State Health Officer Dr. Dan Edney made one big ask of lawmakers this year: $9 million to hire the nurses needed to fully staff county health departments and a program that puts nurses in the homes of low-income pregnant women with high-risk pregnancies.
As he made the request, news headlines in Mississippi and around the country reported on the state’s financially struggling hospitals, worsening maternal mortality crisis and one of the highest uninsured populations in the country as the result of state leaders’ steadfast opposition to Medicaid expansion.
Still, the answer he got was no.
That’s not a novel response from lawmakers — the agency’s budget was slashed in 2017 and is still making up for the loss. But this year, it could be especially damning as the state’s health care crisis reaches a breaking point.
As hospitals bleed out and it becomes increasingly dangerous for Black Mississippians to give birth in the state, the need for public health services offered by the Mississippi Department of Health is seeing a resurgence.
“That was my testimony at the Legislature,” said Edney, the agency’s leader. “I reminded them … we are having to do more, which is not good. It’s a sign that the needle is moving the wrong way.”
But there’s a limit to what his agency can do without adequate funding.
The Healthy Moms, Healthy Babies program, a partnership between the department and the state Division of Medicaid, puts nurses in the homes of expecting mothers who are undergoing high-risk pregnancies. The program serves about 700 moms, Edney said.
He knows the number of moms involved in the program needs to grow. But to do that, he needs more nurses — an increasingly difficult resource to come by in Mississippi, where nurse vacancies and turnover rates are at their highest in a decade.
The $9 million would have paid for a total of 100 nurses, the bare minimum Edney said he needs to adequately cover the state’s public health needs.
The money needed to come from the state, Edney said, because federal funds have strict strings attached.
“One way I explained it at the Capitol was that state-funded nurses could do whatever we needed them to do,” Edney said. “I need Swiss Army knives. The feds give you the knife, and they tell you how to use it.”
But instead, as the agency’s responsibilities continue to grow, they got just enough to keep operating and cover inflationary costs for the next year — despite lawmakers starting the year with a historic $3.9 billion surplus.
Republican Rep. John Read, House Appropriations Chair and principal author of the Health Department’s appropriations bill, said the decision-making process was about prioritization.
“We had some money, but it’s like everything else: You don’t want to spend all your savings,” he said. “Everybody in this legislature wants to help everybody we can … Nobody gets 100% of what they asked for. There’s no way.”
Read maintained that the department’s staffing issue isn’t about their state appropriation — it’s about the nurse availability and desired salaries. To Read, hiring 100 nurses sounds impossible.
Still, Edney can’t hire even one of the 100 nurses without funding.
In an interview with Mississippi Today, Edney said he was grateful for the money his agency did get. He repeatedly expressed his desire to do the necessary work with what he got.
“We’ll keep trying,” Edney said. “That doesn’t mean we ignore those needs. We’ll push ahead with resources that we can find.”
The agency operates with a total budget of over half a billion dollars. The vast majority of that budget comes from federal dollars and a variety of fees generated from other agency operations. Less than 10% comes from the state.
Though the state portion is small, it is essential to the agency’s ability to fulfill its job.
It’s the mission of the state Health Department to promote and protect Mississippians’ health. That includes surveilling for diseases and sexually transmitted infections, as well as other preventative public health efforts. The agency is also responsible for overseeing water testing, inspecting restaurants and licensing and regulating health care facilities.
This year, the Legislature gave the state Health Department $48 million. Of that, about half will go to agency operations, which includes salaries for state-funded positions. The other half goes elsewhere — the state Department of Health acts as a conduit for millions that will fund programs within their agency and others.
While Edney was hoping to increase pay for his employees, he wasn’t able to secure enough funding to hand out uniform raises — just for the lowest compensated employees in the department.
The agency is experiencing a vacancy rate of over 40% across departments – meaning almost one of two jobs at the agency are not filled – according to Edney.
On paper, it looks like the agency got a huge increase in funding, up $13 million from last year. But $12 million of that money is set to go to the Victims of Crime Act program, which provides services for victims of domestic abuse, childhood violence and human trafficking. It’s a program that’s only recently been added to the state Health Department’s list of responsibilities, as well as the state’s new medical cannabis program.
The remaining $12 million of the state appropriation is split among systems such as trauma care, emergency medical services, AIDS-related services and drugs, stroke and heart attack care programs, domestic violence prevention, Mississippi qualified health centers, the early intervention program and Medicaid matching.
And in a last minute change toward the end of the legislative session, lawmakers also decided to task the department with choosing the state’s next burn center and awarding it $4 million. Merit Health Central in Jackson closed Mississippi’s only accredited burn center in October.
“I have to remind folks we’re happy to administer grants and direct funding from the Legislature,” Edney said. “But we had to keep our focus on what is our core appropriation. That appropriation that helps us achieve the things we have to achieve to make sure that the most vulnerable populations in the state are served to the best of our ability.”
For agency operations, the Health Department got an increase of about $720,000, which Edney said covered cost increases caused by inflation.
“So we didn’t go backwards,” Edney said.
In the newly painted lobby of Yazoo County’s renovated health department, Edney was candid about the state Health Department’s financial limitations.
“If I had the money, I would have done it yesterday,” he said of the county health department’s reopening on Monday.
It had been closed since September of last year.
“I have begged for the money to get our county health departments back open again,” Edney said. “We have been struggling.”
Within a month, David Caulfield, central regional administrator for the state Health Department, said the Yazoo clinic will be open four to five days a week, up from its temporary twice-a-week schedule, and be fully staffed.
It’s typically up to the individual counties to provide and pay for their county health department’s building, while the state pays to staff it.
“I want to personally thank the Board of Supervisors for caring about public health in Yazoo County,” Edney said. “Not every county has the same commitment to public health. They don’t look after their folks the same way you do it.
“I can’t tell you the joy in my heart to see this today because it shows me what we can do in Mississippi.”
But Yazoo County’s health department isn’t the standard — it’s an outlier.
As the state Health Department has been gutted by budget cuts over the past decade while simultaneously being tasked with more responsibilities, county health departments have suffered.
After the major budget cuts in 2017, hours were reduced at the majority of county health departments, and they became much harder to staff, Edney said. Services have been cut, too — county health departments stopped offering prenatal care in 2016.
And as hospital closures continue to loom — a report puts a third of rural hospitals at risk — it’s not apparent that the state Health Department is prepared to fill the gaps.
“We utilize all the resources we can from our federal partners to help the county health departments, but the (Centers for Disease Control and Prevention) does not fund public health at the county level,” Edney said. “It’s up to us to do that, and we just don’t have enough state funding to run 86 county health departments the way that we would love to run them.”
Although Mississippi only has 82 counties, there are currently 86 county health departments. Several counties have more than one while others have none.
While county health departments remain a place where Mississippians can access vaccinations, STI testing, diabetes and hypertension care, tuberculosis screenings and treatment, pap smears, family planning and pregnancy testing, Edney wants to increase staffing and get health departments open longer more days a week. They’re also exploring restarting prenatal care at county health departments.
It’s not clear how he’ll pay for it, but Edney’s determined to try.
“I’m not negative, because we have to do a better job on our side of the street,” he said. “We will be doing all that we can do, so when I go back to the Legislature and continue to ask for funding our workforce needs on the county level, I can honestly say we’re doing all we can.”