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'Mississippi First': Medicaid in the Golden Triangle

 

India Yarborough

 

 

Prior to September 2016, Fred Williams was missing out. He couldn't play catch with his 4-year-old son, Fredrick Jr. He wasn't able to mow his own yard. And each of the six days a week he worked, he had trouble breathing, often having to take short breaks throughout the day to sit and catch his breath. 

 

Williams' kidneys were shutting down. Hypertension -- abnormally high blood pressure -- had caused him to develop end-stage renal disease, which he discovered during a 2011 doctor's visit. Although he and his wife, Ashley, both worked full-time, treatment was far out of reach. 

 

That is, until he received what he terms a "blessing" early last year. 

 

The Mississippi Division of Medicaid had sent Williams a letter stating he was eligible for Medicaid based on his former participation in the Supplemental Security Income program, designed to provide cash supplements to low-income aged, blind or disabled people to help meet basic food, clothing and shelter needs. 

 

For several years, Williams, who is 36-years-old, had worked with a doctor to avoid dialysis -- a treatment both knew was inevitable. Months after Williams enrolled in Mississippi's Medicaid program, he began dialysis three times a week to combat his kidney failure, a process that, he said, has saved his life. 

 

Each six-hour treatment session costs $6,500.  

 

"If I didn't have Medicaid, there's no way I could have afforded that," he said, as paying for medicine each month would not leave his family with enough cash to afford living expenses. 

 

"The only thing I can really say is it's a blessing," Williams said. "Without it I'd either be somewhere laid up, or I wouldn't be here at all." 

 

 

 

Serving the underserved 

 

Williams is one of over 41,000 Medicaid enrollees in a coverage region that includes all of Lowndes, Clay and Oktibbeha counties and the majorities of Monroe, Choctaw and Webster counties, according to numbers provided to The Dispatch by the Mississippi Division of Medicaid. 

 

According to Medicaid.gov, Medicaid is the largest source of health coverage in the United States. Medicaid and the federal Children's Health Insurance Program provide insurance to over 72.5 million Americans, primarily targeting low-income families who would otherwise go without healthcare and those with pre-existing conditions. 

 

Between 2013 and 2016, Williams and his wife were both working full time. The pair netted about $17,000 annually -- a little over $1,400 a month. He worked at least 35 hours a week for Jimmy John's in Columbus, and Ashley worked as an assistant teacher for the Lowndes County School District. 

 

The couple's combined income placed them near the federal poverty level of $19,318 before taxes for a family of three, according to 2016 data from the United States Census Bureau. 

 

According to separate data released in December 2016, the Census Bureau estimated 22 percent of all Mississippians were living in poverty in 2015, and according to the Mississippi DOM, over 23 percent of Mississippians are currently Medicaid beneficiaries. 

 

"It's important to note that DOM does not pay beneficiaries," said Mississippi DOM associate communications officer Matt Westerfield. "It reimburses health-care providers for the care and services they provide to beneficiaries." 

 

He said it is the DOM's responsibility to provide coverage to qualified Mississippians under the guidelines of state and federal laws. 

 

The majority of Mississippi Medicaid beneficiaries, 56 percent, are children, Westerfield said, and another 23 percent are disabled. 

 

Williams' now 5-year-old son is also covered through Medicaid, based upon the family's income. Williams and his wife applied for the coverage so they could afford their son's checkups, dentist appointments and eye-doctor visits. 

 

 

 

Politics meeting local needs 

 

Mississippi receives the highest percentage of federal Medicaid funding of any state in the U.S., according to the U.S. Department of Health and Human Services' Federal Medical Assistance Percentages. 

 

State Senator Hob Bryan (D-Amory), vice-chairman of the senate Medicaid committee, said his job is to "try to argue for a rational approach to healthcare." 

 

He argues Mississippi has not done enough to help people in need access healthcare since states gained the option to expand Medicaid under the Affordable Care Act of 2010. 

 

"Medicaid is an incredible bargain for the state of Mississippi," Bryan said, "and it's incomprehensible we don't make better use of the Medicaid program." 

 

Mississippi DOM's Annual Report for fiscal year 2016 notes 74 percent of the state's $5.88 billion Medicaid funding comes from federal sources, meaning that for every dollar the state spends on Medicaid, the federal government contributes three. 

 

Because of our reliance on federal funds, Bryan said major federal cuts, such as those proposed weeks ago in the U.S. Senate's Better Care Reconciliation Act, could be devastating to Mississippi's citizens. 

 

The nonpartisan Congressional Budget Office estimated the senate's proposed bill would result in a $772 billion decrease in Medicaid funding over the next nine years. 

 

"Of course the most traumatic effect is it would either reduce the number of people on Medicaid, or it would reduce the amount of money providers are receiving, or both," Bryan said. "If someone is on Medicaid and suddenly he or she is not on Medicaid, he or she is not suddenly cured just because they are not on Medicaid." 

 

Senator Charles "Chuck" Younger (R-Columbus), Medicaid committee member, said the committee does not have a plan in place to cover potential funding lost at the federal level, but he agrees with Bryan that cuts to Medicaid funding could affect Mississippi "more than any other state." 

 

"Our major goal is just to take care of our citizens -- to take care of Mississippi first," Younger said. 

 

"Naturally, if they cut Medicaid, it's going to hurt Mississippi more than anybody because of the matching funds," he added. 

 

Federal cuts, however, would not just affect health insurance coverage. It could also result in a loss of jobs, as 90 percent of Mississippi's DOM administrative costs are paid for with federal funds. 

 

"While DOM has one of the lowest percentages of administrative costs compared to other Medicaid programs across the nation, we would have to examine all areas of our operations and make adjustments in the event of federal funding changes," Westerfield said. 

 

Bryan said Medicaid is essential to keeping the doors to some hospitals and clinics open, especially in rural areas, and without federal Medicaid funding, people will either go without healthcare or the cost of care will fall on the shoulders of all Mississippians.  

 

"If an individual without insurance is in a life-threatening position, and they arrive to a hospital without insurance, that hospital is going to at least stabilize that individual," Bryan said. "The cost of that problem is borne by everyone else in the healthcare community so everyone else's insurance rates go up to bear the cost. And then some people who don't have access to health care will just suffer." 

 

Williams feels for the people who work hard and still struggle to find the care they need.  

 

"If they need that help, I want to see them get it instead of trying to struggle," Williams said, "because I've been there, done that. I know how that is." 

 

 

 

An improved outlook 

 

According to Williams, his health has improved drastically since September 2016. Although he still struggles with medical issues, Williams has lost nearly 100 pounds since he began dialysis almost 11 months ago, and he said he has never missed one of the six-hour treatment sessions. 

 

"It's getting to that hundred range, and that's just going to dialysis and pulling fluid off," he said. 

 

Williams knows his son, FJ as he calls him, sees the benefit of his improved health, too. They can now play catch. 

 

"I felt bad because I wanted to, but I knew I couldn't," Williams said of his time before treatment. "He couldn't understand that, being four years old. But he knows about me and my dialysis. He knows daddy goes to dialysis, daddy's on the dialysis machine. 

 

"We do all of those things that I couldn't do before."

 

 

 

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