Budget group grapples with health care spending

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Speaker Philip Gunn, R-Clinton, questions state health officer Mary Currier, during a legislative working group hearing Tuesday at the Capitol in Jackson

AP photo, Rogelio V. Solis

Speaker Philip Gunn, R-Clinton, questions state health officer Dr. Mary Currier during a legislative working group hearing Tuesday at the Capitol in Jackson.

Nearly one hour into Tuesday’s legislative working group budget session about the Department of Health, House Speaker Philip Gunn turned the topic from health to education, which lawmakers addressed Monday. He said that it became clear over the course of those sessions that the classroom is the most important part of education.

“So we want to put as much money as we can into the classroom,” Gunn said. “Outside the classroom you have those services that aren’t directly educating the child, like buses and the principal and buildings, but they’re necessary for support. But when we talk about the classroom, we believe that’s where the action is.”

He then looked over at Dr. Mary Currier, the state health officer, and asked her to define what the “classroom” would be in the Department of Health.

“That’s an excellent question,” Currier said. “And as I learn more about the health department, (the focus) has become the community we live in.”

She elaborated, discussing steps the department is taking towards prevention as well as services such as the mobile health units that offer accessible care outside of community health clinics. She stressed the need for the department to “get out” into communities more and said the department had requested grants that would address this.

“So I think our classroom is the whole community,” Currier said.

Gunn sighed. “I think we’re going to want to sit down with you and come up with a more clear definition and determine what is the classroom,” he said.

The speaker brought up this concept of a department’s “classroom” several times over the next three sessions as lawmakers tried to pin down the most vital and effective services in each stage agency.

The working groups, announced by the Legislature’s leadership earlier this summer, are examining the state’s tax code as well as how they distribute funds to the 13 state agencies. Tuesday’s sessions covered five agencies: the Department of Health, the Department of Human Services, the Division of Family and Child Services, the Department of Mental Health and Medicaid.

When Jacob Black and Garrig Shields, attorneys for the Department of Human Services, took the podium later in the morning, Gunn turned the question of their department’s “classroom” to them.

Black discussed the department’s Supplemental Nutrition Assistance Program and how they were working with community colleges to help individuals in the program transition to higher-paying jobs.

“We are very committed to supporting those individuals trying to move into self-sufficiency,” Black said.

Black also broke from several departments that have publicly complained about cuts to their budgets and said that the Department of Human Services was content with the $60 million appropriated to them for fiscal year 2017.

“Well, I definitely think you’re doing a great job with the money you received from the Legislature, and you’re going out there and doing your best and we really appreciate it,” Gunn said.

The goals of the Legislature and the Division of Family and Child services frequently aligned as Kristi Plotner answered questions about how her department would address changes to the foster care system in the wake of the Olivia Y lawsuit. That lawsuit, filed in 2004, alleged that Mississippi’s foster care system was failing to adequately protect children. As a result, in 2008 federal Judge Tom Stewart Lee issued a consent decree mandating that the state create a Division of Family and Child Services that would address the issue. In March of this year, the Legislature gave the division $34.4 million to create 260 new positions in an attempt to reduce current social workers’ case loads.

“Our classroom for child protection services is focused on the families of the children who we have a duty to protect, so everything that we do is critical to that mission of being able to support and protect those children,” Plotner said.

In addition to filling the 260 new positions, they are working to replace some of the long-time social workers in an attempt to “change the culture” that she said had led to some of the agency’s problems.

By and large the lawmakers, many of whom had voted in favor of Senate Bill 2179, which created the new agency, were supportive.

Lt. Gov. Tate Reeves holds a copy of the state Department of Health's submitted budget request for 2018, as he questions state health officer Dr. Mary Currier Tuesday at the Capitol in Jackson.

AP photo, Rogelio V. Solis

Lt. Gov. Tate Reeves holds a copy of the state Department of Health’s submitted budget request for 2018, as he questions state health officer Dr. Mary Currier Tuesday at the Capitol in Jackson.

“I don’t think anyone is going to argue that what’s happened to our kids across this state is anything other than totally and completely unacceptable,” said Lt. Gov. Tate Reeves. “The fact is, failure is not an option. In this instance, in my opinion, it wasn’t resources that led to this. It was a culture that led to very, very poor decisions being made and I hope and I pray that the decisions being made in the most recent legislative session and the requests that were made have been met. … These are real kids, and this is something that we are very, very, very focused on.”

The specter of a different lawsuit hung over the session on the Department of Mental Health, but in this case, lawmakers and agency heads butted heads over how to address it. Two weeks ago, the Department of Justice sued the state of Mississippi, alleging that it violated the Americans with Disabilities Act and Civil Rights of Institutionalized Persons Act by failing to provide community-based mental health services for mentally ill adults.

Gunn asked why the Department of Justice filed the lawsuit when the Legislature had given the Department of Mental Health an additional $16.1 million dollars over the last three years.

“Do you think we’ve done what we should?” Gunn asked.

“Yes sir, I do. It came down to we didn’t do it fast enough,” said Diana Mikula, executive director of the Department of Mental Health.

Mikula has been one of the most vocal critics of the state budget cuts, publicly discussing how lack of funds forced the Department of Mental Health to close its entire male chemical dependency program, a point Reeves noted.

“Your communications department is doing a good job. I would say give them a raise but I think you already have,” Reeves said.

Salaries were another issue of contention. Reeves noted that the salaries of employees who have worked for the department for more than four years rose by $11.4 million over the past four years.

Mikula argued that this is a byproduct of having such low salaries overall. She said her department has one of the highest turnover rates in the state. Direct care workers, who start at a salary of $16,000, have the highest turnover rate at 48%. As a result, employees who do stay are frequently promoted to fill the empty spots, which she said gives individuals a raise without affecting the bottom line.

“There are what we call career ladders, so once you meet the experience and education requirement, and if they have the ability in their budget to do that, then they want to do it to retain staff,” Mikula said.

“So you encourage them to increase their pay?” Reeves said. “So you’re arbitrarily causing your operating costs to go up. Which is fine. But if the Legislature continues to appropriate significantly more money to you … we find ourselves where we are today.”

Mikula, however, said it’s impossible to retain staff at the salaries they’re being paid, and that, ultimately, high turnover ends up costing the state more money.

“This is something we’ve addressed with the state Legislature,” Mikula said. “We’re paying (workers) $16,000 a year to deal with the most vulnerable people in the state. … One thing we try to do in the DMH is grow our own. So if there’s a vacancy, when someone leaves, if there’s someone qualified, they move up.”

Members of the working group were concerned about the costs of running the Medicaid program, now and into the future.

Since fiscal year 2012, the state’s portion of Medicaid’s budget has swelled from around $600,000 to almost $1 billion. Rep. Andy Gipson, R-Braxton, wanted to know why costs continued to rise even though Mississippi has not participated in the Medicaid expansion allowed under the Affordable Care Act of 2010.

Dr. David Dzielak, who heads the Medicaid department, said the main costs drivers were some mandatory requirements of the Affordable Care Act as well as increased costs of medical service. Mississippians’ poor health makes care even more expensive, Dzielak said.

“We’re starting in a hole. We’re 50 in every statistical health category,” he said.
Dzielak added that the state has saved by moving Medicaid enrollees from fee-for-service plans, in which the state pays doctors for each service they provide, to a managed-care system in which doctors receive a flat fee for each enrollee they see.

Contributing: R.L. Nave

  • Otis

    Speaker Gunn and Tate Teeves should work a shift at one of these filicities doing things like changing soiled bed sheets, feeding the disabled, and even bathing those who are unable to bathe themselves.

  • Charles Pearce

    Too many members of the Legislature from both parties are masters of the blame game but clueless at searching and finding practical solutions. Citizens suffer because of the Legislature’s dismal performance caused in large part by political posturing of both sides.

  • vechorik

    Great article. Keep informing Mississippians!