After the Legislature failed to give the state health department the funding it needed to fully staff county health departments, some no longer offer clinical services and the agency may close others.
County health departments now offer one of three levels of care as a part of a plan to ensure their sustainability in the face of limited and unpredictable funding.
Eight county health departments no longer offer the clinical services they have traditionally provided, like immunizations, preventive screening and reproductive health services. Instead, they serve as a connection point to other health departments with higher levels of care.
The reorganization is the county health departments’ “pathway for survival,” State Health Officer Dr. Daniel Edney told Mississippi Today.
Previously, clinicians rotated between county health departments, he said. The new system establishes consistent levels of care.
“That didn’t work,” he said. “But this is working.”
Health departments are now classified into three levels:
- Level 3 clinics, or “super clinics,” have a doctor or nurse practitioner on staff. They offer a full range of services, including family planning, immunizations, disease screenings and programming for mothers and children.
- Level 2 clinics have a nurse on staff and offer limited family planning services, immunization, disease screenings, programming for mothers and children and telehealth appointments.
- Level 1 clinics do not have a clinician on staff, and offer referrals, record services, federal programming for women and children and help people schedule rides to higher level clinics.
Some clinics offer Level 2 services on some days of the week and Level 3 services on others.
The new system aims to concentrate resources and ensure that every region of Mississippi has access to needed health services, said Dr. Renia Dotson, Mississippi’s state epidemiologist and the director of the recently created Center for Public Health Transformation, the health department division responsible for overseeing the changes.
It utilizes telehealth and transportation services – like the department’s partnership with Uber – to ensure that patients can access a doctor or nurse practitioner even in health department locations without one on staff.
In just over one year, the health department doubled the number of nurse practitioners it employs to over 30 and increased the number of Level 3 clinics to 15, said Dotson. She said the health department aims to continue expanding the number of Level 3 clinics.
Drastic budget cuts in 2017 forced the agency to shutter county health departments and lay off staff. The agency has spent the last eight years rebounding from the cuts.
In 2023, the Legislature denied the health department’s $9 million budget request to hire the nurses needed to fully staff county health departments and a program that puts nurses in the homes of low-income pregnant women with high-risk pregnancies.
The Mississippi State Department of Health began implementing a tiered approach to county health departments’ level of care not long afterwards. The agency has been making the changes for the past 18 months, said Edney.
No county health departments have yet been closed as a result of the changes, said Dotson, but there may be some areas where it is not possible to continue operating a county health department. The agency is currently in the process of evaluating the level of care that is needed and that the department is able to support in each county, and considering other health services offered in an area when making determinations on need.
“We’ll make an effort to maintain a presence in every county if that is feasible,” she said.
The agency’s website does not currently include information about the reorganization or provide information about which level of care each county health department provides.
The Department of Health made a meager budget request this year of just $4.8 million to train early-career doctors and help Mississippians enroll in health insurance. It did not include any specific requests for county health department funding or funding positions for doctors or nurses.
The agency is working to create margins in a tight budget by reducing its overhead, Edney told Mississippi Today.
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