Obesity, Medicaid and SNAP among topics discussed by Senate Study Committee on Women, Children and Families

• Obesity is still playing a large part in the negative health outcomes for women, babies and children in Mississippi. And state agencies are working through changes to federal welfare programs.

The health of Mississippi’s youth and their mothers is at risk from several factors, the greatest of which is reported to be obesity and childbirth. 

Those were two of the biggest topics touched on during the health-related portions of the state Senate Study Committee on Women, Children and Families hearing held on Tuesday.

Other health-related topics pertained to helping mothers overcome addiction and the stigma associated with addiction as well as the state of the Medicaid and SNAP programs moving into the next year.

Health outcomes and influences

Mississippi has a longstanding problem with obesity. State Health Officer Dr. Daniel Edney described how the issue is driving a number of the negative health outcomes for mothers and their babies. 

In terms of maternal death, Edney said Mississippi has moved from 50th to 45th, but live births are down by about 1,000 annually. He noted that the state faces issues with access to care, with many expectant mothers having to drive more than 45 minutes to see an obstetrician.

With obesity rates in children being the highest they have ever been, Edney is also concerned that the problems the state currently faces will be exacerbated as today’s children age.

Mississippi Division of Medicaid Executive Director Cindy Bradshaw said during her presentation that about 42 percent of the childhood population in the state is considered overweight or obese, a larger percentage than the adult population. 

Infant mortality rates are another concern affected by the weight of the mother. Dr. Edney added that the weight of the mother directly correlates to pre-term birth rates. In the total cases of preterm births in the state, 44.5 percent of mothers had an unhealthy weight. 

“I know we are all tired of leading the nation in infant mortality,” Edney said.

Addiction is yet another aspect negatively affecting the health of Mississippi’s mothers and their babies. Christina Dent, Founder and Vice President of End It For Good told the Senate committee that illicit drug use in the state has increased over the past two decades.

One of the leading causes for addiction in adults is trauma experienced during childhood. With each instance of trauma, a person’s risk for addiction increases three-fold.

As such, an unborn child exposed to illicit drugs leads to unfavorable outcomes in the child’s health. What usually prevents a mother from seeking help is the fear of legal repercussions. In response, Dent suggested expansion of programs that help women overcome opioid and other addictions, while also providing assurance they will not be arrested when seeking treatment. 

“We can’t force people into healthcare. But we can increase the likelihood that they will access that healthcare and want to access that healthcare,” Dent explained. “And the two main reasons why women are afraid of accessing healthcare specifically related to pregnancy, often they describe as fear of criminal justice involvement or loss of custody of their children.” 

Medicaid update/observations

The Senate committee was also briefed on the work ongoing within the Division of Medicaid.

Bradshaw said that within the state, 66 percent of Medicaid recipients are women, children or infants. Her department is training employees on presumptive eligibility under the new state law, with 180 employees receiving that training so far.

Presumptive eligibility provides eligible pregnant women Medicaid coverage for 60 days while their full application is being processed. 

Employees are working to cut the time to get applications processed. 

“We’ve always had a benchmark to process pregnant women applications within 10 days, and we are exceeding that in that we have most applications, that are clean applications that we don’t need any additional information, we’re processing within 7 days,” Bradshaw explained. “So, our benchmark for all applications is within 9 days.” 

The state Medicaid office has received two grants in aid in their mission.

One award was a grant that only 15 states qualified for, referred to as a Transforming Maternal Health Model. It is a 10-year program that provides up to $17 million with the goal of improving maternal outcomes. To do that, the agency looks to expand maternal healthcare through more birthing centers and provide health education during pregnancy.  

The second grant focuses on cell and gene therapy. Bradshaw said Mississippi was one of 33 states to be awarded this type of grant. The program seeks to ensure access to treatments that use high-cost drugs. 

“So, CMS, kind of for the first time, has gone out and negotiated with these manufacturers not only just for discounts on the drug but quality metrics associated with it so that there is some money that would be refunded to the states if the therapy does not work,” Bradshaw described of the work by the federal Centers for Medicare and Medicaid Services.

Bradshaw added that one of the treatments included in the program focuses on a sickle cell diagnosis, which she said can cost upwards of $3 million. While the treatment can be successful it is not curative, so the condition could still be passed on a person’s children. 

Her office has also noted a decrease in the number of infants born between 28 and 31 weeks. That rate was 21 percent previously, but today it stands at 14 percent. 

Statistics recorded by the Mississippi Division of Medicaid indicate the majority of maternal deaths occur after the mother has delivered the baby, with the cause of death being related to a stroke or heart attack.

“So, we’re asking that the hospital complete a pretty thorough risk assessment on the status of the patient, and if it comes back high risk that they coordinate getting the mom an appointment with her doctor within certain timeframes, depending on what her risk score is,” Bradshaw said.

She added that there is a need for regulatory inspections at adult day cares and for state authority over surrogacy. Currently, Mississippi offers no protection for the mother of the child acting as a surrogate.

“Because if the mother finds out halfway through the pregnancy that their child is going to have a lot of disabilities, the parents can just walk away from it and she’s, you know, held accountable for raising a child that she may not have been otherwise planning to do and vice versa for the parents,” Bradshaw described.

SNAP costs to rise for the state

Several changes enacted by the Trump administration will lead to higher costs for all states across the nation to be part of the Supplemental Nutrition Assistance Program, or SNAP, Senators were told.

Bob Anderson, Executive Director of the Mississippi Department of Human Services, said that last year about 350,000 Mississippians were in the SNAP program, equating to about $800 million in benefits.

He told lawmakers that every state’s share to participate in the federal welfare program will change by October 2027. First, reimbursements for administrative costs are changing from the previous federal reimbursement rate of 50 percent to 25 percent. Anderson said the $15 million required to cover those administrative costs will be included in their annual budget request. 

Error rates will now play a part in how much states are required to contribute, if at all. Previously the federal government covered 100 percent of the benefits paid to beneficiaries. Now, states that can keep their error rate below 6 percent will not be required to share in the costs of the program, outside of adjusted administrative costs. 

As previously reported, Mississippi’s error rate was near 10 percent for Fiscal Year 2024. 

Anderson advised Senators that the error rate is not a reflection of wrongdoing, however. 

“I want to say this. Errors in payment are not indicative of fraud. And that is a misconstruction about what the payment error rate is about. The payment error rate is about how well we as an agency, in working with our clients, perform the eligibility determination function. That’s what the error rate is, and the error rate is composed of agency errors as well as client errors,” Anderson described.

States that have an error rate of 6 to 8 percent will be responsible for 5 percent of the program costs. Error rates up to 10 percent will equate to a cost share of 10 percent of the cost of the program, and error rates above that amount will lead to a cost share of 15 percent. 

Anderson said that if Mississippi were responsible for 15 percent of the cost of the program, it could cost the state an additional $240 million. Keeping the rate below 10 percent would amount to a cost share of $120 million, and an error rate between 6 to 8 percent would amount to a $40 million cost share. 

State Senator Nicole Boyd (R), chair of the Senate committee, asked if there was anything in code that would make it more difficult for Mississippi to lower its error rate. 

“Well, I’m going to say this much, and really not a whole lot more. We’re the only state in the country under change reporting and change reporting is different from every other state (which) uses something called simplified reporting where they do… recertification every six months,” Anderson replied. “Under change reporting our obligation is if there is a $125 change in household income within a month, we are required under current law to re-certify that family for SNAP eligibility.” 

When that change in income is not reported or missed by departmental staff, it is counted as an error in the rate, Anderson said. 

An explanation as to why Mississippi uses a different reporting system than other states was not indicated during the hearing. 

For now, lawmakers will continue to hold hearings and consider possible legislation on these matters when they return to the Capitol in January.