The face of health inequity in Mississippi

By Michelle Chen Mar 27, 2009

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