As the recent coronavirus pandemic has demonstrated, the healthcare system needs some rethinking and retooling. We are in great need of solutions that increase efficiency and quality while also lowering costs for providers and patients.
One such example is the problem of non-emergency medical transportation for Medicaid recipients. Millions of Americans miss their medical appointments each year. These no-shows reduce access for other patients. They also cost an estimated $150 billion a year by increasing administrative costs related to scheduling and rescheduling. In the context of Medicaid, these costs increase the price tag of Medicaid, which is a form of subsidized health insurance paid for by state and federal taxpayers.
Mississippi already offers generous transportation services for Medicaid beneficiaries, with no copay required. The amount allocated for the current Mississippi Medicaid non-emergency transport contract is $96.8 million for the period from October 2018 to September 2021. Total federal spending on non-emergency Medicaid transportation averages $3 billion a year. Could there be a way to reduce federal and state spending on non-emergency transport while also reducing the number of missed appointments?
Mississippi has used the same broker for years to facilitate Medicaid transportation, but the vast majority of Medicaid recipients are not using the service. The current arrangement may be saving some money over more traditional options, but the real question is whether mobile app technology now affords a much better and cheaper way to provide transport.
Thanks to a 2017 rule change by the Trump administration, healthcare providers are allowed to provide free or low-cost transportation services to patients. The administration is also looking at an additional rule change that would provide more flexibility in this area. An obvious solution is to use ridesharing services, like Veyo, Uber Health and Lyft, to lower costs.
Ridesharing is commonplace all across America. It works by allowing qualified drivers to use their own vehicle to transport other people. As in many other areas, the public health insurance system – Medicaid and Medicare – has yet to really catch on. But ridesharing is an innovative way of harnessing technology.
A recent study in the American Journal of Public Health estimates that adopting a ridesharing model would generate $537 million in total Medicaid savings, with an average annual savings of $268 per user. The authors also conclude that ridesharing could improve the patient experience by allowing for “on-demand scheduling, electronic records for monitoring, more-direct routes, greater reliability, and operational simplicity.”
Last year, Arizona became the first state to use ridesharing for non-emergency Medicaid transport. Multiple states have followed suit, including Florida, Georgia, Missouri, Tennessee, and Texas. A 2018 PEER report likewise recommends that the Mississippi Division of Medicaid explore ridesharing options. A conservative estimate is that Mississippi Medicaid could save millions annually from ridesharing.
At a minimum, early evidence suggests that ridesharing results in fewer missed appointments and reduced waiting times, saving money for hospitals and other providers and increasing patient satisfaction. In addition, it is less expensive than traditional transportation models and costs less per trip on average.
Another opportunity that has arisen since the 2017 Trump rule change is that nonprofit hospitals are offering no-cost transportation using ridesharing services. This service is being provided as part of each hospital’s mandated “community-benefit” requirement. Under federal and state laws, nonprofit hospitals receive billions of dollars in tax breaks in exchange for providing some kind of “community benefit,” a loophole that seems to be more of an accounting gimmick than a concrete form of help to those who most need it. Allowing ridesharing to count toward a hospital’s community-benefit activities at least provides some savings to taxpayers while affording more reliable transportation for Medicaid recipients.
Josh Komenda, the president of Veyo, observed that “there's been a huge opportunity to further develop much more modern technologies, automation, and tracking…Think about all the technologies that have been invented: cloud-based technology, mobile technology, GPS tracking, web portals, and mobile apps. These are ways that we have basically built a new management system.”
These technological innovations are revolutionizing the non-emergency medical transportation industry. For instance, legacy medical transport vendors have higher costs and less flexibility because they must maintain and house a fleet of vehicles. Ridesharing avoids this expense and can adapt more easily to spikes in unexpected demand. Ridesharing also employs the latest tracking and monitoring software in order to keep patients safe and reduce waste, fraud and abuse.
In an era of budget cuts where lawmakers are forced to prioritize services and look for more efficient ways of doing things, they should consider that other states are saving money and boosting patient satisfaction by adopting a ridesharing model for Medicaid transport. Consumer-driven and consumer-friendly technological innovations are saving taxpayers millions of dollars every year.
Why should Medicaid patients – and Mississippi taxpayers – miss out?
This column appeared in the Northside Sun.
Mississippi is doing better than most states when it comes to recovering from the economic shutdowns caused by the coronavirus pandemic.
Mississippi’s unemployment rate, which was the highest in the nation at 5.4 percent one year ago, is now more middle-of-the-pack at 8.7 percent. This is down from 10.5 percent in May, and better than the national average of 11.1 percent.
Notably, the increase of just 3.3 percent over the past year is one the lowest jumps in the country. That contrasts with the state’s that were at the center of the COVID-19 pandemic in the spring, including Illinois, Massachusetts, Michigan, New Jersey, and New York. They subsequently made the most draconian moves to shut down businesses and they have seen their unemployment rates jump by 10.6 to 14.5 percent since last June.
Mississippi's relatively low unemployment rate is due to the fact that Mississippi is doing better than most when it comes to the state’s jobs rebound.
February-April job losses that returned in May and June
Almost half of the jobs that were lost from February through April have returned in May and June in Mississippi. The South has been stronger than most other regions of the country, and Mississippi’s rebound of more than 49 percent is seventh best in the nation.
Neighboring Tennessee came in slightly ahead at 52 percent, placing the Volunteer State third nationally. Louisiana, which has seen a rebound of just 32.8 percent of jobs lost, is the only state in the Southeast not in the top half of the recovery.
Still, we know the recovery hasn’t been even, and many businesses – particularly small businesses – continue to struggle. Especially when promised relief funds never show up.
“They promised us all kinds of grants and loans," said Edward Ferrell, owner of the Little Yazoo Sports Bar and Grill in Yazoo City. "Nothing’s happened. I have not received a dime of that money. I’ve had to let good friends go who had worked for me for the last five years because I can’t afford to pay them. I can’t afford to pay the bills. I’m dipping into my savings that we were going to use to update the bar. We can’t do it now.”
That is why the continued focus on the use of federal funds for the recovery efforts in the state should be on private sector needs, not public sector wants.
As Mississippi marks the 54th anniversary of legal liquor sales in the state, the state run liquor warehouse is still not able to meet consumer demand.
In a recent story from WLBT, local liquor store owners are complaining that liquor shipment are still delayed at least two weeks. There was a run on liquor at the beginning of the pandemic, but that has eased off. Sean Summers, owner of Calistoga Wine and Spirits in Ridgeland, said his business is down 50 percent since December.
Yet, Alcohol Beverage Control is unable to complete basic orders. This raises numerous questions, such as, why do we need the state to control alcohol?
But what makes the recent news about shortages more ironic is that yesterday marked the 54th anniversary of the first legal liquor store in the state. On that day, Jigger and Jug opened in Greenville. That happened more than 30 years after the federal government repealed prohibition.
Mississippi has a long history of attempting to control alcohol consumption. It was the first state to pass some form of prohibition in 1908, and then was the first state to ratify the 18th amendment, creating a federal prohibition in 1918.
While prohibition inspired some great blues songs and classic literary characters it was bad public policy. For years before 1966, many establishments openly sold alcohol to customers, and the state even placed a 10 percent tax on the sale of alcohol, essentially making a mockery of its own prohibition laws.
Public policy ought to be rational and easily comprehendible by the public. Our modern laws governing the control of alcohol are anything but that, and continue a long tradition of excess government control.
We have over empowered individual counties to define their own laws, and in so doing have created a chaotic state of regulation, difficult to understand by the average residential citizen, let alone internal and external businesses hoping to sell. Though residents in dry counties or those passing through will soon be allowed to legally posses alcohol.
Furthermore, the state has retained an egregious amount of control of the distribution process. Mississippi has decided that, rather than allow private businesses to control the market, it will run a large warehouse in the central part of the state which will have a complete monopoly over the distribution of all spirits and wines.
As the Department of Revenue states on its own site, “the ABC imports, stores, and sells 2,850,000 cases of spirits and wines annually from its 211,000 square foot warehouse located in South Madison County Industrial Park.”
This warehouse consistently operates at capacity, and government leaders are considering a $35 million expansion. Perhaps our politicians ought to consider giving the free market a chance?
There is no reason that our government should be so deeply involved in controlling the distribution for a product. They hike up prices by a tremendous rate, limit access to the product, and determine which brands are allowed to sell in the state, leaving businesses in the dark and unable to control their own wares.
Private businesses are barred from distributing alcohol in Mississippi. While UberEats, DoorDash, and GrubHub have created thousands of jobs in other states through their delivery systems, our legislative leaders have shut down this opportunity for individuals to order alcohol with their delivery.
And while a variety of companies sell and ship wine, whiskey, and other alcoholic beverages around the country, our legislative leaders have determined that we shouldn’t have this freedom of access.
The excess regulation has made Mississippi last in the nation for craft beer development. For comparison, craft brewers currently produce $150 per capita in Mississippi, while they produce $650 per capita in Vermont. Imagine the difference such an industry could make in our state. This is thousands of tangible new jobs which are being discouraged from coming into existence by our government.
Existing policies have led Mississippi to have the largest shadow economy in the nation (referring to the exchange of products that are not taxed or recorded) at 9.54 percent of GDP. Moonshine is either produced or is available in every single county, which many link to the strict regulation of the alcohol industry. Our egregious taxation of alcohol products displayed here by the Department of Revenue has encouraged many companies such as Costco and Trader Joes to avoid opening locations in the state due to the lack of revenue potential on alcoholic products.
Prohibition is alive and well in Mississippi. Our government has decided we apparently can’t be trusted to make basic purchasing decisions for ourselves, so they must control what alcoholic drinks we’re allowed to have access to, how we’re allowed to receive these drinks, and from whom we’re allowed to purchase these drinks.
Be not fooled by the government “do gooders” who proclaim that they carry out policies like this for our own protection. Too many of our political leaders refuse to give freedom a chance, and instead have decided that they know better than we do when it comes to running our lives.
The fact is that while Mississippi prides itself on having a relatively low income tax, it finds dozens of other ways to tax and control its citizens.
Companies are discouraged from entering into business in the state because we have established covert taxes which discourage entrepreneurial risk taking.
Mississippi controls, regulates, and taxes alcohol worse than New York or California, so imagine what other discrete ways it is shutting down job opportunities and discouraging new business.
For now, the premise is simple: Get the state out of the alcohol business. Alcohol sales shouldn't be another excuse to take from taxpayers. That is not the role of government. Instead, Mississippi leaders should trust in the free market.
“The government shutdown pretty much devastated my business. Today, my business is in financial jeopardy.”
Edward Ferrell and his wife Kristi own Little Yazoo Sports Bar and Grill on Highway 49 in Yazoo City. They purchased it in 2014 when the opportunity occurred.
“It’s always been a bar here,” Ferrell said. “It’s always been lucrative, so we took a chance on it. We’ve owned it for the last six years, and every year we stayed in the black until this year when they decided we needed to shut down for the COVID 19 outbreak.”
Back in March, the bar was forced to shut down by the state. As opposed to restaurants that could hang on by offering curbside or take out, they couldn’t. The bar would stay locked down for more than two months.
“They promised us all kinds of grants and loans. Nothing’s happened. I have not received a dime of that money. I’ve had to let good friends go who had worked for me for the last five years because I can’t afford to pay them. I can’t afford to pay the bills. I’m dipping into my savings that we were going to use to update the bar. We can’t do it now.”
Today, Ferrell has to use his income from his other job to pay the bills at the bar because they aren’t making the money needed to cover costs.
Because even though bars are limited to 50 percent capacity, it doesn’t mean bills have been cut in half.
“My bills are not 50 percent. I still have to pay the same amount of rent, same amount of lights, same amount of water, same amount of insurance. I try to make a dollar for myself, and there’s just no way to do that. We had a full-time kitchen. Now we can’t afford to pay a cook, so we had to shut the kitchen down. You can’t order half stock, you have to order full stock, and you’re going to lose half of it because you’re not selling it. They don’t split the packages in half because were at 50 percent.
“We’re limited to 50 percent, but it took 90 percent at full capacity just to pay the bills.”
To the Ferrell’s, and those that frequent the bar, it’s more than a place to get a drink.
“We firmly believe in giving back to our community. Every year we hold a womanless beauty pageant. We take that money raised, and we take care of the DHS foster kids. Anytime someone comes down with cancer, a friend of ours, a patron of our bar, we jump in and do benefits for them, we raise money to help them. We recently had a nurse who had to have emergency surgery, and she’s out for eight weeks. We did a plate cooking here and raised a lot of money that’s going to help pay her bills while she’s out.”
“We love them, they’re family, we’re all family.”
And so, Edward and Kristi will keep fighting. Even at 50 percent.
On Tuesday, Gov. Tate Reeves announced he will be signing an executive order mandating masks be worn in public statewide.
What do you think about this?
Gov. Tate Reeves announced today that he will be signing a statewide mask mandate for residents in every county in the state. Previously, mask requirements had been in place in about half the counties in the state, which included the most populous counties.
“Every leading indicator says we are starting to see improvement,” Reeves said. “But that does not mean we can declare victory and take a step back.”
During today’s news conference, Reeves made the announcement along with an update on school reopenings amidst a push by some to delay the start of school or move to virtual only. Some schools will be delayed per an order from Reeves.
The start of school will be delayed for two weeks for grades 7-12 for districts in Bolivar, Coahoma, Forest, George, Hinds, Panola, Sunflower, and Washington counties. The order does not effect private schools.
These counties had more than 200 cases and 500 per 100,000 residents in the last two weeks.
Additionally, all students and staff will be required to wear masks during school.
Jackson Mayor Chokwe Lumumba issued an executive today closing bars to indoor guests.
Saying he was “prioritizing saving lives,” bars in the state’s largest city can no longer serve guests inside. Instead they can only provide takeout or drive-thru services. This includes all bars, nightclubs, lounges, taverns, and private clubs located in the city of Jackson.
Bar tops in restaurants must also close, though employees can still work behind the bar to prepare drinks. They can then serve those drinks to customers at a table. Additionally, restaurants can continue to serve alcohol.
The order goes into effect Tuesday night.
Previous, Gov. Tate Reeves has signed an order that closed bars at 11 p.m. and mandated customers be seated before they can be served alcohol.
The long-term financial stability of the Public Employees’ Retirement System of Mississippi could be at risk. Despite a historic bull market run, PERS fell $9 billion further into debt to public employees over the past decade, reaching a record high $18 billion in accrued, yet unfunded, pension benefits prior to the global pandemic.
As of 2019, PERS held only 61 percent of the assets actuaries expect are needed to pay for long-term benefits to state and local public employees. Given recent market volatility and the global recession, this funding challenge is likely to get worst if action is not taken soon.
According to recently released analysis by the Pension Integrity Project at Reason Foundation, the lead driver of PERS’ growing unfunded liability has been overly optimistic investment return assumption. Going back decades, PERS depended on a return of 8 percent and eventually adjusted that expectation down to 7.75 percent in 2015. Unfortunately, actual returns only averaged 5.94 percent since 2001. Looking forward, experts suggest achieving even a 6 percent average rate of return is optimistic over the next 10-15 years.
Using actuarial modeling to test future crisis events with varying market returns, the Pension Integrity Project has found under a wide range of realistic scenarios, Mississippi’s assets are not able to keep up with the growth in promised benefits without major cash infusions.
The results should concern any pensioner, policymaker, or taxpayer.
Such scenarios could result in annual costs more than doubling within the next 30 years – pulling funding from other public priorities like road repairs and education.
Beyond the state’s obvious funding issues, policymakers also need to reevaluate the effectiveness of the current system at providing attractive benefits to all its members. Most workers (71 percent) leave before vesting—within 8 years of service—and are required to forfeit employer contributions to their retirement account. Only a mere 4 percent of workers remain in the system long enough to enjoy full pension benefits, leaving the vast majority of PERS members without a path to a secured retirement.
When it comes to the retirement security of Mississippi’s public workers, there is no better time for stakeholders to come together and adopt meaningful change than now.
The plan’s inability to recover even during the longest bull market run in U.S. history highlights the need for a change. Lowering the assumed rate of return as well as prioritizing paying off the current unfunded liabilities as fast as possible should be at the top of the to do list for state lawmakers. Undoubtedly, this will be difficult to prioritize amid many competing fiscal priorities facing the state in the coming years, but the value of meaningful and lasting reform would extend well beyond this challenging moment.
PERS finds itself in a precarious position, but it is not too late to right the ship. If state policymakers take swift action to make informed and lasting improvements, they very well could save the retirement security of Mississippi’s public workers.
This column appeared in the Clarion Ledger on August 3, 2020.
Over the past two decades, the number of homeschoolers in Mississippi – and in America – has more than doubled as this education choice has moved from the fringes of society to a practice that is legal in every state.
But even with that growth, according to the National Center for Education Statistics, homeschoolers represent just three percent of the student population. However, that was before the coronavirus pandemic shut down more than 100,000 schools for over 55 million children last spring.
Even if it was government led with government curriculum, every family in Mississippi had a taste of homeschooling. Some sarcastically quipped that would end homeschooling. But then polling started to tell us otherwise. Almost overnight, homeschooling favorability rose. Twenty, thirty, even forty percent said they wouldn’t be sending their kids back to school in the fall.
While the strongest advocates of homeschooling know that we probably won’t see numbers like that, we are all expecting a large departure from both public schools, and potentially from private schools as well. Why? There’s an interesting mix of parents who feel that sending their children into a large school setting isn’t safe, while another large group doesn’t like the restrictions that will be coming, limiting interaction with friends, while requiring face masks in many (or perhaps all) school settings.
Fortunately, it is easy to get started homeschooling in Mississippi. For a state that has generally shown little interest in education freedom, the freedom to homeschool is broadly supported and protected by law. The one thing a parent must do is file an annual certificate of enrollment with your local school district’s school attendance officer. All you need on the form is your child’s name, address, phone number, and a simple description of the program such as, “age appropriate curriculum.”
When you do that, your child and you are now exempt from the state’s punitive compulsory education laws. There are no requirements on curriculum or testing or who can teach. Parents, instead, have the freedom to choose the educational system, style, and setting that works best for them and their children.
The Department of Education “recommends” parents review state curriculum guidelines and maintain a portfolio of their child’s work, thought that is not required. As opposed to following a government curriculum that tells your child what he or she must learn at what age, homeschooling allows you to let your child learn at their own pace.
That means a child who is excelling can move forward at a quicker pace, cover additional topics, or take in material at a deeper level. If a child is struggling, you can slow down, switch your teaching style, or bring in new materials. If your child has a unique interest, the world is literally at their fingertips with scores of free, online training materials. Yes, YouTube is filled with funny cat videos. But it also provides a library of instruction on virtually any topic you can think of.
Thanks to today’s technology, a quick Google search can help you get more comfortable with homeschooling. There is an abundance of homeschool Facebook groups with veterans who are willing to share their ideas on getting started, curriculum, extracurricular activities, maintaining your sanity, and much more. Connection to these groups is also a venue to plan an endless variety of outings and field trips. It won’t take long to realize your child will receive as much “socialization” as you would like.
There are also options such as co-ops, where families gather together and share teaching responsibilities among parents. Similarly, we have seen the emergence of microschools this year in which a small group of parents pool their resources together to hire a teacher.
If you’re on the fence about homeschooling, worried about what homeschool might look like in your family, or just not sure you can do it, at least take a closer look. Fill out the necessary forms, do your research, and talk with other homeschool families.
You might find what many homeschool families did long ago: Giving children time and freedom to pursue their individual interests while utilizing a curriculum consistent with the values of your family, rather than following forced government mandates created by faceless bureaucrats, tends to produce very positive results.
This column appeared in the Daily Corinthian on August 2, 2020.