Mississippi
As health infrastructure shrinks, a daughter of the Delta cares for her community
To achieve Gunnison, Mississippi, from Cleveland, the quickest path – although not the route with the best-paved streets – takes you off Freeway 8, down miles of slender roads slicing by way of among the most fertile land on earth. In early December, the fields are nonetheless however not empty. Silvery water swimming pools in gashes within the filth, and cardinals decide on shoots of electrical inexperienced gleaming within the grey mild of winter.
Whenever you attain Freeway 1, you’ve arrived in Gunnison, with a inhabitants of 425 and solely two companies: a gasoline station and Wholesome Residing Household Medical Clinic, opened by Gunnison native Wyconda Thomas in 2019. The squat brick constructing is embellished for the season, with a wreath on the door and letters out entrance spelling “Merry Christmas.”
When Thomas determined to open her personal apply, she selected the place the place she noticed the best want, which additionally occurred to be the group that raised her.
Regardless of the city’s small inhabitants, the clinic is full each day.
“The statistics– it pointed to those areas,” Thomas mentioned. “The Delta, the shortage of assets– in case you take a look at who suffers essentially the most, it’s at all times these areas. That’s the place try to be treating.”
No area of the state has been more durable hit by the decimation of Mississippi’s well being infrastructure than the Delta. Kings Daughters Hospital in Greenville closed in 2005, and Affected person’s Alternative Medical Middle in Belzoni adopted in 2013. Now, Greenwood-Leflore Hospital is scrambling to seek out funding to remain open by way of the legislative session, when it hopes to steer lawmakers to assist.
Even when the cash comes by way of, there isn’t a long-term plan to make sure Delta residents have entry to well being care. The predominantly Black area is without doubt one of the poorest within the nation, and just like the state as a complete, it has excessive charges of diabetes, hypertension and coronary heart illness. Earlier this 12 months, state well being officer Dr. Daniel Edney mentioned the area’s well being infrastructure is “very fragile” and 6 Delta hospitals are liable to closure.
“Nobody’s coming to the rescue,” he mentioned.
Nobody, that’s, apart from Thomas and other people like her: Delta natives who’ve chosen to open their very own small clinics near dwelling. Folks like Mary Williams, who runs Pressing and Main Care of Clarksdale; Juliet Thomas, Antoinette Roby and Desiree Norwood of the cellular clinic Plan A; and Nora Gough-Davis, who operates clinics in Shaw and Drew.
They face insurance policies that appear virtually designed to punish them for making an attempt. Nurse practitioners are reimbursed by Medicaid simply 85% of what physicians obtain for offering the identical companies. State rules require them to have a collaborating doctor, to whom they need to pay a month-to-month price that may attain over $1,000. The state’s failure to increase Medicaid means extra of their sufferers lack insurance coverage, they usually could by no means see a penny for treating them.
“You need to give your self,” mentioned Gough-Davis, who skilled Thomas and 25 different Delta nurse practitioners at her clinics. “It’s actually like group service. Now we have sufferers with low, low well being literacy. So our typical go to goes to require way more training than a go to with somebody who doesn’t have well being literacy points. Training takes time.”
And fee constructions don’t account for that point.
“It by no means comes shut” to full compensation, Gough-Davis mentioned of the everyday reimbursement.
Proudly owning her personal apply, Thomas has needed to learn to deal with paperwork and billing and coping with reimbursement from Medicaid and insurance coverage firms. She works from 8 a.m. to six p.m. most days, and spends weekends and evenings attending trainings and seminars. She sees every little thing from the flu and COVID-19 to anxiousness and melancholy to contraception requests.
WIth the well being division presence in Bolivar County shrinking and hospitals closing, clinics like Wholesome Residing are below stress.
“The struggles are there,” she mentioned. “Every thing is being put onto household apply now.”
And but Thomas struggles to think about working wherever else.
“The folks right here get me and I get them,” she mentioned. “It’s rewarding to make a distinction and to do that. I really feel like I’ve God’s favor due to that.”
‘A private connection to her sufferers’
Simply earlier than 9 a.m. on a current Thursday, Thomas ready to see her first affected person of the day: a 3-year-old boy on the clinic for a well-child examination.
She wore black scrubs, with an identical scarf and glossy sneakers, and a tidy pink manicure. The clinic’s rooms radiated the identical heat and cheerful competence that she did: Within the foyer, posters promote free sports activities physicals and household planning companies. A Christmas tree was embellished with scorching pink ornaments.
Clutching a clipboard, Thomas walked into the primary examination room to see her affected person, accompanied by his mother and grandfather.
“Come on, hop up right here,” she mentioned to him, gesturing to the desk. “I feel he would possibly want some assist.”
She lifted him up and he sat calmly on the desk, his palms folded in his lap and his sneaker-clad toes dangling a number of toes off the ground.
Thomas informed his household that he wanted to be in a booster seat and sporting a helmet when using a motorbike. She confirmed he had not too long ago seen a dentist, and would wish a imaginative and prescient display screen immediately.
“How’s his food regimen?” Thomas requested. “Does he eat a number of meals like rice, cereal, cheeseburgers?”
“That’s about the one factor he’ll eat,” his mother answered.
Thomas laughed. She checked the boy’s ears. He gazed calmly across the room, by no means fidgeting or whining.
“You such a very good little affected person!” she exclaimed.
She informed his household that he had some fluid in his ears, so she would ship a prescription over to their pharmacy.
Then her time with the boy was over. The go to hadn’t been difficult, however Thomas had been in a position to affirm the 3-year-old was wholesome and rising nicely, and his imaginative and prescient was good – a very vital discovering as he approached kindergarten, which most Mississippi youngsters attain with out ever having had a developmental screening.
A number of hours later, a 57-year-old lady named Arlesia Mobley sat in a unique examination room. She complained of a headache and dizziness.
“Been round anyone sick?” Thomas requested.
“My grandbaby,” Mobley mentioned. “She had the flu.”
Thomas checked her ears and noticed fluid, which she defined was in all probability inflicting Mobley’s dizziness. She requested a nurse to conduct a flu swab however went forward and ordered Tamiflu for her affected person. She suggested her to drink loads of fluids, eat rooster noodle soup, and relaxation as a lot as attainable.
A number of days later, Mobley mentioned she was feeling higher, however nonetheless drained.
She had needed to discover a new physician earlier this 12 months due to her insurance coverage. She lives in Rosedale, so Thomas was shut by. She already seems like Thomas is aware of her.
“When she step into the room, she’s bought that smile,” Mobley mentioned later. “When she go by you and also you (are) sitting out within the ready room, she bought that smile. That makes me really feel good, ‘trigger I imply most docs… particularly within the ready room, their thoughts wouldn’t be on you nowhere. Nevertheless it look like she bought a private connection to her sufferers.”
Opening a clinic in her hometown
Thomas is a daughter of the Delta, raised in Gunnison and Rosedale. Her dad and mom each coached basketball, and she or he grew up within the health club. She was a star participant at West Bolivar Excessive Faculty after which performed for Delta State.
Her mother and pa, each Bolivar County natives, too, had excessive expectations for his or her daughter.
“When she was rising up, she couldn’t carry no C’s into my home,” mentioned her mom, Will Ethel Corridor. “I don’t need nothing however A’s, however we’ll speak about a B, since you was enjoying sports activities and perhaps you didn’t get it that means. No C’s have been allowed, and she or he knew that.”
“I used to be actual onerous on her,” mentioned her father, Willie Thomas, who coached her at West Bolivar.
A number of weeks in the past, he bumped into a girl within the retailer who was remembering how he had pushed his daughter. Thomas informed her that wanting again, he felt it had been an excessive amount of, and he would do issues in another way if he might.
“She mentioned, ‘Look how she turned out,’” Thomas mentioned. “I mentioned, ‘You proper. I’d do it the identical.’”
After school, she spent a 12 months instructing biology earlier than deciding she needed to enter nursing and going again to high school. She knew she’d prefer to open her personal apply finally, so she made a degree of working in as many areas as she might – postpartum care, pediatrics, nursery, neonatal intensive care unit, dwelling well being and intensive care.
“You personal your individual apply within the Delta, you gotta be every little thing – assets are very, very restricted, you already know,” she mentioned.
The Greenville NICU the place Thomas skilled closed earlier this 12 months, leaving the Delta with no NICUs in any respect.
As quickly as Thomas turned a nurse practitioner in 2015, she began engaged on plans to open her personal clinic. Her grandfather had owned the little constructing in Gunnison that had as soon as been a county well being facility, and the household left it to her for her enterprise.
When she approached Gunnison leaders about opening a clinic there, they have been elated.
“Our space is actually underprivileged, and we simply wanted a clinic right here on the town to assist our residents,” mentioned Mayor Frances Ward, who has identified Thomas since she was born. “Plenty of them don’t have transportation, they usually needed to pay folks to hold them to Cleveland to the physician. It’s actually a blessing that she is right here. And we’re very pleased with her being from Gunnison, to come back again and assist her fellow folks.”
Thomas opened Wholesome Residing on Jan. 2, 2019.
Gunnison residents like 70-year-old Ruby Corridor, who works for Thomas as a nurse on the school-based clinics she runs in Rosedale, can’t recall a health care provider or nurse coming again to the city within the final 60 years.
Tina Highsmith, government director of the Mississippi Affiliation of Nurse Practitioners, mentioned that’s a typical trajectory for Mississippians of their discipline.
“Despite the fact that I had moved to a number of different elements of the state, after I got here again to open a clinic it was in my hometown,” she mentioned. “These NPs have already established relationships… And so the sufferers know them, they belief them.”
And Thomas is aware of her sufferers, typically personally in addition to by way of her work. That’s a part of what drives her.
Her mom remembers missed lunch appointments as a result of the clinic was so busy, and detours throughout drives to investigate cross-check sufferers at their houses or drop off drugs.
“It’s only a tie that I’ve right here,” Thomas mentioned. “They want me so dangerous. No less than I really feel like they do. That makes me keep right here.
From 13 county well being division clinics to at least one
On the solely different enterprise in Gunnison, Bassie’s Service Station, Charlette Brady slices chilly cuts, makes sandwiches and rings up bottles of soda and beer.
“Actually don’t a lot go on right here,” she mentioned.
The opening of Thomas’s clinic was a uncommon occasion. Earlier than, Brady and her youngsters traveled to Cleveland for docs’ appointments. Now, the entire household goes to Wholesome Residing.
Contained in the foyer of the clinic, a plaque commemorates the constructing’s historical past. Preserved within the cinderblock wall, the black signal with silver lettering reads: “Bolivar County Department Well being Middle. Gunnison, Mississippi. 1960.”
The plaque additionally hints at how rural Mississippi’s well being care assets have shrunk during the last a number of many years, as a result of the Gunnison county well being division web site closed someday within the Eighties. Earlier than Thomas opened her clinic in 2019, it served as a polling location and a small restaurant earlier than sitting vacant for years.
In 1975, Bolivar County boasted 13 satellite tv for pc clinics along with the primary county well being facility in Cleveland.
“We strive, particularly within the Cleveland workplace, to supply basic well being companies each day of the week,” county well being officer Dr. Dominic Tumminello, a Gunnison native, informed the Clarion-Ledger that 12 months. “When an individual walks into our well being clinic, we need to serve that particular person.”
The county well being division constructing in Rosedale, a 10-minute drive away, closed in February 2016, together with eight different such services across the state. Right this moment, there is just one county well being division web site in Bolivar, in Cleveland, and it’s open solely 4 days per week, with restricted walk-ins and household planning companies requiring a name forward of time.
Rosedale’s pharmacy closed not too long ago, too, when its proprietor retired.
The closest hospital is half-hour away, in Cleveland.
The Delta’s inhabitants is declining and has declined dramatically since 1940– a part of the explanation why massive hospitals constructed early within the twentieth century are struggling.
In Bolivar County, 29% of adults lack medical health insurance. Thirty-six p.c of county residents dwell in poverty, in comparison with 20% statewide.
The mixture of poverty, lack of insurance coverage, critical well being wants and a small, spread-out inhabitants makes well being care within the Delta a puzzle that’s solely changing into extra difficult.
But Thomas has discovered a strategy to make it work, by successful federal and state grants that enable her to supply companies on a sliding scale, in order that sufferers with out insurance coverage can nonetheless afford to see her. Wholesome Residing Household Medical Middle was designated a Rural Well being Clinic by the well being division, which implies the federal authorities reimburses the clinic for main care companies. Thomas additionally presents household planning companies by way of the Title X grant, participates in a tobacco cessation program by way of the Institute of Minority Well being, and presents free COVID-19 testing and vaccines.
Her husband, Jervis McGee, sees how onerous she works, taking calls from sufferers after hours and studying up on well being points in her free time.
“Lots of people overlook that she’s a standard particular person, too,” he mentioned.
For Thomas, it feels crucial to supply as many companies as attainable to a group that wants them. Nevertheless it’s additionally exhausting to take part in so many packages, every with its personal paperwork necessities, and to attempt to develop experience in so many areas.
She observed that a lot of her sufferers battle with anxiousness and melancholy, although they don’t at all times use these labels for his or her signs. She tries to refer them to psychiatrists, however availability is proscribed. Efforts to carry a psychiatric nurse practitioner to the clinic in the future a month or to supply telemedicine haven’t panned out. So now she’s planning to return to high school to earn certification as a psychiatric nurse practitioner.
Nora Gough-Davis, the nurse practitioner and clinic proprietor who helped practice Thomas, mentioned working an unbiased household apply clinic is not any simple activity. After a decade in enterprise, Gough-Davis is hoping to promote the clinics and deal with her work instructing nursing at Delta State. She needs to verify any purchaser retains them open.
“I’m drained,” she mentioned. “I need to ensure that entry doesn’t go away.”
And throughout unbiased household apply house owners within the Delta, the partitions are closing in, as hospitals flounder and county well being departments reduce hours and places of work.
Considered one of Thomas’s sufferers that Thursday was a girl named Jennie Usry. Usry has had complications and reminiscence loss ever since a fall on the job in June, and she or he must see a neurologist. A specialist in Clarksdale didn’t take her insurance coverage. And when she tried to make an appointment at Greenwood Leflore, she informed Thomas, it was unimaginable.
“The hospital closing down, in order that they not taking new sufferers,” Usry mentioned. “However you a health care provider, so that you name, it could be totally different.”
“I don’t know,” Thomas mentioned. “I don’t know if that can… however I’ll strive.”
(A spokesperson for Greenwood Leflore mentioned the hospital’s neurology clinic remains to be open and accepting new sufferers. Throughout negotiations with the College of Mississippi Medical Middle, the clinic didn’t make new appointments as a result of it was unclear whether or not any take care of UMMC would enable neurology companies to proceed. Negotiations have ended with no deal and Greenwood Leflore hopes the legislature will approve funding that can enable it to remain open.)
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Mississippi
Report shows Mississippi Legislature retirement reforms this year aren’t effective. See why
Lawmakers, PERS director agree they must work together in the future
How to plan for retirement using an online calculator
Retirement calculators can give you an idea of when you’ll financially be able to retire.
Problem Solved
State lawmakers will need to readdress concerns about the Public Employment Retirement System of Mississippi in 2025 if it is to remain viable long term, according to a July study.
Legislative actions in the 2024 Session to reduce public employer contribution rate hikes and increase state funding are not enough to address billions in unfunded future benefits to retirees, according to a report released by the Legislature’s third-party watchdog group, the Performance Evaluation and Expenditure Review Committee.
Projections show the state’s retirement plan being less than 50% fully funded by 2047 and having $25 billion in liabilities. According to several municipal leaders who spoke to the Clarion Ledger earlier this year, the legislative move from lawmakers in the past session should save public employers from cutting positions and raising taxes to keep and hire more public employees.
“Change in approach for increasing the employer contribution rate, in addition to the one-time funds transfer, reduces the plan’s projected future funded ratio from 65.5% to 49.9%,” the report reads. “…The PERS plan is currently expected to be at a lower-funded level in the future than it currently is today.”
PERS Executive Director Ray Higgins told the Clarion Ledger he wasn’t surprised by the report’s findings.
“The PEER analysis seems to be an accurate report and generally reconciles with our information,” Higgins said. “Also, the legislative action from last session appears to be a short-term solution.”
While the report does not list out any specific recommendations for lawmakers this coming year, it says continued work will be necessary to fix the retirement system that has 118,000 retirees receiving benefits and 147,000 active members paying into the system.
In 2023, the PERS governing board, made up of mostly elected members, as advised by financial actuaries who watch over the state’s retirement plan, passed a rate increase on public employers, such as cities, counties and school districts from 17.40% to 19.90% that was to take effect July 1. The rate would have continued to increase to 22.4% by 2027.
In the 2024 Session, the Legislature passed two bills. Senate 3231, prohibits the PERS Board’s plan to gradually increase the employer contribution rate and replaces it with a plan to increase to 19.90% over the next five years in 0.5% annual increases. SB 3231 also takes the board’s only regulatory power to increase rates and puts it in the hands of the Legislature.
SB 2468 enacts a one-time transfer of $110 million of capital expense funds into the PERS trust.
More on PERS bill MS Legislature passes bill restricting state retirement board’s authority
Lt. Gov. Delbert Hosemann’s Deputy Chief of Staff Leah Rupp Smith told the Clarion Ledger efforts Hosemann helped push forward that resulted in those bills’ passage led to a potentially more stable retirement system.
“To avoid this calamity while developing a future solution, the Legislature adopted a less-aggressive employer increase,” Smith wrote via email. “We are now informed the plan has a projected future funding ratio of 65.5% as of 2047, as compared to 48.6% projected one year ago.”
Republican House Speaker Jason White’s Communications Director Taylor Spillman did not reply to several emails requesting White’s comments on the report.
What are the big problems?
Higgins previously said the ratio of retirees to active members has seen a reverse trend since 2013, when there were 93,000 retirees and 162,000 active members. This increases the unfunded liability of the system as fewer people take jobs in government, reducing active members and more people retire, increasing the funding obligation of PERS.
The other issue lies with projections for the retirement plan’s future if state lawmakers decide not to take action in the years to come.
“While the ($110 million) funding for the first year is comparable, each year in the future could potentially see a greater deviation in expected employer contribution revenues for the PERS plan,” the report reads. “This deviation does not immediately constitute a problem for the PERS plan; however, careful evaluation of the plan’s future liabilities and funding needs will be necessary to ensure the sustainability of the PERS plan.”
Are there any solutions?
Higgins and Smith both said future work on PERS is still a top priority.
Higgins specifically mentioned a new retirement benefits package that could be offered to new public sector employees, which the PERS board has called tier 5.
“The Board has previously recommended a tier 5 for new employees to help better sustain PERS in the future and is currently considering what may be included or resubmitted in next year’s legislative package,” Higgins said.
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Earlier this year, Hosemann told the Clarion Ledger he wanted to see evidence that a new tier of benefits could help maintain the retirement system long term. Smith did not confirm whether Hosemann’s office is currently studying that idea in the legislative off season, but she did say the Legislature is looking at several ideas.
“The Legislature is exploring any option for a more viable plan,” Smith said. “The Lt. Governor continues to be committed to fulfilling current employee and retiree benefits, including the cost-of-living adjustment for these individuals.”
Grant McLaughlin covers state government for the Clarion Ledger. He can be reached at gmclaughlin@gannett.com or 972-571-2335.
Waiting for my suitcase in the arrivals hall at Jackson airport the other evening, it occurred to me that the luggage carrousel was a pretty good metaphor for Mississippi politics.
Like suitcases on a carrousel, many leaders simply sit on the conveyor belt of state politics, waiting their turn to get moved along to the next role.
Too often leaders are carried along by time and process, rarely offering any vision as to what our state should do differently. That explains why Mississippi conservatives have achieved less in 12 years than Arkansas, Louisiana and Alabama have accomplished in the past 12 months. Louisiana did not even have a Republican governor this time last year, yet they’ve already passed universal school choice.
Things could be about to change if House Speaker Jason White has his way. This week, White announced that he will be hosting a Tax Policy Summit on Sept. 24 to take a deep dive into the prospects for tax reform.
My friend, Grover Norquist, will be speaking, as will Gov Reeves, as well as leading conservative figures from the state Legislature.
Having a conversation in public matters because in the past the leadership in our state Senate has done what it can to head off tax cuts. Bringing the facts of what can and cannot be done into the open makes it far harder for anyone to keep finding new excuses to oppose actual conservative policy.
Sunshine is the best disinfectant against the putrid politics of backroom deals. We have seen far too many backroom maneuvers used to kill off good conservative policy in this state. Back in 2022, Mississippi passed a law to cut the state income tax to a flat 4 percent. This $525 million tax cut, driven forward by Speaker Philip Gunn and Gov Reeves, benefited 1.2 million taxpayers and their families. But we must not forget how some in the Senate fought against it — not in the open, of course.
Weak Senate leadership has a history of opposing conservative proposals in our state. Seldom do they have the courage to come out and explicitly kill off conservative measures. Instead, they do it on the sly. The Senate leadership maneuvered to stop anti-DEI legislation in 2024. I don’t recall anyone coming out and explaining why they opposed anti-DEI law. They just killed it in committee with a nudge and wink.
For three years in a row, the Senate leadership has killed off attempts to restore the ballot initiative. Again, those against resorting the ballot lack the courage to say they are against it. They killed that, too, on the sly.
Rep Rob Roberson’s excellent school funding reform bill, perhaps the only big strategic achievement of this year’s session, passed despite attempts to scupper it by some in the Senate. (Part of the backroom deal to get the bill passed was to change its name. It really was that petty.) When the Senate leadership wants to oppose an authentically conservative policy, they follow a now familiar pattern.
A reason is cited as to why what is being proposed can’t be done. School choice, we were once told, would be unconstitutional. An anti-DEI law, it was implied, was unnecessary because there was no DEI on campus.
Once that excuse is shown to be nonsense (there is no constitutional bar to school choice, DEI is rampant on campus), another excuse is promptly conjured up. And on it goes.
Each time the Senate leadership opposes conservative policy this way, I wonder what their alternatives are. The answer is that most of the time there are none. It is pretty low grade to oppose ideas simply because they are not your own. Eventually, of course, a suitcase that sits on the carousel for too long ends up in lost luggage.
As a direct consequence of the 2022 Reeves-Gunn tax cuts, Mississippi is now starting to see a flood of inward investment into the state.
Every time you hear about a new factory opening up in our state, remember who and what helped make it happen. I am very optimistic that this tax summit could see further progress to make our state more competitive.
— Douglas Carswell is the president and CEO of the Mississippi Center for Public Policy.
Mississippi
Ex-official in Mississippi is treated for gambling addiction amid embezzlement charge, lawyer says
JACKSON, Miss. (AP) — A former tax assessor and collector in north Mississippi checked into a residential treatment center for a gambling addiction after he called the state auditor’s office and confessed to misusing more than $300,000 in public money, his attorney said Tuesday.
Shannon Wilburn, 49, resigned in April from the elected office he had held in Benton County since 2016, and he began the 12-week addiction treatment in late July, his attorney Tony Farese told The Associated Press.
“I’ve known Shannon all of his life,” Farese said. “We are shocked that he finds himself in this situation.”
Mississippi Auditor Shad White announced Tuesday that Wilburn has been charged with one count of embezzlement. The announcement came days after Wilburn was indicted. Farese said Wilburn turned himself in to the sheriff’s office Friday, then posted bond and returned to the treatment program.
Wilburn is accused of taking $327,055 paid to the Benton County Tax Collector’s office and using the money for personal expenses, Farese said. He said Wilburn confessed to the auditor’s office before hiring legal representation and has continued to cooperate with investigators.
“He apologizes for disappointing the citizens of Benton County and the state of Mississippi,” Farese said.
If convicted, Wilburn would face up to $5,000 in fines and 20 years in prison.
White said Wilburn’s employment as a Benton County elected official was covered by $200,000 in surety bonds to protect taxpayers from losses from corruption. The county also has an insurance policy that covers theft.
“The dedicated team at the State Auditor’s Office will continue to work closely with prosecutors to get record results, one case at a time,” White said in a statement.
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