kept asking for her father. 

The delusion that her father was still alive technically meets the criteria for psychosis, he said, and so untrained staff may think antipsychotic medication was an appropriate treatment. 

However, trained staff would know how to implement interventions like meaningful diversional activities or validation therapy prior to the use of medications, he continued. 

“The father may represent safety and they may not feel safe in the building because they don’t know anyone there,” Rainer said. “Or the father may represent home and security and warmth and they may not feel quite at home in the facility. You don’t ever agree that their dad is coming to get them. That is not validation therapy. But what you do is you try to key in under the emotional component and get them to talk about that, and redirect them at the same time.”

With more people living longer with conditions such as Alzheimer’s, good dementia care is becoming increasingly more important. 

But first the nursing homes would need to find the staff, Chicotel said. 

As it stands, with the vast majority of nursing homes in the country staffing below expert recommendations – nearly all nursing homes would have to increase staffing under not-yet-implemented Biden regulations, which are less stringent than federal recommendations made in 2001 – non-pharmacological, resident-centered care is hard to come by. 

“Trying to anticipate needs in advance and meeting them, spending more time with people so they don’t feel so uncomfortable and distressed and scared – that’s a lot of human touch that unfortunately is a casualty when facilities are understaffed,” Chicotel explained.

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Mississippi has more rural emergency hospitals than any other state – and there could be two more on the way soon.

Some have hailed the federal designation, created in 2023, as a lifeline for struggling rural hospitals at risk of closure. Others say it forces hospitals between a rock and a hard place. 

Rural emergency hospitals provide 24-hour emergency and observation services, and can also opt to provide additional outpatient services. But the program comes with a catch. 

Hospitals must close their inpatient units and transfer patients requiring stays over 24 hours to a nearby facility. In return, hospitals receive $3.3 million from the federal government each year. 

Rural emergency hospitals in Mississippi currently include Jefferson County Hospital in Fayette, Progressive Health of Batesville, Perry County General Hospital in Richton, Sharkey Issaquena Community Hospital in Rolling Fork and George County Hospital in Leakesville. 

Progressive Health of Houston and Smith County Rural Emergency Hospital in Raleigh, a new department of Covington County Hospital established in collaboration with South Central Regional Medical Center, also intend to apply for the status. 

Nationwide, 29 hospitals have received the designation, according to Centers for Medicare & Medicaid Services enrollment data. Over half of them are located in the Southeast. 

State Health Officer Dr. Daniel Edney last year likened conversion to a rural emergency hospital to a closure because of the corresponding loss of medical services.

Quentin Whitwell, the founder and CEO of Progressive Health Group, said that in his experience, the designation has provided increased sustainability and financial viability for hospitals that have adopted it. 

Progressive Health Group owns and manages six hospitals in Mississippi, Georgia and Arkansas, over half of which are rural emergency hospitals or plan to seek the designation. The organization previously served as a consultant for Jefferson County Hospital. 

“A lot of people saw it as a place where hospitals would go to die. We, on the other hand, saw an opportunity for expanding ancillary and outpatient services and utilizing the federal subsidy to grow those hospitals,” he said.

He said the model has strengthened access in some areas to outpatient services like general surgery, gastrointestinal and primary care and specialty doctors.

Inpatient services are “the drag on small rural hospitals,” he said. 

In Mississippi, 37% of hospitals are facing immediate risk of closure, according to a recent report. 52% face some risk of closure and 64% have experienced losses on services. 

Nearly 200 hospitals have closed nationwide since 2005. Many of these hospitals had low patient volumes and revenues that were insufficient to cover their costs, said George Pink, deputy director of the Rural Health Research Program at the University of North Carolina. 

The rural emergency hospital was designed to offset the financial challenges of running an inpatient unit, which is costly because it requires 24-hour-a-day nursing care, along with administrative and dietary departments, regardless of patient volume, he said. 

“They’re not a model of health care for every rural community, they’re not a panacea for rural communities. They really are targeted at very small communities that are at risk of losing their inpatient hospitals,” he said. 

Sharkey Issaquena Community Hospital converted to a rural emergency hospital after a tornado destroyed the hospital in March 2023. Board Attorney Charles Weissinger said the program made sense given the hospital’s circumstances, but noted that “it’s not the salvation for rural medicine.” 

Pink said that among communities that have experienced hospital closures, emergency services are considered one of the most significant losses. 

Progressive Health of Houston intends to apply for rural emergency hospital status to meet that need. The hospital reopened its emergency department in May after a decade without emergency services in Chickasaw County. Whitwell said that last December and January alone, the county saw 10 cardiac deaths out of a population of 17,000.

Without the ability to provide inpatient services, hospitals may have to give up valuable services, like an intensive care unit or obstetric services. 

Though rural hospitals are allowed to provide obstetric services, “it’s not realistic for the reimbursement model,” said Whitwell. 

Irwin County Hospital in Ocilla, Georgia, a Progressive Health Group facility, continued providing obstetric services after becoming a rural emergency hospital, but was forced to close the unit after just four months. 

David Culpepper, spokesperson for Smith County Rural Emergency Hospital, said the new facility will provide emergency care to the area for the first time in two decades. This is possible by eliminating the cost of inpatient care, he said. 

The hospital will offer “strictly emergency services with a full-on suite of imaging … and radiological services along with a fully functioning lab,” said Culpepper. 

It will be located at the former Patient’s Choice Medical Center of Smith County, which closed in 2023. 

Pink, who studies health care finance and rural hospitals at the University of North Carolina, said because the rural emergency hospital program is just over a year old, it’s too soon to say whether the designation helps hospitals surmount their financial challenges. 

Several changes to the law could make the program more appealing to struggling hospitals, he said, like allowing facilities to participate in the 340B Drug Pricing Program, which requires pharmaceutical companies to provide outpatient drugs to certain hospitals at reduced prices. 

Whitwell said he would like to see the program allow hospitals to operate inpatient psychiatric units and to shore up its definition of “rural.”

Republican Rep. John Lancaster of Houston proposed a bill this year to allow rural emergency hospitals to license psychiatric inpatient beds as a separate entity as a workaround to the federal regulations. The legislation did not make it out of committee.

Less than a year after Alliance HealthCare System in Holly Springs received rural emergency hospital status, the Centers for Medicare and Medicaid Services rescinded the designation, arguing that the hospital is too close to Memphis to be deemed rural. 

As a result, the hospital closed its emergency room in April and began the process of becoming relicensed as an acute care hospital.  

Harold Miller, the director of the Center for Healthcare Quality and Payment Reform, said the rural emergency hospital program poses a “problematic choice” for hospitals by forcing them to eliminate inpatient services in order to receive subsidies from the federal government. 

“There is this narrow, narrow window in which a hospital actually could benefit, and then an even smaller window of the hospitals that could benefit that are willing to do what is necessary in terms of closing services to be able to qualify,” he said. 

He said his research shows that hospital closures would be better prevented by ensuring that insurers pay hospitals adequately for their services. Because rural hospitals often have limited administrative resources, they are often not able to combat claims that are contested by insurance companies, he said. 

“We need to be fixing that,” he said. “…We are letting the private insurers off the hook.”

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The University of Mississippi is in the midst of restructuring its Division of Diversity and Community Engagement as other universities across the state have already made changes to their diversity, equity and inclusion offices, potentially in an effort to ward off a legislative ban.

Earlier this year, the head of Mississippi State University’s diversity division gave a presentation to faculty on the restructuring that was announced last fall. As of July 1, the University of Southern Mississippi’s renamed “Office of Community and Belonging” will serve a broader audience, a spokesperson confirmed.

Delta State University did not to refill its DEI coordinator after the position was vacated last year, according to a statement. The job was eliminated during the recent budget cuts.

At all three institutions, the universities told Mississippi Today the changes did not come with a reduction to any programs, scholarships or initiatives that aim to support the enrollment, retention and employment of students and faculty from historically marginalized groups such as racial minorities, veterans, first-generation and low-income students. In higher education, DEI traditionally refers to a range of administrative efforts to comply with civil rights laws and foster a sense of on-campus belonging among those populations.

At Ole Miss, it’s unclear if the university’s restructuring of the division will result in a reduction to any of the efforts the university announced in its ambitious “Pathways to Equity” plan three years ago.

“University leaders are working to determine the best way to align our resources to focus on what matters for educational attainment and student success,” a spokesperson, Jacob Batte, wrote in an email to Mississippi Today. “We anticipate some changes will be forthcoming, but the internal review is not completed.”

Across the country, conservative legislation has caused universities to shutter such offices, reassign or fire employees, and end scholarships and programs aimed at supporting marginalized students. Fourteen states have passed laws banning or restricting DEI practices of some kind, according to the Chronicle of Higher Education. 

Just last week, the University of Alabama System announced its campuses would close offices and reassign staff in response to a law banning DEI offices, programming and training in state agencies, AL.com reported.

The changes at Mississippi’s universities have come without a legislative mandate. Mississippi lawmakers have nominally banned the teaching of critical race theory, but the Republican-controlled Legislature has not put the kibosh on funding for DEI initiatives. Earlier this year, Rep. Becky Currie, R-Brookhaven, introduced a bill that would have done so, but it died in a House committee. 

Universities in Arkansas and South Carolina also preemptively reorganized their DEI offices, according to Inside Higher Ed. In both states, lawmakers have not passed a ban. The University of Missouri at Columbia announced a similar move earlier this year.

In Mississippi, the state’s loudest advocate for a DEI ban, State Auditor Shad White, focused much of his speech at the Neshoba County Fair this week on DEI. He has used his office to audit DEI programs at the eight public universities, including his alma mater, Ole Miss. In interviews and on social media, White has repeatedly warned about the “dangers of DEI,” saying it teaches college students “that we have to discriminate against some people because of the color of their skin.” 

Last year, White’s office determined the eight universities have spent at least $23 million in state and institutional funds since 2019 on a range of DEI programs, including affinity groups for minority students, programming like International Student Month, and staff members to support students who are veterans.

The bulk of DEI spending occurred at Mississippi’s five predominantly white institutions, with the three historically Black institutions having little programs or initiatives to report. Alcorn State University reported scholarships for non-Black students as DEI spending.

Changes across the system

Mississippi Today asked every university in Mississippi about possible changes to their DEI programs, including if there has been a reduction in any related programs or jobs.

At some schools, it’s unclear what changes, if any, have occurred. Mississippi Valley State University did not respond to a request for comment. Neither did Alcorn State, which listed an Office of Diversity, Equity and Inclusion on the state auditor’s report. The university’s website now lists an Office of Educational Equity and Inclusion, but a spokesperson did not respond to a request for comment.

In response to questions from Mississippi Today, a Jackson State University spokesperson responded “I have no new info to share with you.”

Though USM renamed its Office of Diversity, Equity and Inclusion last month, its mission remains unchanged, according a statement from the university.

“The Southern Miss family is comprised of many first-generation students and graduates, and that is something we are very proud of,” Eddie Holloway, a senior associate provost who helped lead the restructuring, said in a statement. “Ensuring these, and all students at Southern Miss, have opportunities to learn, lead and excel, remains a key priority for our institution.”

Last November, Mississippi State University announced a new organizational structure for its Division for Access, Diversity and Inclusion, as well as a new name. It is now called the Division of Access, Opportunity and Success. This effort got underway in 2020 in an effort to lessen disparate outcomes that a taskforce found among first-generational, low-income and racial minority students at the university.

Alongside the renaming, the university moved programs aimed at low-income, housing insecure and first-generation students under the Office of Access and Success, according to a presentation the division’s vice president, Ra’Sheda Boddie-Forbes, gave to the faculty senate earlier this year.

Boddie-Forbes told the faculty senate it’s not a secret that DEI has come under attack but that it was important for Mississippi State to continue the work of trying to help students from all backgrounds earn a degree. She said she had spoken with President Mark Keenum about how to protect and expand efforts to support the university’s marginalized students.

“When we think about how we deepen that work at the institution, one of the things that we know we can do is think about the nomenclature associated with the work,” she said, according to a recording of the meeting. “So, how does our work become more grounded in the fact that we’re doing work around ‘access,’ we’re doing work around ‘opportunity,’ and we’re doing work around ‘success?’ So that’s what we decided to do.” 

In a statement, Sid Salter, MSU’s vice president for strategic communications, said the restructuring did not result in the loss of any programs, initiatives, scholarships or jobs but that the university’s offerings are “constantly evaluated and are subject to change as the needs of our students evolve.”

“MSU’s Division of Access, Opportunity and Success exists with the express mission of providing programming and assistance to students to help them be successful in obtaining a college degree,” Salter wrote. “Our students come from many diverse backgrounds – some are first-generation college students, some are from the foster system, some are disabled, some are veterans, some have economic challenges – and the list goes on.”

Delta State University, according to a university webpage, started developing diversity initiatives in 2007. DEI programs, which have not been reduced, are now run through student affairs, according to an email from a spokesperson.

A spokesperson for Mississippi University for Women, which does not appear to have a DEI office, said the university had not made any changes.

‘An example for the nation and the world’

At Ole Miss, the division in question was founded in 2017 as a hub for various diversity initiatives the university had developed over the years. 

But its primary responsibility was implementing the university’s ambitious “Pathways to Equity” plan that committed the campus to three, five-year goals: Create more capacity for equity on campus, cultivate a diverse community and foster an inclusive climate. Each administrative school was charged with creating its own DEI goals.

The university hoped the plan could be an inspiration to other institutions. 

“By taking this responsibility seriously and plotting a principled and measurable path forward, we also can play a role in setting an example for the nation and the world,” Provost Noel Wilkin said in a 2021 press release. 

Ole Miss has achieved some of the plan’s specific goals, such as commemorating the 60th anniversary of the university’s integration. The number of Black faculty at the university has increased but still comprises a small portion of the more than 600 faculty, according to IHL and federal data. 

On other goals, progress has been a struggle. Since the plan was announced, the number of Black students on campus has steadily fallen, according to IHL data of on-campus headcount enrollment. In 2023, Ole Miss enrolled 2,156 Black students — several hundred less than it did in 2013.

Many Mississippi higher ed officials support DEI

This trend is not unique to Ole Miss. The IHL system enrolls fewer Black students than it used to while white enrollment remains roughly the same, though the root cause of this trend is likely complex. 

Still, higher education officials in Mississippi continue to say diversity is an important part of their campuses. As of January last year, the governing board of Mississippi’s eight universities evaluates the college presidents, whom the board has the power to hire and fire, based in part on how well they promote “campus diversity.”

The Institutions of Higher Learning Board of Trustees’ policies and bylaws also includes a diversity statement, last issued in 2013, that reads in part, “Institutions of higher learning have a moral and educational responsibility to ensure that talent is developed in all our citizens, and that our universities, individually and collectively, are strengthened by diversity in student bodies, faculties, administration, and in all areas offering employment opportunities, including construction, financing and consulting.”

When IHL held its annual diversity awards earlier this year, the trustee who presented the awards, Steven Cunningham, a radiologist who attended Jackson State University, thanked the presidents for supporting diversity on their campuses. 

“In this current environment of nationwide, orchestrated assaults against DEI programs by organizations such as the Claremont Institute and others like it, you guys continue to foster representative communities on your campuses, and I just want to thank you for your courage and your leadership in that endeavor, so thank you so much guys,” Cunningham said. “Those thoughts are mine and mine alone, and I approve that message.”

The Claremont Institute is a conservative think-tank based in California with ties to former President Donald Trump that has helped to lead the movement against DEI programs, according to the New York Times.

In a sit-down video recorded last fall, Keenum discussed Mississippi State’s diversity programming with Salter.

The president said he was passionate about and defensive of the work Mississippi State does to support marginalized students. Keenum added that the total bans on DEI programs in states like Texas and Florida came from a place of misunderstanding. 

“Because of the perception that there’s a ‘woke indoctrination,’ they’re missing the fact that these programs are here to help students succeed that come to us with different backgrounds,” Keenum said. “And that’s what we’re about here at Mississippi State.” 

“What I heard you say and what I’ve heard Ra’Sheda say as she talks about reorganizing her division is access opportunity and student success,” Salter responded. “And those are all goals nobody can argue with.” 

The post ‘Goals nobody can argue with’: Mississippi universities rebrand DEI to focus on access, opportunity and belonging appeared first on Mississippi Today.

Much has been made nationally of Mississippi’s improvement in fourth-grade reading scores. 

Whether being celebrated or scrutinized, attention has been squarely focused on elementary students and their reading instruction. Mississippi students and educators have closed the gap and reached the national average on the National Assessment of Educational Progress. This growth can be attributed to several factors, but chief among them is a 2013 state law that created a more robust infrastructure around helping children learn to read and holding them back at the end of third grade if they didn’t hit a certain benchmark.

But this national test also measures students again in eighth grade. The gap between the national average and Mississippi’s eighth-grade reading score has gotten smaller over the last decade, but it hasn’t closed at the rate of fourth-grade reading. 

State leaders are paying attention. 

“Some of our challenge points are eighth-grade reading,” Interim State Superintendent Ray Morgigno said when presenting an annual report at the Jan. 18 State Board of Education meeting.

Morgigno then pointed to the pilot programs underway around the state to expand Mississippi’s fourth-grade reading strategies up to the middle school level. One is being operated by the Mississippi Department of Education in conjunction with a regional arm of the U.S. Department of Education. 

Another one of these pilots, the Mississippi Reading Clinic, is a “legacy project of the Barksdale Reading Institute” according to its website. The Barksdale Reading Institute led some early conversations around literacy reform in Mississippi by defining the problem and testing out solutions that eventually became the basis of the 2013 state law.

Kelly Butler, former CEO of the Barksdale Reading Institute, said a unique approach to middle school literacy is necessary because instruction shifts in fourth grade from “learning to read” to “reading to learn.” This means the curriculum no longer focuses on direct instruction in decoding words, instead having students read passages to learn new concepts. For students who may have passed the third-grade test but are still not strong readers, this can be a particularly challenging transition. 

To address this, both pilots are training subject area teachers in upper grades on literacy instruction and methods to incorporate it in their classrooms. Butler said they’re trying to create a paradigm shift that “Everybody is a literacy teacher – this is what it looks like in K-3 and this is what it looks like in 4-8.”

The state partnership with the federal education department is focused on three school districts: Canton, Columbus and Laurel. 

In Laurel, the District ELA Coordinator Kristin Walters said she’s glad to be participating in the pilot program because it “adds purpose and validity” to strategies she was already trying to implement in the district. 

Walters said the approach used in the program employs a research-based practice guide, instructing teachers to first lead students in a discussion on the topic of the text, preview new vocabulary words before encountering them, annotate passages in a manner specific to its subject and structure, and review their annotations with another student. 

“It’s a routine that is just a very structured way to teach the text and have students engage deeply with the text,” Walters said. 

Walters said the district curriculum leads for each subject area have been the point people for making sure teachers are implementing the new strategy. Walters said it’s too early to have definitive results for the program, which is in its second year, but added that the district’s mid-year benchmark testing scores for science and English are both up over last year. 

‘To me, it’s important that we as a state and as a district, that we are focusing on those adolescent readers and they’re not just getting lost in the cracks just because they’re not in elementary school anymore,” she said. 

The partnership also has a second element focusing on training middle school interventionists. Walters said older students who are struggling to read have different needs, in part because students have developed coping mechanisms like skipping words and guessing to get by. For these students, it’s important to help them access the meaning of more complex words without taking it back to the ABCs and talking down to them.

Butler said she believes the Legislature needs to fund middle school interventionists statewide if the state wants to see eighth-grade reading scores improve. 

Leaders at the Mississippi Department of Education are also interested in scaling up their middle school literacy work but don’t have the funding to do so. Kristen Wynn, MDE’s state literacy director, said the department has already developed a model policy for middle-school literacy improvements but legislative funding only applies to K-3 efforts. If additional funding were made available, the model policy would include teacher training and interventionists in upper grades, similar to the 2013 law without a “gate” assessment. 

“We (sic) are well aware that some kids fall through the cracks and have difficulties when we’re moving in that middle school space,” Wynn said. “Kids in middle school still have phonics gaps and so we still have to equip teachers with what they need to fill those holes and to close those gaps.”

READ MORE: Mississippi’s ‘reading miracle’ has been out of reach for some schools

READ MORE: How many students are retained by the ‘third-grade gate’? No one knows

The post Mississippi falls short of an eighth-grade literacy miracle appeared first on Mississippi Today.

Marquitrice Mangham never imagined that she’d open a grocery store in her hometown of Webb, Mississippi. 

She left in the 1990s after high school. But in 2016, she inherited her family’s farm, splitting her time between the majority-Black town of fewer than 500 people in the rural Delta and her current home in Atlanta.

Webb had changed considerably and was regressing, she said. Businesses had closed, and the housing situation got worse — but the food desert still had a Dollar General. Like many counties across the Delta region, Tallahatchie County, where Webb is, is situated in a food desert. Though the town has had the Dollar General since 2009, it only provided frozen and processed foods. Here, the residents never had a grocery store, forcing many to travel more than 20 miles to the nearest one.

Mangham, a military veteran and planning expert, saw a solution. In October 2022, she opened Farmacy Marketplace, a 2,500-square-foot neighborhood grocery store that sells fresh foods and meats sourced mostly from local farmers. Instead of the traditional for-profit store, she used a different model: her nonprofit, In Her Shoes, works at the intersection of farming and food access. 

Mangham is one of many Black entrepreneurs nationwide working to improve health outcomes and food accessibility in rural communities or Black neighborhoods. And as hundreds of dollar stores are closing, more Black entrepreneurs are opening grocery stores anyway — whether it’s Neighborhood Grocery in Detroit, All-In Grocers in Waterloo, Iowa, or Sherman Park Grocery in Milwaukee. 

Research shows that when dollar stores show up in communities — particularly areas that are low-income, rural, and Black — it results in grocery store closure, job loss, and declining sales. From 2000 to 2019, grocery stores experienced a nearly 6% decrease in sales, 4% decline in employment and 2% increase in grocery stores closing. The outcomes are three times larger in rural areas than urban areas, according to new research released by the United States Department of Agriculture Economic Research Service. These negative impacts waned after five years in urban areas. In rural areas, however, the effects continued.

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Read More: The Movement to Stop Dollar Stores from Suffocating Black Communities

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Back in Webb, only a few weeks before Farmacy opened its doors, the Dollar General caught fire and closed down, which served as an opportunity for Mangham to offer household items in the store, too. The dollar store has since reopened.

Opening a grocery store isn’t the only, or best, solution to address the root causes of food insecurity, she said. Affordability, transportation, and lack of education create additional barriers to healthy lifestyles. Mangham is looking to do more: drive a mobile produce truck to other towns and provide financial incentives to encourage families to buy more fruits and vegetables, through programs such as Double Up Food Bucks. It allows people who receive SNAP benefits to earn up to $20 a day when they buy fruits and vegetables.

But what does it really take to open a local grocery store? 

Capital B wanted to understand more about the challenges, the benefits beyond Mangham’s community, and her plans for the future. The conversation has been lightly edited for length and clarity.

Capital B: Why a grocery store? How did you get into this work?

Marquitrice Mangham: There was only one grocery store in the whole county, and that was 15 to 17 miles away from most residents in the county, and some even farther. In Her Shoes, we work closely with farmers and help them to grow their business or at least sustain their business over time. One of the biggest ways to help them is to access markets. We work with farmers who are growing but not able to reach those populations that need it … because the populations are sparsely populated, everything is stretched out over 600 square miles. They’re throwing their hard-earned food away because it’s rotting, meeting its shelf life prior to them actually being able to sell it or reach people who want to buy it. The grocery store was the answer to a number of things.

Why a nonprofit model?

We decided to do it under the In Her Shoes Inc. umbrella or do it as a part of our nonprofit because over time, we felt that it would be more sustainable. There are a lot of resources out there to help address food access. There’s a lot of resources out there to help farmers, so we felt by doing it as a nonprofit, if the sales were short or [there were] issues with trying to maintain over time, there were other programs or resources that would help us to be able to sustain the store longer. Fortunately for us, we’ve been able to sustain ourselves even though there is a dollar store in the community.

What are some of the challenges or startup costs you’ve experienced since opening?

We bought the brick-and-mortar store a year or so prior. We applied for a grant to buy the equipment to do some renovations and upgrades to the mechanicals. It took us maybe four or five months to make the renovations and upgrades.

Most of these wholesale vendors require you to order a minimum amount each week, and if you’re not selling it you can’t buy it — having to order $10,000 or $20,000 a week just to maintain your vendor. That alone would shut down a lot of smaller community grocery stores. Just the overhead outside of that is fairly steep when you’re talking about refrigeration and coolers, electricity and other things. So the price tag not only starts up, but the ongoing or monthly price can get pretty extensive. You’re looking at your small, independent store, so you’re not getting your products at the price that a chain retailer gets. 

Not only are you having to buy more, but you’re having to sell at a higher price because you don’t get the discounts. You don’t have the amount of sales volume that the Family Dollar or the Dollar Generals have, and they’re buying in bulk for hundreds of stores at a time. There are a lot of challenges that we saw in the beginning. 

As far as variety, we have a national wholesale distributor, and we partner with them. They helped us out a lot with relaxing some of their standards to be able to allow us to partner with them and supply our grocery store. For us, the best outlet was to basically open under the nonprofit and do it as economically as possible. 

What should people take into account before going on this journey? Are there alternatives to a grocery store?

After opening Farmacy Marketplace, I’m getting quite a few requests from other local governments and other entities to help build a grocery store in their community. I’m doing the research to see if it’s doable, and if it’s economically feasible over time. Every community is just not able to support a standalone grocery store over time, not as a business. It may be more sustainable as a nonprofit. 

Most elderly people, most people, are going to go to the local pharmacy. You could partner with a local pharmacist to offer a food display for fresh fruits and vegetables. That’s one of the reasons why we’re called Farmacy Marketplace because it’s good, healthy food options that promote good health. Rather than building a brick-and-mortar building, look at those retailers that people visit that are already in place that you may be able to partner with. 

We looked at gas stations and other stores that are existing that we may be able to partner with and make some upgrades to their electrical and plumbing to offer what I call fresh food kiosks, and in those outlets they already have the consumers that are visiting out of necessity or easy access. Why not put a refrigerated display case with fresh fruits and vegetables and some meat options?

Try and address the issue with what’s there, meet people where they are, and build up to that. The idea isn’t to just have a brick-and-mortar. The idea isn’t to just build a grocery store. The idea or the hope is to provide fresh food access in whatever form that might be.

The post Dollar Stores Force Local Grocery Stores to Close. This Woman Opened One Anyway. appeared first on Capital B News.

An education company that helps bring free college-level science courses to poor, rural public schools, many in the Mississippi Delta, will lose federal funding after the Biden Administration did not renew its grant last year. 

The Global Teaching Project has received more than $3.5 million from the U.S. Department of Education to support its work offering Advanced Placement science courses to nearly 40 high-poverty schools.

Over 1,000 have enrolled in the project’s classes, according to its founder, former tax attorney Matt Dolan, who says he has put more than six figures into the project since starting it in 2017. Districts could offer AP courses that they never had before. 

Global Teaching Project’s “blended” instructional model — online course content taught by in-class teachers who are supported by virtual STEM tutors from universities such as Harvard — was even praised by school choice and school voucher proponent Betsy DeVos, the Trump administration’s education secretary. Experts have heralded this approach as “the future of education, especially for rural schools,” and the Global Teaching Project has drawn the attention of entrepreneurs like Mark Cuban.

It’s also a model that has the interest of powerful Mississippi Republicans. Senate Appropriations Chair Briggs Hopson told the Magnolia Tribune earlier this legislative session that he hopes to expand virtual learning for schools that struggle to find qualified teachers. 

But the Global Teaching Project’s growth could falter without more financial support when its federal Education Innovation and Research grant expires this summer as, Dolan said, a majority of that funding went to the program costs. The minimum needed to operate this coming year is $1.2 million, Dolan said. 

The Mississippi Public School Consortium for Educational Access, a coalition of rural public school districts, was technically the recipient of federal funds, but Dolan said the Global Teaching Project was the driver of the initiative, a relationship that grant reviewers in 2019 said could be clarified. 

“My guess is they’ve never seen such a thing where somebody not only develops and implements the program, but they provide the money,” Dolan said. “That’s what we told the school districts when we first started in 2017. We said we want to do this, and we’re not asking you to give us a penny.” 

Last year, the Biden Administration awarded more than $275 million in funding to projects in 20 states. Projects in three states — California, Massachusetts and Texas — received almost as much funding as the remaining 17.

Without the project, the Quitman County School District would not be able to offer AP Computer Science, said Baxter Swearengen, a special-education teacher who acts as a “facilitator” for the courses. 

Neither would the Holmes County School District, said Iftikhar Azeem, the science department chair at Holmes County Central High School. He teaches AP Physics and AP Computer Science. 

That’s because these districts, which have a small tax base, can’t compete with other counties and even states that pay teachers much better, or with other science-professions.

“The very fundamental thing is funding,” Azeem said. “I’ve taught several hundred physics students, but nobody came back as a teacher because when they do get a masters in science, they get a better job. … Why should they work as a teacher?”

Both districts struggle to retain college-educated graduates amid population losses since 2010. 

“A place like Holmes County, Mississippi, has fewer residents today than it did when the Civil War broke out,” Dolan said. “That teachers are not moving there is symptomatic of broader issues about exodus from these communities.” 

The Global Teaching Project helps fill this gap, Dolan said, by providing schools with “turnkey courses,” as well as textbooks and workbooks that students don’t have to pay for. And teachers like Swearengen and Azeem are offered stipends for professional development courses. 

“We are paying our teachers, not the other way around,” Dolan said. “We are providing services to our students. They never pay us a penny. Their parents never pay us a penny. We’ve never used a dollar of state or local tax dollars.” 

More than 90% of students who take Global Teaching Project’s classes go to college, though Dolan couldn’t provide the exact number, he said, due to limitations collecting data from public schools. But when students get to college, they are prepared, he said. 

“Where we make a difference, and here I am confident, is where they go to college, how well they do in college, how prepared they are in college, their persistence and scholarships,” Dolan said. 

Dolan said he has partial data on pass-rates on the AP national exams for Global Teaching Project students and that the pass-rate for AP Computer Science tends to be higher than AP Physics. A majority of students do not earn a qualifying score for college credit on the exams, which is a three or higher, Dolan said. 

“By taking this exam, you are part of an elite group,” Dolan tells his students. 

Both teachers said their classes’ exam scores aren’t as high as they wish due to a myriad of factors. 

In Quitman County, students don’t struggle with the curriculum, Swearengen said, because the Global Teaching Project provides tutors from Ivy League schools. It’s more about attention: Swearengen said his students tend to miss class for major athletic events. Cellphones are another distraction. 

But the biggest struggle, Swearengen said, is technology. His district has limited bandwidth. During end-of-year testing, only so many students can use a computer at one time, he said. Sometimes, all nine of his students have to crowd around one computer.

That’s a huge reason his AP Computer Science pass-rate isn’t where Swearengen wants it to be. 

“We have so many students on computers to where the technology person will just shut the entire network off,” he said. 

Still, Swearengen said the Global Teaching Project has benefited his students in ways that can’t be quantified. Through the project, they have an opportunity to experience college-level curriculum and visit campuses like Jackson State University. 

Their self-regard increases, he said. 

“They get to spend a night in a hotel room when they’ve never been,” he said. “They get to go to conferences and eat different food. And talk about computers. It’s just so much. It’s a bigger picture than I think anybody could have imagined.” 

That was Demeria Moore’s experience when, as a junior and senior at McAdams Attendance Center in Attala County, she took AP Physics and AP Computer Science, the latter course she was able to claim college credit for at Holmes Community College. 

Though it was lonely to be the only student in the AP Computer Science course, Moore said participating in the class helped her understand the “why” behind the world. 

“When I look out the window and I see the leaves, how they’re full of chlorophyll and the sun will allow them to have energy, and how that energy can get transferred to me and that just creates the circle of life,” Moore said. “All those little things have some type of science or math attached to it. It all just blew my mind.” 

Moore said the Global Teaching Project also provided a sense of community at her school where teacher turnover is high. McAdams is a junior-senior high school and, by the time she graduated, all her teachers from seventh grade had left.

“I had some really good teachers and even the students who may have just maybe caused a few issues in class, even they would listen to these teachers. And I just wish they would have stayed so everybody could have a better learning experience,” she said. 

Dolan said one of the successes of the Global Teaching Project also comes with irony. His initiative can help teachers become AP certified, which can lead them away from high-poverty school districts to ones that can pay better. 

“We recognize there are certain issues that we cannot affect,” Dolan said. “We don’t determine who is in the building, but we will serve whoever is there.” 

The post Company deemed ‘future of education’ for rural schools to falter without cash infusion, founder says appeared first on Mississippi Today.

When the North Carolina legislative session ends, Jim Burgin, a conservative Republican state senator who serves as chair of his state’s Senate Health Care Committee, will go back to his daily life as a businessman.

The owner of an insurance company and a partner in a local car dealership group, Burgin fully understands the virtue of hard work. That’s why when Medicaid expansion, the federal program that 10 states including Mississippi have refused to pass, came up for debate in his legislature over the past few years, he wasn’t immediately sold.

“I don’t think we ought to have any kind of government program that people stay on the rest of their lives,” Burgin told Mississippi Today in an interview this week. “Like most of my Republican colleagues, I wanted to put a work requirement in. But we realized the feds would never approve it, so we had to think about what we really wanted to do as it related to work.”

Many Mississippi Republican lawmakers currently face the same dilemma. Though Medicaid expansion is being seriously considered here for the first time, Senate Republicans, led by Lt. Gov. Delbert Hosemann, appear convinced that the only way the state should expand Medicaid is if a work requirement is in place. But with the federal government having shot down 13 states’ previous efforts to implement a work requirement, Mississippi Today reached out to leaders in North Carolina, the most recent Republican-led state to expand, to see how they came to an agreement.

READ MORE: Mississippi lawmakers look to other states’ Medicaid expansions. Is North Carolina, Arkansas, Georgia worth copying?

Burgin and his colleagues, knowing the feds wouldn’t allow the work requirement, went to the drawing board to determine if they could come up with a Medicaid expansion bill that still promoted work without requiring it. They started with a “trigger law,” of sorts, to mandate that if the federal government ever changed their policy on allowing states to implement a work requirement, North Carolina would move immediately to adopt one. They also added a separate trigger that allowed the state to immediately drop out of the expansion program if Congress ever defunded it or changed its funding structure.

They also developed some creative ideas for spending the additional federal dollars the state would receive from the expansion program that were designed to promote work. Shortly after they expanded Medicaid, the North Carolina lawmakers designated hundreds of millions in expansion “signing bonus” funds on mental health reform. The state’s mental health system was in crisis with major funding concerns, so Republicans appropriated $835 million — all money they got from the feds to expand Medicaid — to rebuild the crumbled system.

“That’s going to help so many hospitals and law enforcement officers who often had nothing to do with mentally ill people but take them to emergency rooms, whether those people had health insurance or not,” Burgin said. “Hospitals will never have to treat or pay for care for people in those situations in ERs ever again.”

Additionally, North Carolina Republicans in the coming weeks will work on getting the federal government to grant a waiver to spend federal Medicaid dollars on providing free community college — and workforce skills training — to North Carolinians enrolled in the Medicaid expansion program. Additionally, some Republicans want to add child care vouchers to that list of offerings.

“This is all to get people jobs and to keep them working and ultimately to get them off Medicaid,” Burgin said. “Even though it can’t be a requirement, we’re promoting work. We want to make it easier and better for people to get work that they won’t want to stay on Medicaid. They’ll want a job and hopefully eventually get on a group health plan through their employer.”

So what ultimately convinced Burgin, who wanted the work requirement all along, to move forward on expansion even without it?

“Billions of dollars,” he said plainly. “Look, I’m a business guy. I don’t spend money, I invest money. I looked at (Medicaid expansion) as a great investment. I had a fiduciary responsibility to my constituents to take that money. So we wrote a bill that said that if the feds changed the work requirement, if they change anything, we can add it here or opt out of our program altogether.

“I just couldn’t turn down billions of dollars that we needed in so many areas,” Burgin said. “And we get to spend that on a wide variety of things, and all of it is designed to get people across this state working.”

READ MORE: Mississippi leaving more than $1 billion per year on table by rejecting Medicaid expansion

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Republican state Rep. Donny Lambeth was the primary author of what became North Carolina’s Medicaid expansion program.

For years before an expansion program actually passed, Lambeth filed numerous expansion bills that included work requirements.

“I was a big advocate for work requirements because, well, I felt like it was just one of those things,” Lambeth said. “We shouldn’t want to just add more people to Medicaid rolls. You have to figure out how to help them and get them off Medicaid and into the workforce. But when we talked to people in Washington, it was obvious there was no way, if we went through all the trouble to get votes and get it passed, we would get a work requirement.”

READ MORE: How Medicaid expansion could have saved Tim’s leg — and changed his life

So Lambeth, like Burgin, went to the drawing board. They wrote into their expansion plan a provision similar to red-state Montana: State government agencies would work with private partners who had experience with job training to create a program that would pay for Medicaid enrollees to get job training. They couldn’t require people to participate, but they could make it worth their while.

“We looked at what other Republican states that had expanded had done,” Lambeth said. “What we came up with in lieu of the work requirement was an optional jobs training program. The idea was that even though you’ve got the vast majority of people on Medicaid working, they’re working in low-income jobs. They couldn’t afford health insurance even though they worked.  The theory is that if you take advantage of expansion dollars from the federal government with a job training program like this, you can go back and further your education. You can then get a better job, have a higher standard of living, get off Medicaid and be able to afford your health insurance.”

Peg O’Connell, a health care advocate and consultant who for several years led North Carolina’s push to expand Medicaid, explained how the jobs training program worked in Montana before her state included it in its program.

“A man had been a hit-or-miss carpenter and really wanted a commercial drivers license,” O’Connell said. “So the Montana caseworker under their expansion program helped get him his CDL. They paid for him to take the classes as well as lodging when he had to travel to take his exams, and they even bought him a pair of work boots. This man is now doing what he wants to be doing, he’s got full-time employment with health insurance, and he has worked himself off the Medicaid program. That’s the idea behind our program here.”

Lambeth, like Burgin, is a small business owner. He owns a logistics contracting company, and he “can’t afford to offer my employees health insurance,” he said.

“Are there some quote-unquote deadbeats, people who are not working, playing off the system? Sure,” Lambeth said. “But we were able to identify the farmers in the east part of the state, small, mom-and-pop businesses that were growing at significant rates but couldn’t quite afford to offer health insurance, hard-working people who desperately wanted and needed health insurance but couldn’t afford it. We saw that the vast majority of these people are working, and the ones who weren’t working, we felt like if we could get them training or education and child care, that would help get them off Medicaid.

“If we’re really all about getting people working, then let’s figure out ways to work within the system, draw down those billions of dollars, and use them to get them working,” he continued. “It was really that simple.”

READ MORE: Gov. Roy Cooper, the most recent state leader to expand Medicaid, has advice for Mississippi lawmakers

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Burgin and Lambeth both supported work requirements but saw they wouldn’t get approval from the federal government. They listened to their constituents, they considered the heart of their desire to get North Carolinians working and they found creative solutions.

As Mississippi lawmakers consider Medicaid expansion over the next few days, what advice might the North Carolina Republicans offer to their counterparts here in the Magnolia State?

“You tell any of the hardest nos, the most conservative ones, that if they have any doubts, give them my number. My cell is 919-207-7263,” Burgin said. “I’ll be happy to answer any question they may have and talk to them about why this is so beneficial. I’ve been tracking Mississippi. I testified the other day to Kansas lawmakers. We’ve already talked to folks in Georgia, Florida, Kansas and now Mississippi. All of these holdout states are looking at the same thing saying, ‘We’ve put it off. Why did you do it?’ For me and my Republican colleagues, it came down to a business decision. How could we, in good faith, leave billions on the table?”

Lambeth answered the question with an anecdote.

“I heard from just dozens and dozens of North Carolinians while we were debating this,” Lambeth said. “But I got one letter, in particular, from a Christmas tree farmer in Ash County. She couldn’t afford health insurance, and she was worried they were going to lose their farm because of out-of-pocket medical bills they had.

“These are real people. They’re not the traditional Medicaid where they’re poor and not trying to improve their lives. They are hard-working people just not able to afford health insurance. I promise the average Mississippian is not much different than the average North Carolinian in that way. Why would we be in the positions we’re in and not help them? I mean really, why?”

READ MORE: The Christian argument for Medicaid expansion

The post These Republicans wanted a Medicaid work requirement but couldn’t get approval. So they got creative. appeared first on Mississippi Today.