The face of health inequity in Mississippi

Michelle Chen

The face of health inequity in Mississippi

Imagine being sick and out of work, with a couple of miles and no car standing between you and the nearest public benefits office. You need medical care, but would you travel all that way to prove to the government that you really, truly deserve it?

Mississippi requires that people go to a state office for a “face to face” interview in order to renew or certify eligibility for Medicaid or state Children’s Health Insurance Program services. Governor Haley Barbour recently touted the rule, which has been in place since 2005, as a way to weed out fraud.

But in reality, the “face-to-face” rule seems to just weed out people, period. According to the progressive think tank Center on Budget and Policy Priorities:

The actual result of the interview requirement is that many eligible people have dropped from the rolls. At least 62,000 fewer children and adults in Mississippi were enrolled in Medicaid and CHIP in 2006 compared to 2004, even as the number of uninsured children in the state rose.

Advocates for Mississippi's poor say the extra bureaucratic hurdle can put Medicaid out of the reach of the neediest families. Showing up for an interview, the Center says,

often means that families must miss work, secure special arrangements for child-care and elder-care, and arrange for transportation to far-flung state offices. While Mississippi opened additional offices to increase the locations where interviews could take place, they are limited in number and hours of operation.

The Center also notes that the Governor's claims of reducing fraud are based on distortions of the data. Moreover, income eligibility can be verified through simpler registration procedures and cross-checked with state databases, rather than an in-person interview.

In short: “face-to-face” does not enhance the integrity of Medicaid in Mississippi, which suffers from vast health disparities. But it could save the state money by simply getting rid of beneficiaries. Since nearly a third of Black Mississippians rely on Medicaid and more than one fifth are uninsured, and research suggests that race and community segregation influence local access to Medicaid services.... well, you see where this is going.

This isn't the first such scheme to impact poor people of color in the Hospitality State. Mississippi has a curious history of erecting racially linked bureaucratic blockades. A 2002 study found that among TANF welfare recipients in Mississippi, whites were more likely than Blacks to receive information from case workers on various support programs like medical coverage, job training and child care.

Similar obstacles have emerged when people of color try access to other public resources—like, say, democracy.

On the surface, “face to face” may seem like rational public policy, but a deeper look reveals ugly traces of Mississippi's color line.

Image: Myers Foundation for Indigent Health Care and Community Development

Posted at 6:54 AM, Mar 27, 2009 in Health | Permalink | View Comments

Comments

This a copy of an email I am sending to the Mississippi Medical Board, the local newspaper, and several advocacy agencies. It is another blow to access to medical care for all peoples of Mississippi.

As a student of a Caribbean medical school and and an Arkansas native, I believe the Medical Board of Mississippi, like the Medical Board of Arkansas, has done both states a great disservice by passing these regulations. First and foremost, both states are medically underserved in most of their counties and the standard of living for most residents is much lower than the rest of the US. By not allowing Caribbean students into the state, whether for clinicals, residency, or licensure, you have directly contributed to the shortage of medical doctors in your state.

The pool of medical doctors that you are excluding by this regulation would include graduates of different schools with many variables in size, facilities, etc. but with one important thing in common: in order to be licensed in the US, they have to have ECFMG certification, which you are aware of, and pass the same USMLE as US medical students. The statement that your medical board makes by not allowing these graduates to be licensed in your state, is that the USMLE is not a true standard of knowledge for a medical education. After all, each individual gains the information to become a doctor as it is given and as they seek to learn, then all go to US clinical rotations, performing and competing with US medical students in the states that allow them. If, as is the fact, these students are successfully completely these rotations and the steps of the USMLE, and are recognized by both the ECFMG, WHO, and on the FAIMER list, then I fail to see the problem with licensure for these doctors.

What is the rationale for excluding these doctors from practicing in your state? Are you under pressure from special interest groups to do so? I seriously doubt you have concerns from the constituents of the state. As it is, many citizens of this country are unable to see a doctor to affordability, availability, and access, and this regulation does nothing more than continue this problem.

The question the board should be asking regarding this regulation, is what is the goal of this regulation? What is the motivation? As it stands right now, students like myself who successfully pass the USMLE after graduating from a caribbean medical school will still be licensed to practice medicine, and like myself, if they have the passion, will continue to enroll in these schools to pursue the dream of practicing medicine, even if they are not able to practice in their home state, as long as most of the other states allow them to practice. In short, all this regulation does is shortchange the people of Mississippi (and Arkansas), as qualified doctors get licensed and practice in other states who are historically more open to international medical graduates.

I hope you will consider my words and the welfare of the people of the state of Mississippi. The ECFMG was originally set up to protect people from poorly educated people wanting a US medical license, and to date, has done so. Why some states have chosen to second guess this agency is anyone's guess.

Sincerely,

Kathryn Rahman