While many states have embraced new health care policies, Mississippi, however, is one of the states that have been left behind due to socioeconomic problems. Poverty affects Mississippi's economic and health policies mainly because private and public payers were less involved or concerned in reducing the health care spending, and believed that the state has insufficient budget for health and long term care services.
In fact, Mississippi was voted the worst state in terms of health care system in 1999. Mississippians have poor health status compared to residents of other states, and Mississippi is the 50th state with premature mortality rate. Several factors influence these trembling health concerns such as heart disease, smoking, cancer, infant mortality, and motor vehicle deaths. However, Mississippi prides of having the highest child immunization rates in the country. The low quality of health care can be blamed on demographic factors such as poverty, high unemployment and illiteracy rate.
From 1994 - 1995, 20 percent of non-elderly Mississippians were uninsured, which is 4% higher than the national rate. The high rate of uninsurance in Mississippi is caused by low level of employer-sponsored insurance. Although Medicaid limits the number of eligible policyholders, many impoverished residents (about 16 percent of the state population) participate and rely in Medicaid.
Medicaid Expenditures
Medicaid provides the second largest state budget for health care. This budget comes from the federal government and revenue contributed by health care providers. Mississippi has the highest federal Medicaid reliance in the country that rose to about 77.2 percent in fiscal year 1997.
Mississippi's Medicaid expenditure has been higher the national average since 1990s. The large expenditures were triggered by the growth of DSH spending and higher spending per enrolee. Unfortunately, less Medicaid budget is appropriated for long term care services compared to other services, primarily because of the restrictions on nursing home and home health capacity. With at least 30 percent Medicaid spending that goes on long term care services, the state receives relatively lower than the national rate of 40 percent.
The state government has changed several insurance regulations in the states, which include the limits on pre-existing condition exclusions and portability of insurance. This led to the changes in the Health Insurance Portability and Accountability Act of 1996. The state pursued a high-risk insurance pool to about 1,500 people with serious health conditions, who were not eligible for any health insurance. The risk pool was funded by the insurance companies and member premiums.
Long Term Care
Mississippi has somewhat stringent policies in terms of long term care. The state issued the "certificate-of-a-need-system" that diminished the number of nursing home beds and creation of new home health agencies. The restrictions on nursing home expansion as well as limiting the average stay in nursing home facilities resulted to low occupancy rate of 99 percent. Although Mississippi receives the largest share in Medicaid, the budget that should have been used for long-term care was, otherwise, used on institutional care. Even though home and community-based services have flourished within the state, these programs are dominated by Medicare and remain unpopular that the institutional care. Half of elderly and disabled Medicaid enrolees in Mississippi need long term care services.
Given those underlying health care problems, the Mississippi government enacted the reform bill in 1997. The bill carried few changes on the state's financial system, but it did not make necessary reforms for Medicaid. Lawmakers became worried that recipients would lose cash assistance might lose Medicaid benefits as well.
Meanwhile, the state adopted the long term care partnership program that has been running previously in other states. The Mississippi Long Term Care Partnership program contains the same vision of other states: to help residents protect their assets against the spend down requirements of Medicaid. This program will lessen the burden of getting long term care insurance in Mississippi. The partnership policies have the following features: long term care insurance inflation protection, asset protection, and tax deductions.
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