‘Killers of the Flower Moon’ is starting conversations about history, mental health and more in Indian Country
Medicaid drops another 13,000 Mississippians as agency’s backlog snowballs
Nearly 13,000 Mississippians were kicked from Medicaid’s rolls in September during the most recent batch of disenrollments, while the agency’s backlog grows.
The latest numbers bring the state’s total disenrollments to 81,454 people, most of whom were dropped for paperwork issues, not because they were found to be ineligible.
Medicaid divisions all over the country are reviewing their rolls for the first time in three years after the end of federal regulations that prevented state Medicaid agencies from disenrolling beneficiaries during the pandemic. Prior to this process, referred to as “unwinding,” Mississippi Medicaid enrollment exceeded 900,000 people for the first time in the agency’s history.
Many of them have been children, according to the agency’s monthly enrollment reports. Federal research predicts that kids are most at risk of losing benefits during unwinding, and it’s not clear how many are being dropped despite being eligible. Before the terminations began, children in low-income families made up more than half of the state’s Medicaid rolls.
Almost 45,000 kids in Mississippi have been dropped from Medicaid since the start of unwinding.
Though Medicaid’s spokesperson Matt Westerfield previously told Mississippi Today that the agency hopes to increase its ex-parte rate, or automatic renewal rate, the state continues to disproportionately drop beneficiaries for procedural reasons, which means their paperwork was either not turned in on time or it was incomplete.
Of the 12,828 people dropped in September, around 75% were procedural disenrollments. Overall, Mississippi reports a 78% procedural disenrollment rate thus far. According to KFF, 72% of all people disenrolled were terminated for procedural reasons across all states with available data.
And though it appears in recent data that Mississippi’s disenrollments are decreasing, that’s because the agency’s backlog is growing.
During the first round of disenrollments completed in June, Mississippi Medicaid didn’t get around to checking the eligibility of 5,892 people that were due for the review. However, that backlog has significantly increased — to 19,402 in July; 29,788 in August and now 45,989 in September.
Westerfield did not reply to questions by press time.
As Republican Gov. Tate Reeves continues to voice his opposition to Medicaid expansion, which would insure thousands more working Mississippians, unwinding is set to continue for months. Thousands more Mississippians are poised to lose Medicaid coverage amid a statewide health care crisis — nearly half of the state’s rural hospitals are at risk of closure, according to one report.
KFF says at least 8,696,000 people nationally have been dropped from Medicaid as of Oct. 11.
The post Medicaid drops another 13,000 Mississippians as agency’s backlog snowballs appeared first on Mississippi Today.
In rural Mitchell County, telehealth thrives in one town, falters in another
Even though remote health care has not been widely adopted in Mitchell County, there are signs of success in one clinic that prioritized connecting with the rural culture in this mountain region.
In rural Mitchell County, telehealth thrives in one town, falters in another is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.
Lawmakers tackled New Mexico’s crisis of rural health care workers. It wasn’t enough.
What mobile clinics in Dollar General parking lots say about health care in rural America
Deploying mobile clinics to fill care gaps in underserved areas isn’t a new idea. But pairing them with Dollar General’s ubiquitous small-town presence has been heralded by investment analysts and some rural health experts as a way to ease the health care drought in rural America.
What mobile clinics in Dollar General parking lots say about health care in rural America is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.
State officials tout ‘once in a lifetime’ investment in North Carolina’s mental health services
By Taylor Knopf
Between federal COVID relief funds and the $1.4 billion sign-on bonus North Carolina received for expanding Medicaid, state lawmakers were able to make significant investments in mental health services in the latest state budget.
Though state budget negotiations are done almost entirely behind the closed doors of the majority party in the General Assembly — currently the Republicans — health leaders in the House and Senate said they took care to listen to patients, families and providers while creating their mental health spending plan while also working closely with Department of Health and Human Services Secretary Kody Kinsley.
“Everybody saw that to make big changes was gonna take a lot of money,” Sen. Jim Burgin (R-Angier) said in an interview with NC Health News this week.
“And I think one of the attractions to Medicaid expansion for all of us was this once in a generation or maybe even once in a lifetime opportunity to say, ‘Mental health is a big deal,’” he said, explaining the significance of the federal sign-on bonus that came with Medicaid expansion, which lawmakers decided to use to invest in mental health services.
The result is pages of mental health policy and spending in this year’s budget document, where lawmakers committed to significant rate increases, bonuses and education for a variety of mental health workers. They set into motion big structural changes to the way behavioral health services are delivered to the most vulnerable populations across the state. And they directed hundreds of millions to support children in foster care and expand preventive mental health care and crisis care services.
‘A sense of urgency’
Burgin said he has long been committed to improving the mental health system. He demonstrated that commitment when he embarked on a listening tour with Kinsley and other legislative guests to learn about the mental health needs across the state. After more than a dozen town halls, Burgin said he saw “a different face with the same heartbreaking stories about not being able to get services. We heard that at every meeting.”
“You don’t know how bad something is until you go see it yourself,” Burgin said. “You get a sense of urgency that we have to do something.”
Rep. Donny Lambeth (R-Winston-Salem) has been dedicated to improving health care through his six terms in the state House, and he said he’s never had a better working relationship with a DHHS secretary than he does now. Lambeth described Kinsley as being an open-minded problem-solver. Burgin was also quick to praise Kinsley for the time he’s invested in helping others understand the mental health needs of the state and forming the relationships necessary to move things forward.
“We’re actually getting a lot done, but we’re having a good time doing it because we enjoy talking about it and working on it,” Burgin said. “In the next 24 months, you’re going to see some fantastic things happen in North Carolina.”
Alternatives to the emergency room
Lambeth said that last summer he received three phone calls in one week from families with a child in a mental health crisis asking him what they should do to get help.
“Unfortunately, the only thing I could tell them is, ‘You need to go to the emergency room,’” he said. “We’ve got to get these individuals into a proper care site, not the emergency room.”
Going to the emergency room during a mental health crisis can be a traumatic experience for many, as emergency departments are not set up to treat mental health crises.
In recent years, ERs across the state have been overwhelmed by mental health patients, who often end up waiting days or weeks for an available inpatient psychiatric facility bed. Once that bed does open up, the patients are often transported under an involuntary commitment court order. They are handcuffed and driven by law enforcement officers in marked police vehicles.
Burgin said he gets similar phone calls from families with loved ones in distress. He also said the number is only increasing.
“What a shame that the entry point for mental health has become the door to the emergency room,” Burgin said. “And that’s what we’re trying to stop. There’s got to be a better entry point into mental health care.”
The expansion of Medicaid to about 600,000 low-income North Carolians who previously didn’t have health insurance is the first big step to get people into primary care offices instead of emergency rooms, Lambeth said.
“The foundation of expansion really is developing better access points, primary care — taking care of individuals who historically have not had good access,” he said.
‘It’s primary care’
Because of a lack of psychiatrists and child psychiatrists in the state, primary care providers often find themselves out of their depth with patients who come to their offices with mental health issues. To address this, the state spending plan also includes $2 million per year in recurring dollars for the Psychiatry Access Line (NC-PAL), a partnership between DHHS and the Department of Psychiatry & Behavioral Sciences at Duke University.
“Any health care provider, usually a primary care provider or pediatrician, can pick up the phone and speak to behavioral health experts,” Kinsley said.
The budget states that required annual reports be made to state lawmakers that include the number of consultations, counties using the services and the “estimated number of avoided emergency department visits resulting from the services provided through NC-PAL.”
State lawmakers provided $5 million to advance a collaborative care model — where common mental illnesses are treated in primary care settings, rather than sending patients to another provider, often after a wait. This model of care is something DHHS has been scaling up across the state.
“Behavioral health has been thought of as a specialty-level service. It’s not. It’s primary care. Everybody needs access to it,” Kinsley said in explaining the importance of expanding this model.
The budget allocates $80 million over two years for new mobile crisis teams and for crisis and respite facilities. These are alternatives to the emergency room for people who are experiencing mental health distress. The mobile crisis units consist of specialized teams of behavioral health providers that can meet someone where they are located. Respite facilities give people who are having emotional issues the opportunity to spend time in a therapeutic environment, receiving support from behavioral health workers or peer support specialists, people with lived experience of mental illness, all outside of a hospital setting.
Kinsley said he was happy to see $20 million over two years to fund a non-law enforcement pilot program for transporting patients for voluntary and involuntary psychiatric admissions. Putting distressed mental health patients in handcuffs in the back of a police vehicle is “not trauma-informed. That is not appropriate,” Kinsley said.
This spending plan offers “more access points. There’s more prevention. There’s better crisis services and more trauma-informed services if we need to go down that path,” Kinsley said.
The budget includes hundreds of millions in ongoing funding, which will increase reimbursement rates for several health care positions, including skilled nursing facility workers ($71 million in state dollars), personal care service providers ($50 million in state dollars), direct care workers for people on a state- and federally funded Medicaid program that serves people with intellectual and developmental disabilities ($55 million in state dollars).
Rates for mental health providers have not increased since 2012, and Lambeth and Burgin said they consistently hear about this issue. For years, health leaders have called for rate increases to attract and retain workers for these types of positions.
The budget includes, for example, increasing the hourly rate for direct care providers for people with disabilities who receive enhanced community services. Additionally, the budget provides $10 million in ongoing annual funding for 350 more people to receive services through the program, which makes it possible for people with disabilities to live in the community instead of a facility.
Due to the job’s time commitment and low wages, it’s become increasingly difficult for people with disabilities to keep their direct support providers who help them with simple everyday tasks — from bathing and dressing to going to appointments. Meanwhile, workforce shortages have also led to unstaffed inpatient psychiatric beds at the state’s psychiatric hospitals, thus reducing the overall number of beds available, even as people in need sit and wait in emergency departments for psychiatric beds.
“We can’t do this if we don’t have people to take care of the folks, and we’ve got hundreds of beds empty across the state because we don’t have workers,” Burgin said.
Kinsley said he applauded state lawmakers for committing continuing money to sustain these rates, instead of allocating one-time funding.
“It really unlocks a lot of potential,” he said.
The budget also includes one-time funding of $40 million over two years for sign-on and retention bonuses for employees of state mental health facilities. The spending plan includes $18 million over two years to “establish a workforce training center that would provide no-cost training to public sector behavioral health providers, and to administer grants to community colleges to enhance behavioral health workforce training programs.”
There is also a $2 million grant in the budget to pilot a “mental health in the workplace” program. Truusight Health Solutions will enter into a two-year public-private partnership in Cabarrus and Stanly counties aimed at helping employees access behavioral health services and supporting employers who are navigating the state’s complex behavioral health system.
Improving access in rural communities
Rural communities have long lacked medical care, particularly mental health care.
“We’re desperately short of people that are highly-trained, especially psychiatrists and family practice doctors. So we put dollars aside to pay them up to $100,000 to work in tier-one or tier-two counties,” Burgin said.
The state budget includes large expansions to the N.C. Loan Repayment program — to the tune of $50 million over two years. The North Carolina Area Health Education Center programs will develop and implement plans to recruit and enroll participants, and the state’s Office of Rural Health will track related data. The loan repayment programs are specifically aimed at recruiting and retaining primary care and behavioral health providers to rural or underserved areas of the states.
And with the expansion of Medicaid, more patients with health insurance will be able to walk through the doors. Having insured patients will help financially sustain these rural health practices.
The state spending plan also includes $20 million for grants over two years to rural health care providers for start-up equipment for telehealth, which will improve access for patients with transportation or other barriers to in-person medical care.
Mental health services for children, foster care system
North Carolina’s foster care system has been struggling for years with high-profile failures that include children living in emergency rooms and sleeping on the floors of social services offices. The state health department has also had to take over some failing county operations.
“[The foster care system] is a high priority to us,” Burgin said. “We think that has got to be completely renovated, rejuvenated and reconstituted into a well-run statewide plan, where we can keep up with these kids.”
He said his goal is “limiting the number of times that they have to change places where they lay their little heads.”
The state budget includes the creation of a statewide specialty Medicaid plan for kids in foster care and their families that aims to streamline their physical and mental health care. The groups responsible for providing this care have pushed back on the statewide plan for a couple years, but state lawmakers and Kinsley have said the groups have not made enough progress toward improvement.
The state budget directs DHHS to issue requests for proposals from agencies who wish to hold the contract for the statewide foster care plan, with the new services set to begin by December 2024.
State lawmakers also instructed DHHS to form a work group of child welfare experts and agencies to identify innovative Medicaid service options to address gaps in the care of children receiving foster care services.
Additionally, the state spending plan instructs DHHS to develop a proposal for federal approval to provide more Medicaid-paid mental health services to adults with serious mental illness and to children with serious emotional issues. The goal of this waiver would be to provide more community-based services for these populations while reducing psychiatric hospitalizations and emergency room visits.
The budget provides $80 million over two years “to support families and other caregivers of children with high behavioral health or other special needs by expanding intensive supports in the community and increasing structured options for meeting the needs of these children” and “to strengthen specialized treatment options for children with complex behavioral health or other special needs.”
Diversion and treatment
The budget provides $99 million over two years for community-based, pre-arrest diversion programs and programs to help people reentering the community after incarceration. The money will fund local partnerships between law enforcement, counties and behavioral health providers, as well as community-based and detention center-based restoration programs for those with mental illness and substance use disorders.
Scattered across the budget are several provisions aimed at services for those with substance use disorders, using money from the nationwide opioid settlement funds coming into the state.
The General Assembly is given a small portion of those settlement dollars to distribute, while the majority flows directly to the counties to spend in their communities according to set guidelines. Many of those dollars are flowing to smaller organizations in lawmakers’ home districts, some which have thin track records.
The legislature also set aside nearly $11 million to make grants available on a competitive basis to each campus of the University of North Carolina system for opioid abatement research and development projects.
Meanwhile, at a time when people are dying at record numbers from drug overdoses, state lawmakers eliminated annual funding of $100,000 to the North Carolina Harm Reduction Coalition which was used to purchase overdose reversal medications.
One substance use allocation that pulls from funds outside of the opioid settlement funding is $2.3 million to DHHS for administration, about half of which to be used to create nine new positions to help administer substance use grants.
Local quiltmakers combine to supply new detox center with a homemade quilt for each bed
ITHACA, N.Y.—A months-long effort to organize and sew dozens of quilts for those in need culminated Tuesday, as 63 quilts were presented to a room full of quiltmakers and onlookers. The quilts are being sent to the Alcohol and Drug Council’s new Open Access Detox and Stabilization Center, and will be placed on each bed in the facility for people undergoing treatment.
The sentiment of covering every bed in the new facility “with the warmth and beauty of a quilt created with love and care by a community member” fueled the quilters, organized by members of the Community Quiltmaking Center. The effort was coined “40 Quilts for 40 Beds” and was led by Brigid Hubberman with materials donated by Peggy Dunlop, one of the founders of the Community Quiltmaking Center.
The quilts were presented during an event at Kendal at Ithaca Tuesday evening celebrating the quiltmakers and officially dedicating the quilts to the center. In total, there were 63 quilts displayed, made by 65 quiltmakers, most of whom are local (and listed at the bottom of this article). While the initial goal was 40 quilts to cover the 40 beds in the detox center, the community’s enthusiasm produced far more than was anticipated.
Tuesday night’s event featured the parading of each of the quilts across a stage to applause, with some of the quiltmakers coming to the front and addressing the audience about their inspiration, the design and materials, or simply waxing poetic about their love of quilting.
State Assemblymember Anna Kelles, Tompkins County Deputy Commissioner of Mental Health Services Harmony Ayers-Friedlander and the Alcohol and Drug Council’s director of marketing and development, Emily Parker, were among several speakers who commended the effort and emphasized the importance of supporting people struggling with addiction.
“I can’t imagine a more beautiful symbol of connection than these gorgeous quilts, made by giant-hearted, generous, caring women,” Parker said. The detox and stabilization center has struggled to fill out its workforce as it ramped up to launch earlier this year, but is currently partially open for patients.
Ayers-Friedlander added that the quilts would help those struggling with addiction to know “your community sees you as a person,” in line with the event’s overall goal of reducing stigma around addiction and seeking treatment.
Others shared emotional and personal stories about their connections to addiction. One woman named Dorothy stitched a quilt depicting the sun at dawn, which she said represented her brother’s 30 years of sobriety. The quilt is currently hanging in the Tompkins County Center for History and Culture.
Ithaca Youth Bureau Executive Director Liz Klohmann had a particularly close connection to two of the quilts. In front of the audience, Klohmann disclosed that her son died from a fentanyl overdose in 2022. Before his death, her son had gathered a sizable amount of thread for a creative endeavor but died before he was able to put it to use. Instead, Klohmann said the thread had been used in two of the quilts that were presented Tuesday.
Quilters of all skill levels volunteered to put their stitching talents to work, including Pat Costantini. Like most others who assisted in the effort, Costantini has relatives who were impacted by substance use issues.
But Costantini said her passion for quilting was enough to get her involved.
“I love to quilt, it’s my therapy,” Costantini said. “I’m happy to be part of it, to be able to contribute.”
She has been involved in similar efforts before, and has donated some of her work to the Quilts for Valor Foundation, a non-profit that donates quilts and blankets to veterans. Her daughter-in-law organized an effort to make Christmas stockings for troops overseas when Costantini’s son was stationed in Afghanistan during the holidays, in which Costantini also participated.
Nora Burrows, another quilter, was looking for an outlet for her love of quilting, which like Costantini, pushed her to get involved. She said her quilt took months to finish, but she “loves every second of it.”
“The idea of being comforted and being in an environment that may be scary and wanting to feel some sense of calm,” Burrows said. “Quilts are, traditionally, that feeling of calm. I wanted to be a part of that.”
The below pictures were provided by NYS Assemblymember Anna Kelles.
Leisa Morris White moved to the area from Australia and said quilting had been a central way for her to make new friends in her new surroundings.
“My favorite thing to make is a community quilt,” White said. “When people join together and make things happen, it’s amazing. It brings people together and you get to know people, you really bond and make friends.”
She continued that she hopes the quilts are useful for decades to come as a source of warmth and comfort.
“I just hope [the quilt] lasts longer than me,” White said. “If when I’m gone someday, someone else is wrapped up in it, that would make me very happy.”
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Rape, beatings and racial slurs: None of it was enough to shut down this Idaho youth facility
Employees at Cornerstone Cottage alerted state officials to the dangers, only to be fired themselves…
The post Rape, beatings and racial slurs: None of it was enough to shut down this Idaho youth facility first appeared on InvestigateWest.
The post Rape, beatings and racial slurs: None of it was enough to shut down this Idaho youth facility appeared first on InvestigateWest.