MISSISSIPPI
Rural Health Plan
2022
PREPARED BY:
Mississippi State Department of Health
Ofce of Rural Health and Primary Care
570 East Woodrow Wilson Blvd.
P.O. Box 1700
Jackson, MS 39215-1700
(601) 576-7216
2022
HOLD FOR LOGO
TABLE OF CONTENTS
Executive Summary..................................................................................................................................................................1-2
State Rural Health Plan Improvement Strategies..............................................................................................3-4
About our Ofce..............................................................................................................................................................................6
MORHPC Funding............................................................................................................................................................................7
Subchapter 1. Introduction and Purpose........................................................................................................................8
Subchapter 2. State Prole................................................................................................................................................9-12
Subchapter 3. State Rural Area Denition...................................................................................................................13
Subchapter 4. Health Systems in Mississippi.....................................................................................................15-19
Rural Health Systems Findings...................................................................................................................................20-21
Subchapter 5. Health Workforce..............................................................................................................................23-30
Rural Health Workforce Findings.......................................................................................................................................31
Subchapter 6. Mississippi Rural Hospitals.........................................................................................................33-37
Subchapter 7. Critical Access Hospitals.....................................................................................................................38
Subchapter 8. State Criteria Necessary for Provision of Services............................................................38
Subchapter 9. Critical Access Hospital Designation Application.............................................................39
Subchapter 10. Critical Access Hospital Certication Application Review Committee.............39
Subchapter 11. Critical Access Hospital Relocation Requirements...........................................................39
Subchapter 12. List of Mississippi Critical Access Hospitals...........................................................................40
Rural Hospital Improvement Strategies......................................................................................................................40
Rural Health Equities and Health Disparities...........................................................................................................42
COVID CARES and ARP 2021-2022....................................................................................................................................43
Crosscutting Issues..........................................................................................................................................................42-45
Conclusions....................................................................................................................................................................................46
Partners and Stakeholders...................................................................................................................................................47
Appendix A. 2022 MS Rural Health Care Plan Steering Committee...............................................48-49
Appendix B. Federal Requirements for Critical Access Hospitals.............................................................50
Appendix C. Critical Access Hospital Performance Data......................................................................51-53
Appendix D. List of Mississippi Qualied Health Centers.................................................................................54
Appendix E. Urban-Rural Demographics...................................................................................................................55
Appendix F. Health Conditions Graphs...............................................................................................................56-57
Appendix G. Differences in Health Behaviors Rural-Urban...................................................................58-59
LIST OF ACRONYMS
APRN – Advanced Practice Registered Nurse
CAH – Critical Access Hospital
CHCAM – Community Health Center Association of Mississippi
CMS – Centers for Medicare and Medicaid Services
CNA – Certied Nursing Assistant
EMS – Emergency Medical Services
EMT – Emergency Medical Technician
FLEX – Medicare Rural Hospital Flexibility Program
FORHP – Federal Ofce of Rural Health Policy
FQHC – Federally Qualied Health Center
IDD – Intellectual/Developmental Disabilities
HCAPHPS – Hospital Consumer Assessment of Healthcare Providers and Systems
HP 2030 – Healthy People 2030
HPSA – Health Professional Shortage Area
HRSA – Health Resources and Services Administration
LPN – Licensed Practical Nurse
MCES – Mississippi Center for Emergency Services
MDMH – Mississippi Department of Mental Health
MNA – Mississippi Nursing Association
MQHC - Mississippi Qualied Health Center
MS – Mississippi
MSHA – Mississippi State Hospital Association
MSPHI – Mississippi Public Health Institute
MORHPC - Mississippi Ofce of Rural Health and Primary Care
MSDH – Mississippi State Department of Health
NHSC – National Health Service Corps
RHC – Rural Health Clinic
RWJF – Robert Wood Johnson Foundation
SDOH – Social Determinants of Health
SHIP – Small Rural Hospital Improvement Program
SORH – State Ofce of Rural Health
SRHP – State Rural Health Plan
TA – Technical Assistance
TS – Technical Support
Executive Summary
and Rural Health
Improvement Strategies
Page 1
Background
The legislative authority for the Mississippi State Ofce of Rural Health (SORH) is contained in the
Mississippi statute, Section 41-3-15, which species that the SORH operates under the Mississippi
State Department of Health (MSDH). MSDH has organized the SORH to be administered by the
Mississippi Ofce of Rural Health and Primary Care (MORHPC). As such, MORHPC is responsible for
developing the Mississippi State Rural Health Plan (SRHP), which must satisfy SORH’s legislative
duty to develop and implement a SRHP plan, and to dene rural areas and facilities in the state.
This 2022 SRHP update retains the format of the 2015 Plan, which also followed the Public Health §
41-
3-15 functions, duties, and authority of the State Board of Health and SORH. As further
mandated by the state code, this plan was prepared in consultation with the State Rural Health
Plan Steering Committee. MORHPC invited state officials and members of the private healthcare
community to be members of the SRHP Steering Committee in order to provide input on the plan
update. A list of Steering Committee members is included as Appendix A.
Purpose and Objectives
The purpose of the SRHP is to document the status of health and healthcare services in rural
Mississippi including health status outcomes, access to healthcare services, workforce needs and
development, and healthcare systems. The following planning strategies have been identied and
prioritized by the MORHPC staff and SRHP Steering Committee:
1. Update the 2015 data in order to identify trends in rural health outcomes.
2. Document the capacity of the rural health workforce and healthcare facilities, including rural
hospitals and state and federally operated or supported outpatient clinics.
3. Increase our understanding of the rural healthcare system and identify challenges faced
by rural health ofcials, administrators, and providers to develop systems and resources to
improve the health status of Mississippi’s rural residents.
4. Highlight MORHPC’s programs and resources available to rural health providers and agencies.
5. Identify action items that are within the scope and role of MORHPC to improve rural health
outcomes.
Planning Process
MORHPC contracted with the Mississippi State Public Health Institute (MSPHI) to assist with
compiling and authoring the plan. MSPHI completed the following activities in support of SRHP:
1. 2015 SRHP data update: The 2020-2021 data was reformatted in tables alongside the 2015 data
to illustrate changes and trends.
2. SRHP Steering Committee member recruitment: The Steering Committee included
representation from state health ofcials; private nonprots in the healthcare arena
specializing in hospital, clinic, and health workforce areas; and individuals with expertise in
healthcare strategic planning and nance.
3. Stakeholder Survey: Using Survey Monkey, MSPHI developed a survey, based on baseline data
from 2015 SRHP and 2020 data updates, that was elded to the Steering Committee to provide
input on Mississippi’s emerging rural health care challenges and priorities; and, to provide
strategies to advance rural healthcare facilities and workforce and to improve the health
status of rural residents.
EXECUTIVE SUMMARY
Mississippi State Department of Health | Rural Health Plan Page 2
4. Working Groups (MQHCs): MSPHI utilized the stakeholder survey ndings and data updates
to prepare a preliminary plan draft that was then distributed to the Steering Committee for
feedback during ve working group sessions. Working group sessions were organized by topics
and expertise. The topics included:
a. Mississippi Qualied Health Centers, also known as Federally Qualied Health
Centers (FQHCs)
b. Rural healthcare infrastructure, systems, and rural health networks
c. Rural health needs, emergency services, and long-term care services
d. Rural health disparities, social determinants of health, and strategies to achieve rural
health equity
e. Rural health workforce and workforce training
2022 Rural Health Priorities
The following list of 2022 rural health priorities were identied
from feedback from the Steering Committee and the
MORHPC staff.
1. High transmission of infectious disease, including
COVID-19.
2. High poverty and low educational levels
3. Lack of infrastructure to facilitate access to
health services, including transportation
and broadband to support expansion
of telehealth services and educational programs
in rural areas
4. High morbidity and mortality from chronic
diseases
5. High prevalence of mental illness
6. Lack of access to adequate health insurance or
no health insurance
7. Rural health disparities
8. Poor access to healthcare services
including primary care, emergency
care, and trauma care
9. Underutilization of rural healthcare
networks as a systems-
improvement strategy
Page 3
Introduction
MORHPC selected the following strategies based on Steering Committee feedback. The action
items are primarily categorized by rural health systems; health workforce, enhanced mental
health services for the elderly, health innovations through telehealth technologies, rural health
equity, and rural hospitals.
Rural Health Systems
Emergency Services
• Identify federal funding designed to enhance emergency medical systems, workforce, and
training.
• Increase awareness of emergency service needs in rural areas.
• Assist hospitals with the development of comprehensive community needs assessments,
ensuring the incorporation of strategies to promote equitable emergency services.
Rural Healthcare Networks
• Provide and promote rural healthcare network development by hosting events to promote new
partnerships and provide training on rural network development.
• Identify both geographical and conceptual gaps in access to care that could be augmented
by rural health networks.
• Engage a consortium of key providers to utilize a data-driven decision-making process to
identify gaps in services.
Health Workforce
Physician Shortage
• Assist overburdened rural providers through facilitating locum tenens arrangements with
workforce programs.
Nursing Shortage
• Conduct regional workshops that support recently trained Certified Nursing Assistants (CNAs)
with completing their certification process.
Mental Health Provider Shortage
• Partner with Mississippi Qualied Health Centers (MQHCs) and the Mississippi Department of
Mental Health to recruit and place mental health counselors in community settings including
long-term care facilities.
• Host convenings and training opportunities to encourage tele-mental health expansion.
Enhanced Mental Health Services for the Elderly
• Collaborate with the Nursing Corps, National Health Service Corp, local MQHCs, and other
programs to increase the number of mental health professionals placed in mental health
professional shortage areas.
• Encourage partnerships between the above agencies to recruit and place mental health
therapists in rural longterm care facilities located in rural areas.
STATE RURAL HEALTH PLAN IMPROVEMENT STRATEGIES
Mississippi State Department of Health | Rural Health Plan Page 4
Health Innovations through Telehealth Technologies
• Support the expansion of broadband to remote rural areas to lay a foundation for innovative
health systems expansion through telehealth.
• Incorporate telehealth solutions into local planning activities.
• Host convenings and webinars to promote teleheath solutions in care delivery and medical
education.
• Work with local health providers and infrastructure ofcials to develop and expand telehealth
services, especially in the areas of emergency and mental healthcare.
• Increase awareness of telehealth costs by facilitating a nancial analysis of investment and
ongoing maintenance of telehealth technology.
Promoting Rural Health Equity through Planning and Systems Development
• Identify existing gaps in service delivery and share this information with rural leaders and
planners.
• Engage existing private and public rural health providers in collaborative efforts to develop and
enhance the community health system to address the needs of all community members,
focusing on eliminating health disparities in vulneraable populations.
• Utilizing the Robert Wood Johnson Foundation (RWJF) County Health Rankings to establish
baseline scores and the Healthy People 2030 health objectives to establish goals, assist county
health officials, administrators, and residents with establishing community-specific plans to
address and reduce health disparities in rural counties.
• Conduct a planning session to devise a targeted strategy or strategies to address the negative
health effects of occupational hazards on poor and vunerable
workers including African Americans, Latinos, and
Vietnamese.
• Coordinate with Medicare Rural Hospital
Flexibility Program (FLEX) hospitals to conduct
community health needs assessments to
ensure that these assessments specifically
address reducing health disparities.
Rural Hospitals
• Conduct focus groups to determine
reasons why critical access hospitals
are not fully participating in the FLEX
program.
• Conduct trainings and with hospital
partners to promote broader
participation in FLEX.
Introduction, Purpose
and State Health
Prole
Mississippi State Department of Health | Rural Health Plan Page 6
Requested TA Topics
for MORHPC
The Mississippi State Ofce of Rural Health and Primary Care (MORHPC) provides technical
assistance (TA) to different audiences to strengthen the rural health care delivery system,
increase access to care and improve health outcomes in rural communities. MORHPC
accomplishes this by collecting and disseminating health-related information, coordinating state
rural health resources and activities; providing TA to rural health providers, communities, and
ofcials; encouraging the recruitment and retention of health professionals to rural communities;
and strengthening state, local, and federal partnerships. The COVID crisis resulted in an increase
in technical support to providers and communities (See Table 3).
ABOUT MORHPC
Source for Tables 1-4: Internal SORH Report, Available on Request
• Behavioral Health
• Community Development
• COVID - 19
• Grant Writing
• Needs Assessment
• Older Adult Services
• Opioid Information
and Resources
• Population Health
• Rural Health Network
• Telehealth
• Workforce Issues
Table 1. Information
Dissemination Methods
We Disseminate
Information Through:
2018-
2019
2019-
2020
2020-
2021
Listserv 103 103 6,168
Newsletter 10,000 8,000 2,678
Website hits 1,048 1,417 1,130
Table 2. Technical Assistance Mediums for MORHPC
We Provide Technical Assistance (TA) Via…
2016-
2017
2017-
2018
2018-
2019
2019-
2020
2021-
2022
Face to Face 31 20 14 25 356
Telephone/Email 54 65 68 50 73
Webinars 3 7 6 4 31
Other 61 43 28 2 174
Total 149 135 116 81 634
Table 3. Entities receiving technical assistance from MORHPC
TA is Provided to These Types
of Partners & Stakeholders
2016-
2017
2017-
2018
2018-
2019
2019-
2020
2020-
2021
Hospitals 12 12 16 57 20
Clinics 14 17 10 5 65
Gov. Ofcials 2 28 5 20 7
Agencies 56 20 5 5 4
Associations 26 21 11 11 5
Providers 4 8 4 5 55
Networks 1 1 5 7 57
Communities 0 0 0 0 140
Acad. Insts. 11 11 14 14 22
Emergency Ser. 1 0 0 0 22
Other 15 17 10 15 15
Total: 142 135 80 139 412
Table 4. Topics for MORHPC TA
During 2020/21
TA spiked 93%
due to COVID
Page 7
MORHPC FUNDING
During 2021, MORHPC received $16,966,016 for SHIP hospitals for COVID-related mitigation
and services.
$1,493,507.00
$1,429,299.00
$1,409,434.00
$723,709.00
$740,000.00
$-
$200,000.00
$ 400,000.00
$ 600 ,000 .00
$ 800 ,000 .00
$1,000,000.00
$ 1,200,0 00 .00
$1,400,000.00
$1,600,000.00
Five Year Summary of MORHPC Federal Funding
2017-2022
2021-22
2020-21
2019-20
2018-19 2017-18
Five Year Summary of MORHPC Federal Funding 2017-2022
Mississippi Qualied
Health Center (MQHC)
$3,400,000
State Primary Care Ofce (PCO)
$165,775
State Ofce of Rural Health (SORH)
$223,410
Small Rural Hospital Improvement Program (SHIP)
$616,128
Medicare Rural Hospital Flexibility Program (FLEX)
$488,194
One Year At a Glance of MORHPC Funding by Program Area (2021-22)
Figure 2.
Figure 1.
Source for Figures 1 & 2: MORHPC Ofce. Figure 1 totals do not include funding for the MS Qualied Health
Center Grant Program.
Mississippi State Department of Health | Rural Health Plan Page 8
SUBCHAPTER 1. INTRODUCTION AND PURPOSE
Rule 1.1.1.
Authorization of State Ofce of Rural Health Program
In 1990, the Mississippi State Legislature authorized MSDH to direct the State Ofce of Rural Health
(SORH), under the auspices of the MS Ofce of Rural Health and Primary Care (MORHPC). The
SORH was then tasked to develop and implement a state rural health plan (SRHP), including an
operational denition of MS rural areas and facilities. The specic legislative authority for the SORH
is contained in the Mississippi statute, Section 41-3-15. Additionally, the Federal Ofce of Rural
Health Policy (FORHP) at the Health Resources and Services Administration (HRSA) periodically
requires states to review and update its SRHP to guide program activities when seeking Medicare
Rural Hospital Flexibility Program (FLEX) Program funding for assisting critical access hospitals
(CAHs).
Rule 1.1.2.
State Rural Health Plan Steering
Committee
The 2022 Mississippi SRHP follows the
format of the 2015 Plan, with updates
provided for the 2014 baseline
statistics and new data added as
appropriate. The plan was developed
in partnership with the SRHP Steering
Committee. The 2022 Steering
Committee included representation
from the Community Health Center
Association of Mississippi (CHCAM),
Mississippi State Department of
Health (MSDH) Mississippi Hospital
and Nursing Associations, and the
Mississippi Public Health Institute
(MSPHI). Steering Committee
members provided subject matter
expertise on Critical Access Hospitals
(CAHs), the FLEX Program, Mississippi
Qualied Health Centers (MQHC),
and rural health clinics, infrastructure
(eg. broadband, transportation, rural
network development), and rural
health workforce needs.
Page 9
SUBCHAPTER 2. STATE PROFILE
Rule 1.2.1.
State Historic Information and Geographic
Description
Mississippi is named for the Mississippi River
that forms its western boundary and empties
into the Gulf of Mexico. The name is roughly
translated from Native American folklore
meaning “Father of Waters.” Mississippi was
organized as a territory in 1798 and was
admitted as the 20th state to join the Union on
December 10, 1817. David Holmes was chosen
as the rst governor of the state (Miss. Code
Ann. § 41-3-15)
Rule 1.2.2.
Geographic Boundaries and Topography
Mississippi is bounded on the north by
Tennessee, on the east by Alabama, on the
west by Arkansas and Louisiana, and on
the south by the Gulf of Mexico. Mississippi
contains 47,715 square miles of area, mostly
rural farmland. In the north, the large, fertile
alluvial Delta was mostly swampland until the
mid-1850s when, by the sweat of men and
mules, some 300 miles of levees claimed this
broad region. At the Delta’s eastern edge,
the land suddenly changes from table at
to the rising bluff hills, stretching north into
Tennessee and south into Louisiana. From
Mississippi’s northeast hills southward, the
land changes into rolling farmland, hardwood
highlands, then red clay hills to fertile pasture
lands, on to piney forest, eventually giving way
to the man-made white sand beaches of the
Gulf Coast.
Mississippi State Department of Health | Rural Health Plan Page 10
Rule 1.2.3
Population Distribution and
Demographics
Mississippi is a predominately rural
state with an estimated population of
2,949,965 (US Census Bureau 2020).
There are approximately 60 residents
per square mile and 21.58% of the
population resides in three counties:
Hinds (237,085), Harrison (206,650),
and Desoto (182,001). Only one city in
the state has a population exceeding
100,000, and that is the capital city,
Jackson, MS. Only two additional cities
have a population of at least 50,000:
Gulfport (Harrison) and Southaven
(DeSoto). Approximately 25% of the MS
population is under 18 years old and
16.4% are age 65 or older; 56.4% of MS’s
population is non-Hispanic white and
37.8% is African American.
Rule 1.2.4
Poverty in Mississippi
The poverty rate of Mississippi is
considerably higher than the national
poverty rate with a median household
income greater than 25% below
the national average. Nearly 20% of
Mississippians are living in poverty.
Poverty is racialized in MS, with 46%
of African American MS children in
poverty compared to 15% white.
Rule 1.2.5 and Rule 1.2.6
Economic and Employment Trends
MS has the lowest ranking of any
state on the Human Development
Index (HDI), a numerical measure of
health, education, and income (United
Nations Development Program).
MS’s current HDI score of 0.866 lags
behind that of the United States in
the late 1980s. MS has the lowest life
expectancy of any state; the highest
rate of adults 25 or older who have
not completed high school or earned
a high school equivalency degree;
and is among the lowest in average
per capita income ($23,121 in 2017 vs.
$32,397 for the U.S.).
Table 5. Mississippi Population and Demographic
Information
Mississippi
2020
US 2020 Mississippi
2008-2012
(Five Yr.
Estimate)
Total Population 2,949,965
(.6%)
__ 2,967,620
Percent Rural 51.2% 17.2% --
Poverty Rate 18.7% 11.4% 22.3%
Median Age 37.7 38.1 36.0
Residents>65 16.4% 16.9% 12.9%
Males 48.5% 49.2% 48.5%
Females 51.5% 50.8% 51.5%
White (non-Hispanic) 56.4% 57.8% --
Black (non-Hispanic) 37.8% 12.8% --
Native American 0.6% 2.0% --
Hispanic 3.4% 18.4% --
Source: 2021 data from U.S. Census Bureau, Quick Facts; 2008-
2012 data from the American Community Survey
Table 6. Mississippi Economic and Employment Data
Percent MS 2020 US 2000 MS 2014
High School
Graduation
88.4%*
(2017-2018)*
88.6% 81.0%**
White H.S. Graduation 87.7%
(2022)*
89.0% *
(2019)
82.0%**
(2011)
Hispanic H.S.
Graduation
-- 82.0%**
(2019)
79.0%**
(2011)
Black H.S. Graduation 79.7%**
(2022)
80.0% **
(2019)
69.0% **
(2011)
Bachelor’s Degree 22.8% 37.9% -
Unemployment 6.4% ***
(2022)
8.31%*** 10.6%
Uninsured Rate 14.5%****
(2018)
-- 17.5%***
*Graduation Rates, Mississippi Department of Education
** National Center for Education Statistics
***Unemployment Rates: U.S. Department of Labor, Bureau of Labor Statistics
****MS Unemployment Rate, W.K. Kellogg Foundation
Page 11
Figure 3. RWJF State Health Outcome
Rankings by County
The Robert Wood Johnson Foundation’s
(RWJF) County Health Outcome Rankings
factor in selective measures impacting length
of life (e.g. COVID-19, age-adjusted mortality,
life expectancy, premature mortality, etc.) and
quality of life indicators (physical and mental
health measures; prevalence of chronic
conditions). Light shades indicate better
health outcomes. Source: 2022 State Report,
Mississippi, County Health Rankings.
Rule 1.2.7 Key Health Measures as Indicators of
Health Status
Mississippi is a medically underserved state with
statistics that indicate poor overall health status
statewide. Compared to national health data,
Mississippi ranks highest in chronic disease rates
and related factors.
Historically, health problems have often been
attributed to individual-level, high-risk behaviors.
While these behaviors (e.g. smoking, lack of
physical activity, and poor nutrition) hold true, it
is now well-established that contextual factors
are just as, if not more, important in determining
one’s health behaviors. Environmental factors,
such as food deserts, exposure to air and soil
toxins, exposure to occupational toxins, climate
change resulting in natural disasters, and
targeted messaging that promotes unhealthy
and risky behaviors, can hinder good health.
Social determinants of health (SDOH) are the
negative or positive conditions in which people
are born, grow, live, work, and age. These factors
can negatively inuence health status and
include a person’s access to health insurance
and medical care, access to nutritious foods,
a livable wage, quality education, a sanitary
environment and reliable transportation.
SDOH have exacerbated health disparities
among racial groups and in poor, underserved
areas. They contribute to higher morbidity and
mortality rates for cardiovascular disease,
diabetes, obesity, infectious disease, teenage
pregnancy, premature births, low birthweight,
and infant mortality among these groups.
These factors disproportionately inuence
rural populations of color. Table 7 includes
key health indicators that result from these
conditions. These same health indicators are
prioritized by the Health Resources and Services
Administration (HRSA) to determine health
status.
SUBCHAPTER 2. STATE PROFILE
Mississippi State Department of Health | Rural Health Plan Page 12
Rule 1.2.8.
Rural Health Priorities
Health priority data from
the 2015 SRHP is included
in the two columns to the
right of Table 7. Updated
data for 2017-2019 is
provided in the four
columns to the left. The
updated data highlight
health disparities for non-
Hispanic Blacks. This data
points to the need for
more targeted initiatives
to address the needs of
this population.
Rule 1.2.9
Mental Health Needs
The prevalence of mental
illness, although difcult to
assess, serves as a proxy
for a need indicator for
mental health services in
a given population.
The Mississippi
Department of Mental
Health (MDMH) State Fiscal
Year 2013 Annual Report
estimated that 165,000
Mississippians would need
mental health services.
The 2022 World Population
Review, indicated
that 4.4% of adults in
Mississippi had serious
mental illness, compared
to Wisconsin with less
than 1% and Virginia with
5.5%.
MS
Rate
2020
US
Rate
2020
Non-Hispanic
White, MS
Non-Hispanic
Black, MS
MS
2014
US
2014
(other)
Children With
Obese Weight
Status Based
on Body Mass
Index for Age
22.3% 16.2% 16.5% 28.1% 21.9% 16.4%
Source: Childhood Obesity, Aged 10-17, 2019-2020,
(www.childhealthdata.org)
National Survey of
Children’s Health
(childhealthdata.org), 2017
Suicide Rate
(Crude Rate
per 100,000)
14.9 14.5 20.8 6.1 13.1 12.4
Source: Americas Health Rankings Annual Report
(www.americashealthrankings.org), 2019
WONDER Database
(wonder.cdc.gov)
Percentage of
Adults With a
Visit to Dentist
or Dental
Clinic
57.7% 66.7% 59.7% 54.6.7% 56.8% 65.3%
Source: Americas Health Rankings Annual Report (www.americashealthrankings.org)
Table 7: Mississippi Core Health Indicators
2017-2019 Data 2014 Data
MS
Rates
US
Rates
Non-Hispanic
White, MS
Non-Hispanic
Black, MS
MS
Rates
US
Rates
Diabetes
Prevalence,
Adults 18+,
Age-
Adjusted
12.9 % 9.1% 11.1% 16.6% 12.1% 8.7%
Source: United States Diabetes Surveillance System
(cdc.gov), 2018
Source: Chronic Disease
Indicators (cdc.gov)
Mortality
Rates from
Heart
Disease per
100,000
231.6 168.5 230.5 264.9 292.1 223.3
Source: Stats
of the State of
Mississippi
(cdc.gov), 2017
Source: Annual Mississippi Health
Disparities and Inequities Report, 2015
Source: WONDER
Database
(wonder.cdc.gov)
Women
Age 50+(No
Mammogram
in Past 2
Years)
28.0% 22.0% N/A N/A 28.9% 23.0%
Source: Breast
Cancer Facts &
Figures 2019-2020
Source: SMART: BRFSS City
and County Data and
Documentation
(
cdc.gov)
Adults Who
Are Current
Smokers
20.4% 14.2% 24% 18.8% 24% 19.6%
Source: Map of
Cigarette Use
Among Adults,
STATE System,
CDC, 2019
Source: Adult Cigarette Smoking in
Mississippi, 2018
Infant
Mortality
Rate/1000
8.71 5.8 5.9 11.6 10.5 6.8
Source: Stats
of the States –
Infant Mortality
(cdc.gov), 2019
Source: Stats of the State of
Mississippi (cdc.gov), 2017 data
Source: WONDER
Database
(
wonder.cdc.gov)
Page 13
SUBCHAPTER 3. STATE RURAL AREA DEFINITION
Rule 1.3.1.
State Rural Denition. The state denes a rural area as: 1) a Mississippi county that has a
population less than 50,000 individuals; 2) an area that is less than 500 individuals per square
mile; or 3) a municipality of less than 15,000 individuals. Rural Mississippians bear a larger burden
of higher poverty, lower income, lower education, and a higher disease burden.
There is also an uneven distribution of health providers that impairs rural access to healthcare
services and negatively impacts health status.
Sources: Behavioral Risk Factor Surveillance System (2020 Survey). See Appendix E for more rural/urban differences.
* Health Resources Services Administration
Figure 4. Rural-Urban comparisons
53.2%
RURAL
46.8%
URBAN
Percent of State
Population*
51.9%
RURAL
48.1%
URBAN
Rural vs. Urban
Population**
15.3%
RURAL
10.8%
URBAN
Annual Household
Income < $15,000
35.1%
RURAL
39.2%
URBAN
Avg. Annual
Income > $50,000
18.7%
RURAL
14.5%
URBAN
Did Not Complete
High School
10.5%
RURAL
7.8%
URBAN
Heart Disease
Diagnoses
17.3%
RURAL
13.8%
URBAN
Diabetes Diagnoses
53.2%
RURAL
46.8%
URBAN
Percent of State
Population*
51.9%
RURAL
48.1%
URBAN
Rural vs. Urban
Population**
15.3%
RURAL
10.8%
URBAN
Annual Household
Income < $15,000
35.1%
RURAL
39.2%
URBAN
Avg. Annual
Income > $50,000
18.7%
RURAL
14.5%
URBAN
Did Not Complete
High School
10.5%
RURAL
7.8%
URBAN
Heart Disease
Diagnoses
17.3%
RURAL
13.8%
URBAN
Diabetes Diagnoses
Healthcare
Systems
Page 15
SUBCHAPTER 4. HEALTHCARE SYSTEMS IN MISSISSIPPI
Table 8. Numbers of Mississippi Critical
Access Hospitals and SHIP Eligible-Hospitals
2022 2014
Critical Access
Hospitals (Rule 1.4.3)
31 32
SHIP-Eligible Hospitals 50* 51
*Sites located outside of urbanized areas
Figure 5. Selected Rural Healthcare Facilities in Mississippi
Table 10. 2015 vs. 2020 Rural
Utilization of Mississippi Qualied
Health Centers
2020
MQHCs
2015
MQHCs
Unduplicated Counts 126,136 116,957
Non-Hispanic Blacks 76,029
65.0%
71,924
61.5%
Non-Hispanic Whites 41,570
33.0 %
39,106
33.4%
Hispanics 5,004
4.0%
3,876
3.3%
Medicaid Insured 26,081
20.7%
35,531
30.4%
Private Insurance 38,205
30.3%
28,978
24.8%
No Insurance 39,313
31.2%
35,224
30.1%
Source(s): data.HRSA.gov, U.S. Department of Health and
Human Services, April 2021
Rule 1.4.1
Rural Health Facilities
Mississippi Ofce of Rural Health
and Primary Care is committed
to assisting communities in
determining the best action
plan to develop rural healthcare
systems, including plans that
improve access to healthcare
services, reduce duplication of
services, and develop and support
rural healthcare networks. The
Mississippi Public Health System
is led by the Mississippi State
Department of Health (MSDH).
Figure 5 illustrates the location
of the main types of public rural
healthcare facilities in Mississippi
that comprise the rural healthcare
infrastructure.
Rule 1.4.2
Hospitals
Mississippi has 111 hospitals, of
which there are ninety-ve (95)
acute care, four (4) psychiatric,
one (1) rehabilitation, one (1)
ObGyn and ten (10) long-term
acute care facilities (2015 State
Rural Health Plan). Seven counties
in the state, shaded in gray, do
not have a hospital: Amite, Benton,
Carroll, Humphreys, Issaquena,
Itawamba, and Tunica.
Rule 1.4.3
Mississippi now has thirty-one (31)
Critical Access Hospitals (CAHs)
and 50 SHIP-eligible hospitals. The
Small Rural Hospital Improvement
Program (SHIP) is a federal grant
program to support the viability of
small rural hospitals.
Mississippi State Department of Health | Rural Health Plan Page 16
Table 9. Numbers of Mississippi Local Health
Departments, Rural Health Clinics and
Mississippi Qualied Health Centers (MQHCs)
2022 2014
Local Health
Departments
86
80
Rural Health Clinics 186 159
Mississippi Qualied
Health Center Sites
208 207
Rule 1.4.4
Local Health Departments
MSDH operates eighty (80) local health
departments, one in every county except in
Benton and Issaquena counties. Issaquena is
combined with Sharkey county to create the
Sharkey-Issaquena County Health
Department. Over 100 clinics are operated
through these local health departments.
County health departments provide
immunizations, family planning, Special
Supplemental Food Program for Women,
Infants and Children (WIC), tuberculosis
treatment and prevention services,
sexually transmittied infection disease
services (including for HIV/AIDS), and other
communicable disease follow-up. Child
health and maternity services are available
according to county need. The number and
type of staff vary according to the need and
resources available; however, every county
provides all general public health services.
Rule 1.4.5
Rural Health Clinics (RHCs)
RHCs provide care in areas designated by the
U.S. Department of Health and Human Services
(DHSS) as medically underserved. RHCs can be
staffed by physicians or mid-level providers
including physician assistants (PAs) or
advanced nurse practitioners (ANPs). RHCs that
are staffed by mid-levels must be overseen by
a physician located within 15 miles. RHCs may
be free-standing and owned by physicians,
clinic corporations or hospitals.
Rule 1.4.6
Mississippi Qualified Health Centers (MQHCs)
MQHCs, also known as Federally Qualified
Health Centers (FQHCs), were formerly called
Community Health Centers. MQHCs are
federally subsidized, nonprofit corporations
that serve medically underserved populations
designated by DHSS. FQHCs provide medical,
dental, radiology, pharmacy, nutrition, health
education, and transportation services.
Table 8. Numbers of Mississippi Critical
Access Hospitals and SHIP Eligible-Hospitals
2022 2014
Critical Access
Hospitals (Rule 1.4.3)
31 32
SHIP-Eligible Hospitals 50* 51
*Sites located outside of urbanized areas
Table 10. 2015 vs. 2020 Rural
Utilization of Mississippi Qualied
Health Centers
2020
MQHCs
2015
MQHCs
Unduplicated Counts 126,136 116,957
Non-Hispanic Blacks 76,029
65.0%
71,924
61.5%
Non-Hispanic Whites 41,570
33.0 %
39,106
33.4%
Hispanics 5,004
4.0%
3,876
3.3%
Medicaid Insured 26,081
20.7%
35,531
30.4%
Private Insurance 38,205
30.3%
28,978
24.8%
No Insurance 39,313
31.2%
35,224
30.1%
Page 17
SUBCHAPTER 4. HEALTHCARE SYSTEMS IN MISSISSIPPI
Rules 1.4.7.
Long-Term Care
Mississippi’s long-term care (nursing
home and home health) facilities and
programs primarily serve those with
disabilities and the elderly population.
Current projections for the state place
the number of people in this age group
at approximately 642,506 by 2025, with
more than 186,327 disabled in at least
one essential activity of daily living.
Rule 1.4.8
Disability
The risk of becoming frail, disabled, and
dependent dramatically increases with
age. While the average length of life
has increased, people are often living
longer with disabling and incurable
chronic conditions that compromise
the quality of life. Aged individuals may
become dependent upon professional
care for years prior to death.
Rule 1.4.9
Nursing Home Capacity
The number of nursing homes in
Mississippi has increased by one
since 2014. Conversely, there has
been a decrease in number of home
health agencies, but an increase in
the number of branches, suggesting
consolidations and mergers. The
forecasted increase in the elderly
population by 2025 in need for elder
care suggests the need for investment
in creative solutions.
Table 11. Capacity of Mississippi Nursing
Homes and Home Health Agencies
2022 2014
Nursing Home
Facilities
211 210
Home Health
Agencies
49 61
Approximately
642,506
PEOPLE
term care by
2025
in need
of long
Mississippi State Department of Health | Rural Health Plan Page 18
Rule 1.4.10
Emergency Medical Services (EMS)
Quick access to emergency healthcare in rural areas
is problematic. The Federal Emergency Services Act
of 1973 and the Mississippi EMS Act of 1974, along with
subsequent amendments, authorized MSDH to create
an Ofce of Emergency Medical Services (EMS). EMS
licenses all ambulance services; requires specic
equipment and standards; and provides training,
certication and technical assistance for emergency
medical technicians (EMTs) and other medical rst
responders. They also provide critical emergency
response data that informs the state in both improved
response efforts and strategic funding requests.
Rule 1.4.11
Training of Emergency Medical Personnel
Mississippi requires all ambulance drivers to complete
an approved driver certication (EMS-D), which is
inclusive of academic, clinical, and practical training.
All EMTs, both advanced and basic levels, must
complete a National Highway Safety and Trafc
Administration training program. Upon completion,
students must pass the National Registry for
Emergency Medical Technicians test and receive their
national certication before applying for Mississippi
certi
cation.
Rule 1.4.12
With the passage of legislation during the 1991
Mississippi Legislative Session, the MSDH was
designated as the lead agency to a develop trauma
care plan for the state. The primary goals of the
Mississippi Trauma Care Program is to provide the
architecture for a trauma system which will decrease
morbidity and mortality from traumatic injury.
Rule 1.4.13
Mississippi Trauma System of Care
The 1991 Mississippi Legislative Session authorized
MSDH to develop the Mississippi Trauma System Care
Program to decrease morbidity and mortality from
traumatic injury.
Rule 1.4.14
Using a multi-disciplinary approach following the
patient from pre-hospital to rehabilitation, trauma
centers provide care regardless of the patient’s
nancial status.
The University of Mississippi Medical
Center, Center for Emergency Services,
has been engaged in disaster planning
and improved emergency response
communications and coordination during
large-scale and small scale-events.
The Center also provides education
and training for personnel and health
professionals; critical care support; and
research to improve clinical treatment of
patients.
Table 12. Hospitals Participating in the
Mississippi Trauma Care System
May
2020
August
2013
Level I Trauma Centers 4 4
Level II Trauma Centers 3 4
Level III Trauma Centers 16 15
Level IV Trauma Centers 62 60
Burn Centers 2 1
Ground EMS Providers N/A 58
Air EMS Providers N/A 17
Total 87 84
Source: Mississippi (MS) Trauma Care System
Foundation, Inc.
Note: Level I Trauma Centers serving MS are located
in Jackson (1), Memphis (2) and Mobile (1)
Mississippi’s rural nature accentuates the
need for an integrated, statewide trauma
system to ensure that rural emergency
patients are transported in the least amount
of time to a hospital with the capabilities to
care for the patient’s injuries.
Page 19
SUBCHAPTER 4. HEALTHCARE SYSTEMS IN MISSISSIPPI
Rule 1.1.15
Mental Health
The Mississippi Department
of Mental Health (MDMH)
administers programs for
mental illness, substance use
disorders, and intellectual/
developmental disabilities
(IDD). Programs have not
changed appreciably from 2015
to present.
MDMH provides a network
of services through three
major components: state-
operated programs, regional
community mental health/
mental retardation centers, and
nonprot service agencies/
organizations. The state-
operated programs include
four state comprehensive
behavioral health programs,
six IDD regional programs, a
mental health community living
program, and two specialized
programs for adolescents.
These programs serve
designated counties or
service areas and provide
inpatient psychiatric, chemical
dependence, forensic, limited
medical/surgical hospital
services, and intermediate
care program services for
persons with intellectual and
developmental disabilities.
Nursing facility services are
provided on the grounds of two
of the state’s comprehensive
psychiatric facilities. The MDMH
certies, monitors, assists and
contracts with community
agencies to provide a range
of services for persons with
developmental disabilities.
Table 13. Mississippi State and Regional Mental/
Behavioral Health Programs FY 2021
2022 2015
Comprehensive Behavioral Health
State Programs
4 4
Intellectual Developmental
Disability Regional Programs
6 5
Specialized Programs for
Adolescents
2 2
Regional centers with county
governing authorities
13 15
Tele-Mental Health Services
Telehealth technology has provided a break through in
mental health service delivery. The privacy provided by this
treatment modality has reduced the stigma associated
with treating mental illness; and tele-health has increased
access in rural areas without sacricing quality. The overall
result has been an increase in compliance and better
outcomes.
Rural Health Networks
Rural health networks or partnerships have developed
over the past several decades as a strategy for linking
complementary services, such as hospitals and clinics,
to enhance service delivery and reduce costs. These
partnerships can smooth the referral process, enhance
continuity of care, reduce duplication of services, provide
cost-shaving opportunities through sharing health
promotions and marketing costs, improve interagency
communications and data sharing, and overall enhance the
effectiveness of services.
Rural networks that include regional or out-of-state
healthcare members can retain patients and dollars in the
community. An example is primary care clinics utilizing a
regional or out-of-state imaging center.
Federal funds are available for network development, and
recent funding goes further to address social determinants
of health through integrating non-health partners including
housing, transportation, and education sectors.
Mississippi State Department of Health | Rural Health Plan Page 20
RURAL HEALTH SYSTEMS FINDINGS
Three priorities emerged from the SRHP’s discussion on rural health systems in the areas of
trauma and emergency medical services, rural health networks, and mental health services.
Trauma and Emergency Medical Services
A. Issues, Challenges, and Opportunities
A shortage of emergency personnel, including emergency medical technicians and
equipment (e.g. ambulances) is resulting in increased wait times for responses to rural
medical emergencies. The impact of the personnel shortage is exacerbated by the need for
better communications between the EMS personnel and trauma centers. Another unrelated
issue that burdens emergency services is that community residents who are not connected to
a regular provider or who may be uninsured frequently utilize emergency rooms as a primary
care provider.
B. Workgroup Recommendations
C. Create new staffing models to improve efficiencies, supported by staff training.
D. Promote the use of rural health clinics and MQHCs as primary care alternatives to emergency
rooms as outpatient models.
E. Update the trauma registry to improve performance and reduce required hospital resource.
F. Incorporate and expand the emerging role of telehealth in trauma care.
G. Establish a data-bridge to link EMS and trauma center data.
H. Improve insurance reimbursement for trauma services.
I. Increase the availability of instrument-rated helicopters and ground transport.
C. What Can MORHPC Do?
1. Identify federal funding to increase emergency medical systems, workforce, and/or staff
training.
2. Raise awareness of emergency service needs in rural areas.
3. Collaborate with rural hospitals and providers towards the development of comprehensive
community needs assessments, providing additional input on the needs of emergency
services, especially impacting vulnerable populations.
Rural Healthcare Networks
A. Issues, Challenges, and Opportunities
Analysis provided by The Flex Monitoring Team (see page 35 for detailed analysis) indicates
that Mississippi’s critical access hospitals belonging to a rural healthcare network are more
effective in providing community outreach, health promotion, indigent care, and hospice
services. There are clear advantages and benets associated with existing Mississippi rural
healthcare networks, particularly within the hospital sector. For example, by referring patients
to local imaging centers and laboratories, rural networks can stimulate the local economy.
Conversely, network arrangements which include larger out-of-state medical centers can use
telehealth technology to provide access to specialty care for rural patients closer to home.
Page 21
RURAL HEALTH SYSTEMS FINDINGS
B. Workgroup Recommendations
1. Expand rural health networks in Mississippi.
2. Investigate developing telehealth networks with larger healthcare centers to improve
emergency care services.
3. Work with local providers to explore network development, linking rural outpatient providers
and hospitals to enhance specialty care such as regional imaging centers.
C. What Can MORHPC Do?
1. Determine both geographical and conceptual gaps in access to care.
2. Provide and promote rural network development by facilitating partnership and training
opportunities.
Mental Health
A. Issues, Challenges, and Opportunities
Mental health needs across the state, including in rural communities, have grown exponentially,
especially as the COVID epidemic has increased loss and isolation. At the same time, seeking
mental health services has become less stigmatizing which is also increasing demand. The
result is an explosion in the need for services and a shortage of mental health providers. Mental
health needs are more effectively addressed when integrated into all levels of care through
screening and assessment, and mental health services are most effective when rendered
closest to the homes of residents.
B. Workgroup Recommendations;
1. Train more mental health providers.
2. Cross train primary care providers to effectively screen for mental, behavioral health, and
substance use disorders.
3. Continue to develop tele-mental health programs and services. Tele-mental health services
have emerged as an effective innovation and promising model for expanding care.
C. What Can MORHPC Do?
1. Prioritize recruitment of behavioral and mental health professionals.
2. Host networking events and trainings to promote tele-mental health expansion.
Health Workforce
Page 23
Rural Health Workforce Programs in Rural Mississippi
• The Appalachian Regional Commission (ARC) offers the J-1 Visa Waiver Program to
physicians who commit to serving for three (3) years in underserved, rural areas of the
Appalachian region, waiving the foreign medical residency requirement and allowing them to
remain in the United States.
• The Delta Regional Authority (DRA) offers a Delta Doctors J-1 Waiver Program in an eight-
state region consisting of 252 counties, waiving the foreign medical residency requirement
to those who commit to serving three years in a Health Professional Shortage Area (HPSA) or
Medically Underserved Area (MUA) and allowing them to remain in the United States, provided
they meet the Delta Doctors program requirements.
• The National Health Service Corps (NHSC) provides scholarships and student loan repayment
to health care professionals in exchange for a service commitment to practice in designated
areas across the country where shortages of health care professionals exist. The NHSC is a
Bureau of Health Workforce Program.
• National Rural Recruitment and Retention Network (3RNET) is the most trusted resource
organization for health professionals seeking careers in rural and underserved communities.
The 3RNET program connects health care professionals with the right jobs. They work through
fty-four (54) Network Coordinators to create a “hub” for jobs in rural and underserved areas
across the country.
• The Mississippi Conrad State 30 J-1 Visa Waiver Program offers a J-1 Visa waiver to foreign
physicians who commit to serving for three (3) years in an underserved area of Mississippi,
waiving the foreign medical residency requirement, and allowing them to remain in the United
States.
• The National Interest Waiver is an employment-based, second-preference Worker Visa
Preference Category (EB-2) program. It allows individuals of exceptional ability and those who
are members of professions holding advanced degrees to obtain a green card (United States
permanent residence). The Physician National Interest Waiver may be granted by the United
States Citizen and Immigration Services to a physician that agrees to work for a period of ve
(5) years in a designated underserved area.
• Nurse Corps, a Bureau of Health Workforce Program, helps address health care needs in
underserved communities and supports the development of future nursing workforces in
exchange for a commitment to either work at eligible health care facilities with a critical
shortage of nurses or serve as nurse faculty in eligible schools of nursing. The Nurse Corps
offers RNs and APRNs substantial nancial assistance to repay a portion of their qualifying
educational loans in exchange for full-time service either at a Critical Shortage Facility (CSF) or
an eligible school of nursing.
SUBCHAPTER 5. HEALTH WORKFORCE
Mississippi State Department of Health | Rural Health Plan Page 24
Rule 1.5.1
Essential health service delivery requires an adequate supply and appropriate distribution of fully
qualied physicians, nurses, and other healthcare personnel. High quality healthcare services
depend on the availability of competent healthcare personnel in sufcient numbers to meet the
population’s needs.
Rule 1.5.2
Health Professional Shortage Areas (HPSAs) Designations
There have been substantial increases in primary care, dental health, and mental health HPSA
designations since 2014. In 2014, 74% of primary care and 77% of dental HPSAs were single county
designations.
Figure 6. 2021 Mississippi Rural Health Professional Shortage Areas Designation Types,
Source: HRSA
Facilities: 67
Geo. Areas: 53
Pop. Groups: 33
Totals:
2021: 153
2014: 140
9.3% Increase
Dental Health
HPSAs
Mental Health
HPSAs
Primary Care
HPSAs
Facilities: 64
Geo. Areas: 56
Pop. Groups: 23
Totals:
2021: 143
2014: 125
14.4% Increase
Facilities: 67
Geo. Areas: 16
Pop. Groups: 0
Totals:
2021: 83
2014: 13
538% Increase
(areas)
Page 25
Field Strength Report
Field strength refers to the total number of National Health Service Corps (NHSC) and Nurse Corps
practitioners employed at a program-approved site as of September 30th of each scal year. This
number is pulled at the same time every year given that numbers uctuate due to changes in
employment status, program compliance, and differences in the individual award start and end
dates.
The Mississippi Ofce of Rural Health and Primary Care (MORHPC) and the Nurse Corps have had
very active and successful recruitment and placement of providers in rural areas. The Nurse Corps
has had a signicant increase in placements of advanced nurse practitioners in rural primary care
settings. MORHPC has signicantly increased placements of licensed clinical social workers and
nurse practitioners for mental health.
Table 14. Rural Vs. Urban Field Strength: 2020 Mississippi Placements
2020 2019 2020 2019
Provider Type Clinical Discipline Number Rural
Placements
Number Non-Rural
Placements
Dental Dental 1 2 2 2
Registered Dental Hygienist 1 1 -- 1
Mental Health Licensed Professional Counselor 24 20 3 3
Licensed Clinical Social Worker 3 1 3 1
Nurse Practitioner -- 5 -- --
SUD Counselor 2 -- -- --
Marriage and Family Therapist -- -- -- 1
Health Service Psychologist 1 -- 1 2
Registered Nurse -- -- -- --
Physician Assistant 1 -- -- --
Registered Nurse 1 -- -- --
Nurse Corps Nursing Faculty 2 1 1 --
Nurse Practitioner 8 -- -- 5
Registered Nurse 2 2 2 5
Nurse Anesthetist 1 -- -- --
Primary Care Nurse Practitioner 49 47 22 18
Physician 10 10 5 4
Physician Assistant 2 3 2 1
Total Field Strength 108 92 46 42
SUBCHAPTER 5. HEALTH WORKFORCE
Mississippi State Department of Health | Rural Health Plan Page 26
Rule 1.5.3.
Primary Care Medical Providers
There was a 3.3% increase in licensed physicians from 2013 to 2021. This increase was only slightly
more than the increase in population, which was less than 1 percent. Although there was an
8.8% increase in Internal Medicine physicians, the percent of family practitioners and general
practitioners both declined by 1% and 21.6%, respectively. This trend is not supportive of the need
for dramatic increases in primary care providers.
Rule 1.5.4.
Dental Providers
There was a 54.0% increase in dentists from 2013 to 2021.
Table 15. Number of Active Mississippi Primary Care Medical and Dental Providers
2021 2013
Medical Doctors 5,688 5,499
Osteopaths 533 350
Podiatrists 67 67
Primary Care 2,375 (42%) 2,267 (41%)
Family Practitioners 758 765
General Practitioners 69 88
Internal Medicine Physicians 741 681
OB-Gyns 317 327
Pediatricians 490 406
Dentists 1,620 Licensed (1,450 Active) 1,051 Licensed (1,025 Active)
Page 27
Table 16. Number, Practice Location, and Types of Nurses
in Mississippi
2020 % Increase
from 2012
2012
Total RNs 52,106 20.9% 43,103
Full Time or Part-
Time RNs by
Practice Location
42,088
(80.8%)
19.3% 35,266
(86.0%)
Hospital-Based 21,606
(41.5%)
5.7% 20,433
(59.0%)
Community,
Public, or Home
Health
3,781 (7.2%) 5.1% 3,598
(10.0%)
Physician Ofces 2,654 (5.1%) 6.2 % 2,499
(7.0%)
Nursing Homes 2,326 (4.5%) 22.7% 1,895
(5.0%)
Diploma 3,945 18.6% 1,378
Associates 20,164 11.4% 18,102
Baccalaureate
Non-Nursing
3,996 207.4% 1,300
Baccalaureate
Nursing
14,612 46.7% 9,961
Masters
Non-Nursing
Not listed -- 684
Masters Nursing 8,313 134.0% 3,549
Doctorate 1,706 482.3% 293
Source: Mississippi Board of Nursing
Rule 1.5.5. Nursing
Updated nursing capacity
data was obtained from the
Mississippi Board of Nursing for
FY 2020. The increase in nursing
capacity from 2012 to 2020
is extraordinary, particularly
among baccalaureate nursing
and master’s level programs;
however, the percent of nurses by
practice location in 2020 closely
approximated those from 2012
(See Table 16).
Although total RNs increased
by 20.9% from 2012 to 2020, the
number has not kept pace with
the needs in hospitals and in the
long-term care area. (See Figures
7-10).
Nursing homes experienced
the largest increase in nurse
employees from 2012 to 2020
(22.7%). In comparison, there was
a 5-6% increase in nurses working
in hospital-based, community-
based, and physicians’ ofces.
Licensed Practical Nurses
The Board of Nursing reported
12,909 licensed practical
nurses (LPNs) in FY 2020, with
10,537 working full or part-
time in nursing careers. That
includes 3,652 in nursing
homes; 1,049 in hospitals;
1,743 in community, public,
or home health; and 5,196 in
other nursing careers. There
were 5,478 LPNs certied for
an expanded role in FY 2020,
including intravenous therapy;
184 in hemodialysis; and 154 in
both expanded roles.
Advanced Practice Registered Nurses
Advanced practice registered nurse (APRN) includes
any person licensed to practice nursing in Mississippi
and certied by the Board of Nursing to practice in an
expanded role as an advanced practice registered nurse.
APRNs include nurse midwives and certied registered
nurse anesthetists. For FY 2020 there were 6,425 RNs
certied as APRNs, with 5,444 family nurse practitioners;
948 certied registered nurse anesthetists; and 33 certied
nurse midwives. The APRNs practiced in such specialties
as adult and family mental health, gerontology, midwifery,
neonatal, pediatric, women’s health care, family planning,
and anesthesia care.
SUBCHAPTER 5. HEALTH WORKFORCE
Mississippi State Department of Health | Rural Health Plan Page 28
Nursing Shortages in Mississippi
Figure 7. RN Vacancy Rates in Mississippi Hospitals
Despite increased numbers of
nurses documented in Table 16,
nursing shortages in Mississippi
and nationally have reached record
highs. This shortage is associated
with the aging of the Baby Boomers
who are approaching retirement;
an increasing need for nursing care
among this aging population; and
an inability of nursing schools to
expand capacity to meet the rising
demand.
Mississippi hospitals are acutely
feeling this shortage, especially
due to the COVID pandemic. Rural
hospitals are also experiencing
difculties hiring and retaining
nurses (See Figure 8). Figure
9 indicates that every year,
increasing numbers of Mississippi
nurses opt to become employed
with agencies that may place them
out of state.
Figure 8. Hospital LPN Vacant Positions
Figure 9. MS Hospital Travel Nurses
© Mississippi Hospital Association 2022
© Mississippi Hospital Association 2022
© Mississippi Hospital Association 2022
Page 29
Although Table 16
indicates an increase in
RNs practicing in nursing
homes, shortages of
nurses for nursing homes
remain problematic.
Figures 10 and 11 illustrate
how the RN and LPN
vacancy rates at long
term care facilities in
Mississippi have been
rapidly increasing since
2015.
Advocates attribute this
increase in vacancies
to a combination of the
corona virus pandemic,
a general labor shortage,
and a looming vaccine
mandate at many long-
term care facilities. These
conditions are making it
more difcult to retain the
nursing staff.
Long Term Care RN Vacancy Rates
Long Term Care LPN Vacancy Rates
Figure 10. Nursing RN and LPN Vacancy Rates in
Mississippi Long-term Care Facilities
SUBCHAPTER 5. HEALTH WORKFORCE
Mississippi State Department of Health | Rural Health Plan Page 30
Rule 1.5.6.
Emergency Medical Services
(EMS)
EMS is a system of health care services
delivered under emergency conditions
that occur as a result of a patient’s acute
condition, natural disasters, vehicular or
occupational accidents, or other situations. In
Mississippi, EMS is provided by public, private,
or nonprot entities with the authority and the
resources to effectively administer services.
People with diverse backgrounds contribute
to the EMS system in Mississippi, including
bystanders, reghters, law enforcement
ofcers, emergency medical dispatchers,
medical rst responders, emergency medical
technicians (EMTs), nurses, physicians, and
volunteers.
Rule 1.5.7 Emergency Medical Responders
(EMR)
Beginning July 1, 2004, the Mississippi
Legislature authorized the MSDH Ofce of
Emergency Medical Services (EMS) to certify
Mississippi’s EMRs.
Rule 1.5.8 Emergency Medical Technician
(EMT) Certications
Beginning July 1, 2004, the Legislature
authorized the MSDH EMS to certify
Mississippi’s medical rst responders.
The certication for emergency medical
personnel requires advanced and basic level
training for ambulance operators and EMTs.
Mississippi requires all ambulance drivers
to have EMS driver certication (EMS-D).
To qualify, an individual must complete
an approved driver training program that
involves driving tasks, vehicle dynamics,
vehicle preventative maintenance, driver
perception, night driving, and information
on different driving maneuvers. This training
offers both academic and clinical (practical
hands-on) experiences for the prospective
ambulance driver.
Additionally, all emergency medical
technicians – both advanced level and
basic level – must complete a National
Highway Safety and Trafc Administration
training program for the respective level. This
training provides extensive academic and
clinical hours for prospective students. Upon
completion, students must pass the National
Registry for Emergency Medical Technicians
test and receive their national certication
before applying for the Mississippi
certication.
Table 17. Certications Issued by the Mississippi Ofce of Emergency Medical Services
Five levels of certied EMS Providers: FY 2020 Certications FY 2012 Certications
1. Medical First Responders 9 2,020
2. Emergency Medical Services
– Drivers
1,166 __
3. Emergency Medical Technician
– Basic (EMT-Basic)
4,334 1,906
4. Emergency Medical Technicians
– Intermediate (EMT Intermediate)
__ 24
5. Emergency Medical Technicians
– Paramedics (EMT-Paramedics)
1,265 1,599
Page 31
RURAL HEALTH WORKFORCE FINDINGS
Workforce shortages are most acute in the nursing profession, and especially among Certied
Nursing Assistants (CNAs). In addition, an acute shortage of mental health professionals was
experienced in rural Mississippi, especially in longterm care facilities.
Nursing Shortages are an Acute Workforce Issue
A. Issues, Challenges, and Opportunities
Although the nursing data indicates an increase in the number of nursing professionals
and entry-level nurses trained, Mississippi hospitals and long-term care facilities are
experiencing nursing shortages and high turnover. Nursing shortages have grown even
more acute across the state since the COVID crisis. Addressing the shortages of Certied
Nursing Associates (CNAs) can be seen as an opportunity to impact a small area of this crisis.
Although individuals are graduating from CNA courses, in order to be certied, they must also
complete a brief practicum under the supervision of a higher-level nurse. The opportunities
for completing this practicum have decreased.
B. Workgroup Recommendations
1. Expand nurse training programs.
2. Increase opportunities for CNAs to become certied.
C. What can MORHPC do?
1. Collaborate with stakeholders and partners to support regional workshops to facilitate the
CNA certication process.
Long-term care and Services for the Elderly
A. Issues, Challenges and Opportunities
Mississippi’s elderly residents’ need for mental health services is increasing. Both those who
are community-based and institutionalized frequently suffer from depression, dementia, and
other conditions that negatively impact their quality of life.
B. Workgroup Recommendations
1. Expand mental health screening by integrating screening into all outpatient visits and
conducting regular screenings in long-term settings.
2. Expand mental health treatment options for the elderly in long-term care and community-
based settings.
C. What Can MORHPC Do?
1. Collaborate with the Nursing Corps, National Health Service Corps, MQHCs, and other
program afliates to increase the number of mental health professionals placed in mental
health professional shortage areas.
2. Facilitate the provision of mental health services in long-term care facilities by encouraging
partnerships with MQHCs and MDMH to recruit and place mental health counselors in rural
long-term care facilities.
Mississippi Rural
Hospitals
Page 33
Figure 6. Hospitals in Mississippi
BMH ATTALA
BMH CALHOUN
CHOCTAW REG
CLAIBORNE COUNTY MED
HC WATKINS MEM
COPIAH COUNTY MED
COVINGTON COUNTY HOSPITAL
FRANKLIN COUNTY
MEM
GREENE COUNTY HOSPITAL
MONROE REG
UMMC HOLMES COUNTY
JEFFERSON DAVIS
COMMUNITY
JOHN C STENNIS MEM
LAWRENCE COUNTY
HOSPITAL
BMH LEAKE
TYLER HOLMES
MEM
LAIRD HOSPITAL
NOXUBEE GEN
PEARL RIVER COUNTY HOSPITAL
PERRY COUNTY
HOSPITAL
NMMC PONTOTOC
SCOTT REG
LACKEY MEM
SHARKEY ISSAQUENA
COMM
SIMPSON GENERAL
NORTH SUNFLOWER
MEDICAL
TALLAHATCHIE GEN
TIPPAH COUNTY
WALTHALL
GENERAL
BMH YAZOO
MH NATCHEZ
MAGNOLIA REG
BOLIVAR MEDICAL
TRACE REG
NMMC WEST POINT
۰ BMH DESOTO
۰ METHODIST HEALTHCARE
OLIVE BRANCH
۰ PARKWOOD BEHAVIORAL HEALTH SYS
FORREST GENERAL HOSPITAL
GEORGE REGIONAL
UMMC GRENADA
OCHSNER MEDICAL— HANCOCK
۰ KEESLER MEDICAL CENTER
۰ MEMORIAL HOSPITAL AT GULFPORT
۰ MERIT HEALTH BILOXI
۰ OCEANS HEALTHCARE
۰ SELECT SPECIALTY GULF COAST
۰ SINGING RIVER GULFPORT
۰ VA GULF COAST VETERAN’S HEALTHCARE
۰ SINGING RIVER OCEAN SPRINGS
۰ SINGING RIVER PASCAGOULA
JASPER GEN
JEFFERSON COUNTY
SOUTH CENTRAL REGIONAL
BMH NORTH MS
۰ MH WESLEY
۰ SOUTH MS
STATE HOSPITAL
۰ NORTH MS MEDICAL CENTER
۰ NORTH MS STATE HOSPITAL
GREENWOOD LEFLORE
KING’S DAUGHTERS
MEDICAL
CENTER
BMH GOLDEN TRIANGLE
MH MADISON
MARION
GENERAL
ALLIANCE
HEALTHCARE
NMMC GILMORE-AMORY
۰ CHOCTAW HEALTH
CENTER
۰ NESHOBA GENERAL
OCH REGIONAL
PANOLA MEDICAL
HIGHLAND COMMUNITY
۰ BEACHAM MEMORIAL
۰ SOUTHWEST MS REG
BMH BOONEVILLE
۰ BRENTWOOD BEHAVIORAL HEALTHCARE
۰ MERIT HEALTH RANKIN
۰ MERIT HEALTH RIVER OAKS
۰ MERIT HEALTH WOMAN’S
۰ MISSISSIPPI STATE HOSPITAL
MAGEE GENERAL
MEMORIAL AT STONE COUNTY
۰ MS DEPT OF CORRECTIONS
۰ SOUTH SUNFLOWER COUNTY
DELTA HEALTH
HIGHLAND HILLS
NMMC IUKA
BMH UNION COUNTY
۰ KPC PROMISE OF VICKSBURG
۰ MERIT HEALTH RIVER REGION
۰ ALLEGIANCE SPECIALTY OF GREENVILLE
۰ DELTA HEALTH THE MEDICAL CENTER
WAYNE GENERAL
۰ DIAMOND GROVE
۰ WINSTON MEDICAL
NMMC EUPORA
YALOBUSHA GEN
۰ GV (SONNY) MONTGOMERY VA
۰ BMH MS BAPTIST MEDICAL
۰ MERIT HEALTH CENTRAL
۰ MS METHODIST HOSPITAL & REHAB
۰ SELECT SPECIALTY BELHAVEN
۰ SELECT SPECIALTY JACKSON
۰ St DOMINIC-JACKSON MEMORIAL
۰ UNIVERSITY OF MS MEDICAL CTR
FIELD HEALTH
LEGEND:
ACUTE CARE:
CRITICAL ACCESS:
NON-ACUTE CARE
NO EMERGENCY DEPT AS OF 10 13 2021
BMH: BAPTIST MEMORIAL HOSPITAL
COMM: COMMUNITY
GEN: GENERAL
MED: MEDICAL
MEM: MEMORIAL
MH: MERIT HEALTH
MS: MISSISSIPPI
NMMC: NORTH MS MEDICAL CENTER
REG: REGIONAL
۰ ALLIANCE HEALTH CENTER
۰ ANDERSON REGIONAL MEDICAL
۰ ANDERSON REGIONAL MEDICAL-
SOUTH
۰ EAST MS STATE HOSPITAL
۰ REGENCY HOSPITAL OF MERIDIAN
۰ RUSH FOUNDATION HOSPITAL
۰ SPECIALTY HOSPITAL OF MERIDIAN
DELTA HEALTH NORTHWEST REG
8-18-22
QUITMAN
COUNTY HOSPITAL
Mississippi State Department of Health | Rural Health Plan Page 34
Rule 1.6.1 Mississippi Rural
Hospital Flexibility Program
The Medicare Rural Hospital
Flexibility Program (FLEX) is a
federal initiative that provides
funding to state governments
to strengthen rural health.
(See Table 18). The purpose
of the FLEX program is to help
sustain the rural healthcare
infrastructure, with critical
access hospitals (CAHs)
as the hub of an organized
system of care. The program
includes development of the
FLEX State Rural Health Plan,
population health management
initiatives, quality improvement
initiatives, EMS integration, CAH
designation, and development
of rural health networks.
MORPHC administers FLEX and
provides related technical
assistance.
Rule 1.6.2 Critical Access
Hospital Authorization
The 1998 session of the
Mississippi Legislature
authorized the MSDH to develop
regulations for the designation
of CAHs.
Rule 1.6.3 Critical Access
Hospital Denition
CAHs are acute care facilities
that provide outpatient
emergency and limited inpatient
services and receive cost-based
Medicare reimbursement. In
2014, Mississippi had thirty-two
(32) CAHS, and now has thirty-
one (31).
Table 18: List of Mississippi Critical Access Hospitals
Name City No. Beds
1. Baptist Medical Hospital, Leake Carthage 25
2. Baptist Medical Center, Yazoo Yazoo City 25
3. Baptist Medical Center, Attala Kosciusko 25
4. Baptist Memorial Hospital, Calhoun Calhoun City 21
5. Choctaw Regional Medical Center Ackerman 25
6. Claiborne County Hospital Port Gibson 25
7. Copiah County Medical Center Hazelhurst 25
8. Covington County Hospital Collins 25
9. Field Memorial Community Hospital Centerville 25
10. Franklin County Memorial Hospital Meadville 23
11. Greene County Hospital Leakesville 3
12. HC Watkins Memorial Hospital Quitman 25
13. Jefferson Davis Community Hospital Prentiss 25
14. John C. Stennis Memorial Hospital DeKalb 25
15. Laird Hospital Union 25
16. Lawrence County Hospital Monticello 25
17. Monroe Regional Hospital Aberdeen 25
18. North MS Medical Center Pontotoc 25
19. North Sunower Medical Center Ruleville 25
20. Noxubee General Hospital Macon 25
21. Pearl River County Hospital and
Nursing Home
Poplarville 24
22. Perry County General Hospital Richton 23
23. Quitman Community Hospital Marks 25
24. S.E. Lackey Memorial Hospital Forest 25
25. Scott Regional Hospital Morton 25
26. Sharkey Issaquena Community Hospital Rolling Fork 25
27. Simpson General Hospital Mendenhall 25
28. Tallahatchie General Hospital Charleston 9
29. Tippah County Hospital Ripley 25
30. Tyler Holmes Memorial Hospital Winona 25
31. University of MS Medical Center, Holmes Lexington 25
32. Walthall County General Hospital Tylertown 25
Page 35
Rule 1.6.4 Mississippi Critical Access
Hospital Performance Information
The data represented in Table 19 for 2013
was presented in the 2015 SRHP and
originated from the MSDH Annual Survey
of Hospital Reports. Data from 2021 has
been included in this SHRP as a point of
comparison.
Since 2013, there have been notable shifts
in CAH infrastructure including:
• A substantial decrease in the numbers
of facilities owned by the county and
not-for-prot entities.
• An increase in part-time stafng.
• A decrease in RNs and LPN and
ancillary personnel.
Demand for rural hospital services
continues to grow including a shift from
inpatient care to outpatient visits that are
non-emergency-related:
• A greater than 100% increase in non-
Rural Health Clinic or ER visits
• An over 200% increase in Rural Health
Clinic visits.
Table 19. Utilization, Stafng, and Ownership
Status of Mississippi CAHs in 2013 and 2021.
2021 2013
County Owned 18 (58%) 65%
Corporate
Ownership
(not-for-prot)
9 (29%) 24%
City and
County Owned
2 (6%) 3%
For Prot 0 8%
Part of Health
System
16 (52%) 28%
Full-Time
Employees
3,931 3,286
Part-Time
Employees
1,492 1,080
Workers on
Contract
783 162
RNs 717 825
LPNs 259 345
Ancillary
Personnel
297 420
ER Visits 156,150 152,016
Non-RHC Visits 255,640 138,644
Average Daily
Census
130.37 160.32
Admissions 8,470 12,732
Inpatient Days 47,343 59,359
Swing-Bed
Days
79,755 51,938
RHC Visits 574,793 245,705
Source: MSDH Annual Survey of Hospitals
SUBCHAPTER 6. MISSISSIPPI RURAL HOSPITAL
Mississippi State Department of Health | Rural Health Plan Page 36
Small Rural Hospital Improvement Program (SHIP)
The Small Rural Hospital Improvement Program (SHIP) is a grant program supported by the U.S.
Department of Health and Human Services, Health Resources and Services Administration’s
Federal Ofce of Rural Health Policy (FORHP). Section 1820(g)(3) of the Social Security Act (SSA)
authorizes SHIP to assist eligible hospitals in meeting the costs of implementing data system
requirements established under the Medicare program, including using funds to assist hospitals in
quality improvement initiatives in value and quality to health care such as:
• Value-Based Purchasing Programs (VBP)
• Accountable Care Organizations (ACOs)
• Payment Bundling (PB)/Prospective Payment System (PPS)
Small non-federal rural hospitals, with forty-nine (49) available beds or less, that provide short-
term, general acute care to their communities are eligible for SHIP grants. They may be for-prot,
not-for-prot, or tribal organizations. Critical access hospitals are eligible for the program.
2020-2021 SHIP Grantee Performance:
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, also
known as the HCAHPS® Hospital Survey or Hospital CAHPS®, is a standardized survey instrument
and data collection methodology that has been in use since 2006 to measure patients’
perspectives of hospital care.
• Mississippi has 32 CAHs, of which 29 CAHs are SHIP grantees and 2 are not SHIP hospitals
• As of FY 2022, 30 of the 51 eligible Mississippi hospitals participate in HCAHPS.
• Mississippi’s SHIP Value Based Purchasing (VBP) scores measure patient satisfaction and
experiences. For 2020-21, VBP scores ranged from 69-21 out of a possible 100. The VBP score
includes 9 measures:
• 6 related to communication with providers concerning medications, staff responsiveness,
and discharge planning, etc.
• 2 related to cleanliness and quietness of the hospitals
• 1 global or overall rating measure
• Anticipated Revenue Loss/At Risk for network SHIP hospitals ranged from a high of $195,997 to a
low of $5,135
• 18 SHIP-eligible hospitals planned to provide services via mobile health and telehealth
SUBCHAPTER 6. MISSISSIPPI RURAL HOSPITAL
Page 37
Table 20. Community Impact and Benet Activities of Mississippi Critical Access Hospitals, 2018
CAH Rural Emergency Medical Services Performance
In Median Minutes:
MS (n=31) US (n=1,320)
Average Length of Stay 91.0 106.0
Before transfer for acute care 87.5 68.0
Quality Improvement*Avg. 24.5
reported
• Mississippi CAHs ranked:
• 38 for inpatient quality (83.9%
reported)
• 36 for outpatient quality (74.2%
reported)
Long-term Services and Supports
Averages US CAHs MS CAH MS CAH
Directly Directly Networks
Adult Day Care 5.1 6.5 9.7
Home Health 22.4 0 19.4
Hospice 15.8 3.2 32.3
Skilled Nursing 38.4 35.5 38.7
Protability (%) & Liquidity Indicators
April 2020 US MS
Total Margin 1.61 -3.12
Cash Flow 5.71 -0.36
Operating Margin 0.17 -4.80
Days Cash 75.9 19.5
Days in Accts. Receivable 50.8 43.77
Percent Population Health Activities: US vs. MS
Averages US CAH MS CAH MS CAH
Directly Directly Networks
Cmty Outreach 68.1 48.4 58.1
Enrollment Asst. 52.7 22.6 22.6
Health Fair 76.1 58.1 67.7
Immunization 49.4 32.3 38.7
Indigent Care 10.1 16.1 16.1
Percent Providing Behavioral Health
Service, MS vs. US
MS CAH US
Substance Use Inpat. 0 1.7
Substance Use Outpat. 3.2 2.9
Psych, Inpatient 19.4 5.5
Psych, Outpatient 48.4 27.0
Other Essential Services Offered at CAHs, Percent MS compared to US
US MS US MS
Ambulance 22.4 6.5 Obstetrics 34.0 0
Dental Services 5.6 22.6 Hemodialysis 3.0 3.2
Certied Trauma Center 45.0 77.4
Source: 2018 American Hospital Association Annual Survey, www.exmonitoring.org
Hospital Performance Information for Mississippi Critical Access Hospitals
Table 20 compares MS CAH performance data with national data on select indicators. This
report is prepared by a consortium of universities on behalf of HRSA. The data illustrates that
Mississippi performs lower than the national average on population health activities, obstetrical
care, and ambulance services. That being said, MS surpasses the national average based on
shorter length of stay, dental care and psychiatric care. MS quality improvement scores were
generally higher than the national average; however, MS scored lower on protability and
liquidity indicators. CAHs that were a part of a network performed better including adult day
care, hospice, community outreach such as health fairs, and skilled nursing care.
SUBCHAPTER 6. MISSISSIPPI RURAL HOSPITAL
Mississippi State Department of Health | Rural Health Plan Page 38
Table 20. Community Impact and Benet Activities of Mississippi Critical Access Hospitals, 2018
CAH Rural Emergency Medical Services Performance
In Median Minutes:
MS (n=31) US (n=1,320)
Average Length of Stay 91.0 106.0
Before transfer for acute care 87.5 68.0
Quality Improvement*Avg. 24.5
reported
• Mississippi CAHs ranked:
• 38 for inpatient quality (83.9%
reported)
• 36 for outpatient quality (74.2%
reported)
Long-term Services and Supports
Averages US CAHs MS CAH MS CAH
Directly Directly Networks
Adult Day Care 5.1 6.5 9.7
Home Health 22.4 0 19.4
Hospice 15.8 3.2 32.3
Skilled Nursing 38.4 35.5 38.7
Protability (%) & Liquidity Indicators
April 2020 US MS
Total Margin 1.61 -3.12
Cash Flow 5.71 -0.36
Operating Margin 0.17 -4.80
Days Cash 75.9 19.5
Days in Accts. Receivable 50.8 43.77
Percent Population Health Activities: US vs. MS
Averages US CAH MS CAH MS CAH
Directly Directly Networks
Cmty Outreach 68.1 48.4 58.1
Enrollment Asst. 52.7 22.6 22.6
Health Fair 76.1 58.1 67.7
Immunization 49.4 32.3 38.7
Indigent Care 10.1 16.1 16.1
Percent Providing Behavioral Health
Service, MS vs. US
MS CAH US
Substance Use Inpat. 0 1.7
Substance Use Outpat. 3.2 2.9
Psych, Inpatient 19.4 5.5
Psych, Outpatient 48.4 27.0
Other Essential Services Offered at CAHs, Percent MS compared to US
US MS US MS
Ambulance 22.4 6.5 Obstetrics 34.0 0
Dental Services 5.6 22.6 Hemodialysis 3.0 3.2
Certied Trauma Center 45.0 77.4
Source: 2018 American Hospital Association Annual Survey, www.exmonitoring.org
Rule 1.7.1. Designation of CAHs
The designation process for achieving critical access hospital (CAH) status involves two steps:
1) submission of a satisfactory CAH application and 2) successful completion of a CAH survey by
the Division of Licensure and Certication of the MSDH Division of Licensure and Certication.
Rule 1.7.2. CAH Survey
To satisfy state requirements for designation of a CAH, a hospital must meet all federal
requirements for designation including successful completion of the survey by the Division of
Licensure and Certication.
Rule 1.7.3 Federal Requirements for CAH Designation
See Appendix A.
SUBCHAPTER 8. STATE CRITERIA NECESSARY FOR
PROVISION OF SERVICES
Rule 1.8.1 Certication of Hospitals Not Meeting CAH Federal Mileage Requirements
A hospital that does not meet the federal mileage requirements to be certied as a CAH is
otherwise eligible to be certied by the state as a necessary provider of health care services if it
meets two (2) or more of the following criteria:
1. The hospital is located in a county that is federally designated as a HPSA for medical care.
2. The hospital is located in a county that is federally designated as a Medically Underserved
Area (MUA).
3. The hospital is located in a county where the percentage of families with income less than
100% of the federal poverty level is higher than the state average for families with income less
than 100% of poverty.
4. The hospital is in a county with an unemployment rate that exceeds the state’s average
unemployment rate.
5. The hospital is in a county with a percentage of the population age 65 and older that exceeds
the state’s average.
6. The number of Medicare admissions to the hospital exceeds 50% of the facility’s total number
of admissions as reported in the most recent Hospital Annual Report for the facility.
Rule 1.8.2 CAH Appeal Conditions
Any hospital not meeting two (2) of the above criteria may appeal the decision to the MSDH, Ofce
of Health Policy and Planning. Appeals must be submitted in writing and will only be considered
if the appeal provides sound evidence that future access to health for the citizens of the facility’s
primary service area, as dened by the most recent patient origin study, will be jeopardized if it is
not declared a necessary provider of health care services.
Rule 1.8.3 Designated Necessary Providers Must Complete the CAH Application Process
Facilities that meet the necessary criteria for provision of services are still required to complete
the designation application process that includes: 1) submission of a satisfactory CAH application
to the CAH Certication Application Review Committee, and 2) successful completion of the CAH
survey by the MSDH Ofce of Licensure and Certication.
SUBCHAPTER 7. CRITICAL ACCESS HOSPITALS
NOTE: Subchapters 7 - 12 all address Critical Access Hospitals. These sections are
directly from the 2015 State Rural Health Plan.
Page 39
SUBCHAPTER 9. CRITICAL ACCESS HOSPITAL
DESIGNATION APPLICATION
Rule 1.9.1 The CAH Designation Application Content
The CAH Designation Application includes the following information:
1. A community needs assessment that includes an inventory of local health services and
providers.
2. Evidence of implemented strategies to inform county and community residents, public ofcials,
and health care providers of the proposed conversion of the hospital to CAH designation.
3. A nancial feasibility study that will include:
• Audited nancial statements and notes for the three most recently completed years
• Adult and pediatric admissions, adult and pediatric patient days, deliveries, and
inpatient surgeries
• Outpatient and emergency room utilization data
• An inventory of medical staff by name, age, and medical specialty
• A three-year CAH cost and revenue projection
• A signed network agreement with a full-service hospital detailing the facility
relationships including:
• Patient referral and transfer
• Communications systems
• Provision of emergency and non-emergency transportation
• Arrangements for credentialing and quality assurance
• Other information and data that the Review Committee may determine are needed
in order to make an appropriate recommendation
SUBCHAPTER 10. CRITICAL ACCESS HOSPITAL
CERTIFICATION APPLICATION REVIEW COMMITTEE
Rule 1.10.1 A CAH Certication Application Review Committee
A CAH Certication Application Review Committee will be established by MSDH to review CAH
applications and make recommendations to the State Health Ofcer regarding designation.
The Committee membership will be comprised of one representative from each of the MSDH
Mississippi Ofce of Rural Health and Primary Care (MORHPC); MSDH Ofce of Licensure and
Certication; and the Mississippi Hospital Association; and two hospital representatives appointed
by the Mississippi Hospital Association. The State Health Ofcer may appoint representatives of
additional groups to the committee.
SUBCHAPTER 11. CRITICAL ACCESS HOSPITAL
RELOCATION REQUIREMENTS
Rule 1.11.1
Information regarding guidelines for 42 CFR 485.610 (c), concerning CAH location relative to
other hospitals or CAHs, and 43 CFR 486.610(d), concerning relocation of CAHs with a necessary
provider designation, is available on the CMS website. This website also provides information
about eligibility for the shorter, fteen (15)-mile standard due to mountainous terrain or lack of
primary roads.
Mississippi State Department of Health | Rural Health Plan Page 40
SUBCHAPTER 12. LIST OF MISSISSIPPI CRITICAL
ACCESS HOSPITALS
A 2021 list of Mississippi CAHs and other CAH information is included in Appendix B.
Rural Hospital Improvement Strategies
The SRHP Steering Committee stated that there were additional opportunities for Mississippi’s
CAHs to benet further from performance improvement opportunities provided through CAH
federal programs; and, that CAHs should increase their participation.
A. Issues, Challenges, and Opportunities
Critical Access Hospitals (CAHs) are sometimes reluctant to apply for the FLEX program due to
the extensive program requirements.
B. Workgroup Recommendation
1. Promote the advantages of the FLEX program.
C. What Can MORHPC Do?
1. Conduct focus groups to determine reasons why CAHS are not fully participating in the FLEX
program.
2. Conduct trainings and workshops to develop strategies to promote broader participation in
FLEX.
Crosscutting Issues
and Conclusions
Mississippi State Department of Health | Rural Health Plan Page 42
Addressing Health Disparities
Mississippi data on health
disparities for all racial and ethnic
groups are unavailable, in part,
because some racial and ethnic
groups are small in number
and difcult to disaggregate.
Available data indicates large
health disparities among non-
Hispanic Blacks compared to non-
Hispanic Whites. Table 7 illustrates
that non-Hispanic Blacks suffer
disproportionately from diabetes
prevalence, cardiovascular
disease mortality, infant mortality,
and childhood obesity.
Every community is unique, and
addressing health disparities may
often be more effective at the local
level. This means that access to
county and community level data
is necessary to identify the highest
need(s), make a case to funders
for support, establish baselines
and evaluate success.
What Can MORHPC Do?
The MORPHC staff is skilled at
applying data to health problems
and could provide technical
support to communities for such
projects. The MORHPC could use
the RWJF County Health Rankings
to assist rural communities with
establishing plans and use Healthy
People (HP) 2030 to establish
goals for making local health
improvements. HP 2030 has
updated health objectives which
can be found at https://health.
gov/healthypeople/priority-areas/
social-determinants-health.
The targets delineated in each
objective are inclusive of related
social determinants of health.
CROSSCUTTING ISSUES
Rural Health Inequities
Health disparities and healthcare inequities are
challenging to address because they are complex
in origin and require comprehensive approaches
to resolve. For example, lower access to healthcare
services among rural residents is associated with
multiple factors including lower levels of health
insurance, household nancial insecurity, unreliable
transportation, lower education levels, provider bias,
and policies that have discouraged private investment
in healthcare and the general economy. Yet, one
fundamental policy change, such as the adopting the
Affordable Care Act (ACA) provision, can be a game
changer in promoting statewide healthcare access
and is also associated with other nancial advantages
for consumers and providers. Multiple case studies are
available that provide evidence of how the ACA has
leveled the playing eld for impoverished rural residents
and boosted protability for rural providers and facilities
(www.ThatsMedicaid.org).
Involvement of multiple sectors of government is often
required when implementing innovations that increase
equity. This report uses tele-health technology as an
example of a technological innovation that expands
access to mental health care for rural residents. Yet,
without infrastructure investments in expanding
broadband to remote areas, this innovation may still
be out of reach for many rural communities. Thus,
collaboration between at least two sectors, health
and public works, would be necessary to formulate a
successful tele-health project.
Finally, cultural and language barriers may be at
the core of some health inequities. The settings for
these equity issues may be small ethnic communities
whose health access issues are invisible to the
broader public health delivery system, but could be
resolved with a simple intervention such as utilizing a
community health navigator (CHN) as a translator or an
intermediary. For example, placing a bi-lingual CHN at a
rural chicken processing plant to promote vaccinations,
health screenings, and provide onsite primary care
treatment could reduce transmission rates among
these vulnerable populations. This type of occupational
intervention could protect and save a vulnerable
community from preventable diseases, while protecting
workers’ extended families from disease, and preserving
family incomes.
Page 43
Coronavirus Aid, Relief, and Economic Security Act
The COVID-19 pandemic has resulted in many innovations in outreach to small and remote areas
and federal resources have been awarded to fund expanded services. The Health Resources and
Services Administration’s (HRSA) Federal Ofce of Rural Health Policy (FORHP) received funding
through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, made available from
April 2020 through September 30, 2021. HRSA used CARES funding to assist hospitals eligible for the
Small Rural Hospital Improvement Program (SHIP).
• Ensuring hospitals safety for staff and patients
• Detecting, preventing, diagnosing, and treating COVID-19
• Maintaining hospital operations
American Rescue Plan Act (ARPA) COVID-19 Testing and Mitigation
• HRSA’s FORHP received funding through the American Rescue Plan (ARP) for COVID-19 testing
and mitigation initiatives. HRSA anticipates $398 million will be available to support the Small
Rural Hospital Improvement Program (SHIP) to increase COVID-19 testing efforts, expand
access to testing in rural communities, and expand the range of mitigation activities to meet
community needs within the CDC Community Mitigation Framework. Mississippi was awarded
$12,918,800, which allowed fty (50) SHIP hospitals to receive $250,000 each.
CROSSCUTTING ISSUES
Mississippi State Department of Health | Rural Health Plan Page 44
Enhancing Emergency and Telehealth Services
Expanding Broadband, Connecting Rural Mississippi
Mississippi’s expansion of internet services, fueled by $570 million in federal money in April 2021,
with additional funding anticipated, is life-altering for rural Mississippi residents. Mississippi
ranked near the bottom, near 49th in broad-band access. This funding from the federal Rural
Digital Opportunity Fund resulted in $75 million in federal COVID-19 relief money for broadband
expansion. The state expects to receive additional millions for broadband and other
infrastructure improvements from the recently passed federal American Rescue Act.
Coordinating with Mississippi Emergency Support
The purpose of the Mississippi Emergency Support Function No. 8 (ESF 8) is to provide state
assistance and coordinate local resources in response to public health and disaster medical
care needs. The MSDH is responsible for the coordination of health response for ESF 8 including
providing and coordinating services and resources, including but not limited to, emergency
treatment and prevention; inspection of food, potable water, and on-site wastewater disposal;
emergency mortuary service and mass fatality management; patient rehabilitation; vector and
disease control; disease surveillance; and the restoration of health and medical infrastructure.
Innovating through the Mississippi Center for Emergency
Services (MCES)
The University of Mississippi Medical Center established the
Mississippi Center for Emergency Services (MCES) in 2014 to expand
Mississippi’s ability to maintain medical communications for
disaster and emergency preparedness and response.
Telehealth as a Rural Health Innovation
Case Study:
From July 1, 2020, through June 30, 2021, Southwest Mississippi Mental Health Complex (SMMHC)
experienced a 30% increase in clients served. SMMHC serves a largely rural, impoverished
geographic region encompassing more than 5,000 square miles, with more than 150,000
individuals. Last year, SMMHC received a $659,092 Federal Communications Commission (FCC)
grant for telehealth to broaden the availability of services to clients, enhance staff ability, provide
services, and increase service options. SMMHC expanded computer equipment access to 80%
of staff by purchasing fourteen (14) telemedicine carts and placing one in each of the sites
throughout the region; creating three (3) telemedicine kiosks in the largest sheriff’s departments
in the region; upgrading the server and software; and purchasing a “Mist” system that enables
clients to access a “guest” service login from the parking lots of facilities, allowing them to
access services without entering facilities. These enhancements: 1) expanded telehealth services;
and 2) allowed staff to access the Emergency Health Records from tablets or laptops to provide
remote telehealth services, thereby eliminating the need for staff to travel to remote ofces and
reducing travel costs
40% of
MS lacks
access to
broadband.
Page 45
A. Challenges, Issues, Opportunities
Telehealth Challenges
Having made considerable advances, tele-mental health is an important model to study.
Documented successes include increased patient receptivity because the care environment is
associated with increased privacy and reduced stigmatization. The more private care setting
results in increased compliance with the telehealth model.
Despite advances in the eld, there are still challenges such as insufcient reimbursement for
telehealth services. In the past, insurance companies have reimbursed small rural providers
less for telehealth, not recognizing the expenses related to acquisition of telehealth equipment
and software, as well as the ongoing maintenance and upgrading costs. Adequate broadband
coverage is still a problem in many rural areas; however, policy changes and federal
prioritization of broadband expansion may provide new opportunities.
Emergency Services
When telehealth technology is part of the infrastructure for emergency services, it improves
access to tertiary and specialty services closer to home. For example, emergency room
physicians located at remote medical centers can be consulted in cases of rural injuries.
Additionally, local telehealth networks can create business opportunities closer to home.
For example, when primary care centers or CAHs use local or regional imaging centers,
laboratories, etc., more business activity is captured closer to home.
B. Work Group Recommendation
1. Consider applying for new broadband funding to expand telehealth capacity, in association
with the recent legislative appropriation towards innovative growth.
C. What Can MORHPC Do?
1. Work with local health providers to promote viable telehealth modeling to expand emergency
care capacity and quality, and to expand mental and behavioral healthcare.
2. Incorporate telehealth solutions in local planning activities.
3. Host convenings and webinars to promote telehealth solutions in care delivery, medical
eduction, and nancing.
CROSSCUTTING ISSUES
Mississippi State Department of Health | Rural Health Plan Page 46
CONCLUSIONS
Mississippi’s greatest asset for improving the health status of its rural residents is its diverse
array of skilled public health ofcials and health providers. Many served as stakeholders for
the 2022 State Rural Health Plan planning process, clearly demonstrating high motivation and
professionalism dedicated toward creating a healthier rural Mississippi. The resounding theme
of the stakeholders was that more can be accomplished when health entities collaborate.
Stakeholders encouraged broad participation in conducting community health assessments
and collective action to develop solutions. They emphasized avoiding duplication, applying
a keen focus on lling service gaps, and the importance of listening to colleagues and
contributors at all levels. With stakeholder input, specic recommendations were developed
for each major component in the Plan. MORHPC staff reviewed these recommendations and
identied how they can contribute within their scope of activities and resources. The next steps
for the MORHPC is to identify the key items to be implemented in the coming years and to
formulate goals, objectives, and timelines for these activities.
The rural health stakeholders share common objectives and potential resources. MORHPC
will utilize a number of resources to inform and guide this work. Some of these are mentioned
below:
• The Healthy People 2030 (HP2030) is an excellent resource for establishing state goals and
objectives that mirror the larger goals and objectives set for the nation as a whole
(https://health.gov/healthypeople/objectives-and-data/browse-objectives). HP2030 is
a source of national comparison data for health conditions, health behaviors, population
health, and health systems and settings. HP2030 also addresses the impacts of the social
determinants of health and provides research and examples of best practices.
• The most recent MSDH Strategic Plan provides guidance on state health priorities and
strategic direction.
Page 47
PARTNERS AND STAKEHOLDERS
Major Technical Assistance Partners and Roles
• The Community Health Center Association
of Mississippi supports twenty-one (21)
Community Health Center corporations and
208 sites providing primary care services
throughout the state.
• MS Hospital Association provides technical
assistance to CAHs under the FLEX grant
program.
• The MS Public Health Institute provides
technical support to the MORHPC.
• MS Nurses Foundation encourages high school
students to become nurses.
• MS Rural Health Association coordinates
annual rural health and rural health clinic
conferences, webinars, and newsletters.
• MS State Medical Association supports the
Rural Physician Scholars Program, which
recruits and retains health professionals in the
state’s rural areas.
• MS State University Extension Services exposes
high school students to rural medical practice
and health sciences.
Mississippi State Department of Health | Rural Health Plan Page 48
APPENDIX A: 2022 MS RURAL HEALTH CARE
PLAN STEERING COMMITTEE
Organization Name & Title Contact Information
Mississippi Nurses Foundation Amanda Crawford, MS
Executive Director
MSDH
Ofce of Oral Health
Angela F. Filzen, D.D.S.
State Dental Director
angela.[email protected]
MS Academy of Family Physicians Beth Embry
Executive Director
Mississippi Hospital Association
Chad Netterville
Executive Director
Rural Hospital Alliance
and Center for Rural
Health
Mississippi State Medical
Association
Claude D. Brunson, MD,
MS, CPE, FASA
Executive Director
Baptist Medical Center of Leake Daryl Weaver
Chief Executive Ofcer
Division of Medicaid Drew Snyder
Executive Director
Mississippi Public Health Institute Glenda Crump
Chief Administrative Ofcer
Tishomingo Hospital Jamie Pruitt
Director of Support Services
North Mississippi Health
Services
UMMC
Ofce of MS Physician Workforce
John Mitchell, MD, FAAFP
Executive Director
Page 49
Organization Name & Title Contact Information
Aaron E. Henry Community
Health Services Center, Inc.
Dr. Johnnie
Cummings, Jr.
Director
Mississippi Department of
Mental Health
Katie Storr
Chief of Staff
MSDH
Ofce of Preventive Health
And Health Equity
Dr. Kina White
Director
Ofce of Community Health
Improvement
Mississippi Hospital
Association
Lanelle Weems, MSN, RN
Director
Center for Quality and
Workforce
MSDH
STD/HIV Ofce
Melverta Bender, MLS, MPH
Director
North Mississippi Health
Services of Eupora
Robin Mixon, MSHA, NHA,
CHSP, FACHA, FACHE
CEO/Administrator
Mississippi Rural Health
Association
Ryan Kelly
Executive Director
The University of Mississippi
Medical Center
Tammy Dempsey, Ed.D
Director of Community
Engagement and Service
Learning
Community Health Center
Association of Mississippi
Terrance Shirley
Chief Executive Ofcer
APPENDIX A: 2022 MS RURAL HEALTH CARE
PLAN STEERING COMMITTEE
Mississippi State Department of Health | Rural Health Plan Page 50
Rule 1.7.3 Federal Requirements for Critical Access Hospitals
1. Located in a state that has established a Medicare Rural Hospital Flexibility Program with the
Centers for Medicare and Medicaid Services (CMS)
2. Currently participates in Medicare as a rural public, nonprot or for-prot hospital; or was a
participating hospital that ceased operation during the 10-year period from November 29,
1989, to November 29, 1999; or is a health clinic or health center that was downsized from a
hospital
3. Located in a rural area or area treated as rural
4. Located more than a 35-mile drive from any other hospital or CAH (in mountainous terrain or
in areas with only secondary roads available, the mileage criterion is 15 miles)
5. Maintains no more than 25 inpatient beds
6. Maintains an annual average length of stay of 96 hours per patient for acute inpatient care
7. Complies with all CAH Conditions of Participation, including the requirement to make available
24-hour emergency care services seven days per week
8. Staff must be sufcient to provide the services essential to the operation of the CAH
(e.g., emergency services, direct services, and nursing services).
9. Must have a professional health care staff that includes one or more physician assistant, nurse
practitioner, or clinical nurse specialist
10. A registered nurse, clinical nurse specialist, or licensed practical nurse on duty whenever the
CAH has one or more inpatients
11. Inpatient and emergency care, laboratory, and x-ray services required. Some ancillary services
(lab, radiology) may be provided part time off-site
12. Emergency services required 24 hours a day, seven days a week. Staff in the emergency room
must have emergency services training/experience
13. A system in place with the local emergency medical system so emergency medical personnel
are aware of who is on call and how to contact them
14. A doctor of medicine or osteopathy available by phone or radio 24 hours a day, seven days a
week
15. Facilities have an agreement with at least one hospital that is a member of the network for:
• Patient referral and transfer
• The development and use of communications systems
• The provision of emergency and non-emergency transportation
• Credentialing and quality assurance
16. CAH applicants meet all additional CAH Conditions of Participation as established by CMS.
Compliance with the CMS CAH Conditions of Participation is determined by the survey
conducted by the MSDH Ofce of Licensure and Certication
APPENDIX B: FEDERAL REQUIREMENTS FOR
CRITICAL ACCESS HOSPITALS
Page 51
APPENDIX C: CRITICAL ACCESS HOSPITAL
PERFORMANCE DATA, 2021
Critical Access Hospitals (CAHs) Total Hosp. Other or
NH
Total Hosp.
Inpat.
Other or
NH Inpat.
Totals 8,692 8,470 222 197,074 47,343 149,731
Baptist Memorial Hospital - Attala 337 337 -- 1,136 1,136 --
Baptist Memorial Hospital - Calhoun 290 249 41 1,335 1,335 --
Baptist Memorial Hospital - Leake * 544 544 -- 2,185 2,185 --
Baptist Memorial Hospital - Yazoo ** 465 465 -- 1,848 1,848 --
Choctaw Regional Medical Center 167 151 16 1,887 499 1,388
Claiborne County Medical Center 242 242 -- 5,422 3,161 2,261
Copiah County Medical Center 443 443 -- 5,542 2,118 3,424
Covington County Hospital 252 252 -- 21,093 1,038 20,055
Field Health System 223 223 -- 918 918 --
Franklin County Memorial Hospital 71 71 -- 245 245 --
Greene County Hospital 63 63 -- 164 164 --
H.C. Watkins Memorial Hospital, Inc. 343 343 -- 718 718 --
Jefferson Davis Community Hospital 76 54 22 179 179 --
John C. Stennis Memorial Hospital 84 84 -- 266 266 --
Lackey Memorial Hospital 745 739 6 7,647 3,695 3,952
Laird Hospital 318 318 -- 4,619 4,619 --
Lawrence County Hospital 298 298 -- 3,026 3,026 --
Monroe Regional Hospital 342 342 -- 3,325 3,325 --
North Mississippi Medical Center-Pontotoc *** 384 353 31 16,377 1,143 15,234
North Sunower Medical Center 556 537 19 27,549 2,615 24,934
Noxubee General Hospital 358 329 29 23,108 3,219 19,889
Pearl River County Hospital & Nursing Home 25 23 2 29,446 58 29,388
Perry County General Hospital 41 41 -- 107 107 --
Scott Regional Hospital 229 229 -- 341 341 --
Sharkey-Issaquena Community Hospital 117 117 -- 411 411 --
Simpson General Hospital 418 418 -- 3,284 1,201 2083
Tallahatchie General Hospital 88 66 22 28,900 3,556 25,344
Tippah County Hospital 480 446 34 1,611 1,583 28
Tyler Holmes Memorial Hospital 356 356 -- 3,239 1,488 1,751
University of Mississippi Medical Center
-Holmes County
212 212 -- 729 729 --
Walthall General Hospital 125 125 -- 417 417 --
2021 Critical Access Hospitals (CAHs) Data Admissions (Hosp., Other & NH) Inpatient Days (Hosp., Other & NH)
Page 52
Mississippi State Department of Health | Rural Health Plan
APPENDIX C: CRITICAL ACCESS HOSPITAL PERFORMANCE DATA, 2021
Critical Access Hospitals (CAHs) County
Owned
Corporate Ownership
(not-for-prot)
City and
County Owned
For Prot Partnership State Part of Health System
Totals 18 9 2 0 1 1 16
Baptist Memorial Hospital - Attala -- 1 -- -- -- -- 1 Baptist Memorial Health Care Corporation
Baptist Memorial Hospital - Calhoun -- -- 1 -- -- -- 1 Baptist Memorial Health Care Corporation
Baptist Memorial Hospital - Leake * -- 1 -- -- -- -- 1 Baptist Memorial Healthcare Corp
Baptist Memorial Hospital - Yazoo ** -- 1 -- -- -- -- 1 Baptist Memorial Healthcare Corporation
Choctaw Regional Medical Center 1 -- -- -- -- -- 0 None
Claiborne County Medical Center 1 -- -- -- -- -- 0 None
Copiah County Medical Center 1 -- -- -- -- -- 0 None
Covington County Hospital 1 -- -- -- -- -- 0 None
Field Health System 1 -- -- -- -- -- 0 None
Franklin County Memorial Hospital 1 -- -- -- -- -- 0 None
Greene County Hospital 1 -- -- -- -- -- 1 George Regional Health System
H.C. Watkins Memorial Hospital, Inc. -- 1 -- -- -- -- 1 Rush Health Systems Inc.
Jefferson Davis Community Hospital 1 -- -- -- -- -- 1 Forrest Health
John C. Stennis Memorial Hospital -- 1 -- -- -- -- 1 Rush Health Systems
Lackey Memorial Hospital -- 1 -- -- -- -- 0 None
Laird Hospital -- 1 -- -- -- -- 1 Rush Health Systems
Lawrence County Hospital 1 -- -- -- -- -- 1 Southwest Health Systems
Monroe Regional Hospital -- -- 1 -- -- -- 1 Boa Vida Hospital of Aberdeen, MS, LL
North Mississippi Medical Center-Pontotoc *** 1 -- -- -- -- -- 1 North MS Health Services, Inc.
North Sunower Medical Center 1 -- -- -- -- -- 0 None
Noxubee General Hospital 1 -- -- -- -- -- 0 None
Pearl River County Hospital & Nursing Home 1 -- -- -- -- -- 1 Forrest Health
Perry County General Hospital -- -- -- -- 1 -- 0 None
Scott Regional Hospital -- 1 -- -- -- -- 1 Rush Health Systems, Inc.
Sharkey-Issaquena Community Hospital 1 -- -- -- -- -- 0 None
Simpson General Hospital -- 1 -- -- -- -- 0 None
Tallahatchie General Hospital 1 -- -- -- -- -- 0 None
Tippah County Hospital 1 -- -- -- -- -- 0 None
Tyler Holmes Memorial Hospital 1 -- -- -- -- -- 0 None
University of Mississippi Medical Center -Holmes County -- -- -- -- -- 1 1 University of Mississippi Medical Center
Walthall General Hospital 1 -- -- -- -- -- 1 Forrest Health
Ownership
*f/k/a Baptist Medical Center - Leake
** f/k/a Baptist Medical Center-Yazoo
***f/k/a Ponotoc Health Services
Source: FY 2022 Hospital Applications; FY 2021 Hospital Data/Statistics
Page 53
Mississippi State Department of Health | Rural Health Plan
APPENDIX C: CRITICAL ACCESS HOSPITAL PERFORMANCE DATA, 2021
Critical Access Hospitals (CAHs) Full-Time
Employees
Part-Time
Employees
Workers
on
Contract
RNs LPNs Ancillary
Personnel
ER
Visits
Non-RHC
Clinic
Visits
Average
Daily Census
Admissions Inpatient
Days
Swing-Bed
Day
RHC
Visits
Totals 3,931 1,492 783 717 259 297 156,150 255,641 130.37 8,470 47,343 79,755 574,793
Baptist Memorial Hospital - Attala 100 53 35 46 4 0 10,191 13,714 3.11 337 1,136 3,218 3,996
Baptist Memorial Hospital - Calhoun 96 26 32 20 1 10 4,480 9,562 3.66 249 1,335 3,292 2,667
Baptist Memorial Hospital - Leake * 139 39 0 36 7 0 8,971 0 5.99 544 2,185 3,800 3
Baptist Memorial Hospital - Yazoo ** 149 43 11 28 6 0 9,043 13,199 5.12 465 1,848 2,171 0
Choctaw Regional Medical Center 122 76 4 19 16 0 3,461 15,221 1.37 151 499 1,388 31,138
Claiborne County Medical Center 82 83 15 17 3 9 4,015 2,446 8.66 242 3,161 2,009 0
Copiah County Medical Center 118 92 8 28 3 0 9,633 0 5.80 443 2,118 3,424 0
Covington County Hospital 250 105 55 33 26 24 7,827 28,438 N/A 252 1,038 4,824 42,641
Field Health System 138 56 33 25 11 12 4,052 11,724 2.52 223 918 2,694 36,067
Franklin County Memorial Hospital 137 69 32 25 5 20 2,100 0 0.67 71 245 6,428 16,041
Greene County Hospital 36 16 4 8 1 4 3,118 0 0.45 63 164 1,253 5,304
H.C. Watkins Memorial Hospital, Inc. 70 53 0 11 4 6 3,221 37,784 1.97 343 718 2,344 37,784
Jefferson Davis Community Hospital 52 17 43 13 4 5 4,456 6,847 0.49 54 179 841 5,611
John C. Stennis Memorial Hospital 49 54 0 14 3 2 3,385 0 0.89 84 266 2,113 48,846
Lackey Memorial Hospital 206 79 35 49 11 38 7,206 296 10.83 739 3,695 2,512 60,510
Laird Hospital 114 45 0 15 1 3 4,123 10,288 12.65 318 4,619 4,006 73,896
Lawrence County Hospital 94 39 1 21 9 6 4,390 0 8.29 298 3,026 1,723 5,700
Monroe Regional Hospital 278 97 66 34 33 22 5,133 4,002 9.11 342 3,325 3,320 15,004
North Mississippi Medical Center-Pontotoc *** 162 24 29 33 11 8 8,931 0 0.00 353 1,143 3,768 32,171
North Sunower Medical Center 424 38 77 49 19 37 3,757 60,435 7.16 537 2,615 4,463 46,789
Noxubee General Hospital 106 34 17 14 1 10 3,141 0 8.82 329 3,219 1,826 19,202
Pearl River County Hospital & Nursing Home 80 34 37 14 3 6 4,333 9,305 0.16 23 58 2,246 9,705
Perry County General Hospital 49 3 2 13 3 0 2,333 0 0.29 41 107 922 9,345
Scott Regional Hospital 52 45 4 13 1 5 3,855 3,020 0.93 229 341 2,107 19,209
Sharkey-Issaquena Community Hospital 69 14 9 13 3 9 1,990 0 1.13 117 411 0 0
Simpson General Hospital 156 62 0 22 22 25 3,224 7,230 9.00
418 1,201 2,841 17,453
Tallahatchie General Hospital 174 47 11 19 17 11 2,199 0 9.74 66 3,556 3,116 0
Tippah County Hospital 121 76 100 25 6 5 5,501 3,783 4.34 446 1,583 2,971 3,898
Tyler Holmes Memorial Hospital 140 38 118 21 14 8 6,189 7,616 4.08 356 1,488 1,751 13,152
University of Mississippi Medical Center - Holmes County 91 14 4 21 8 5 5,855 413 2.00 212 729 1,463 6,702
Walthall General Hospital 77 21 1 18 3 7 6,037 10,318 1.14 125 417 921 11,959
Employees by Category Utilization (Hospital)
*f/k/a Baptist Medical Center - Leake
** f/k/a Baptist Medical Center-Yazoo
***f/k/a Ponotoc Health Services
Source: FY 2022 Hospital Applications; FY 2021 Hospital Data/Statistics
Page 54
Rural Mississippi Qualied Health Centers (MQHCs) Main Site
• Aaron E. Henry Community Health Services Center Clarksdale
• Access Family Health Services Smithville
• Claiborne County Family Health Services Port Gibson
• Delta Health Center Mound Bayou
• East Central Mississippi Health Care Sebastopol
• Family Health Center Laurel
• Greater Meridian Health Clinic Meridian
• Jefferson Comprehensive Health Center Fayette
• Mallory Community Health Center Lexington
• Mantachie Rural Health Care Mantachie
• North Mississippi Primary Health Care Ashland
• Northeast Mississippi Health Care Byhalia
• Outreach Health Services Shubuta
Urban MQHCs
• Central Mississippi Health Services Jackson
• Coastal Family Health Center Biloxi
• Family Health Care Clinic Pearl
• G.A. Carmichael Family Health Center Canton
• Jackson-Hinds Comprehensive Health Center Jackson
• Southeast Mississippi Rural Health Initiative Hattiesburg
Source: Community Health Center Association of Mississippi
APPENDIX D: LIST OF MISSISSIPPI
QUALIFIED HEALTH CENTERS
Page 55
Mississippi State Department of Health | Rural Health Plan
2017
2021
Urban Rural State Urban Rural State
Rate 95% LCI 95% UCI Rate 95% LCI 95% UCI Rate 95% LCI 95% UCI Rate 95% LCI 95% UCI Rate 95% LCI 95% UCI Rate 95% LCI 95% UCI
Urban --
-- -- -- -- --
76.1 74.5235 77.6055
-- -- -- -- -- --
76.5 75.1002 77.9458
Rural
-- -- -- -- -- --
23.9 22.3945 25.4765
-- -- -- -- -- --
23.5 22.0542 24.8998
White, NH 58.9 56.3845 61.3828 59.6 55.7566 63.4616 59.1 56.9535 61.1586 57.6 55.224 59.9244 61.8 58.2558 65.2748 58.6 56.5821 60.5259
Black, NH 35.3 32.8662 37.7854 35.8 31.9226 39.5921 35.4 33.3572 37.4995 36.3 34.0947 38.5819 32.6 29.3156 35.8351 35.5 33.5863 37.3309
Other 5.8 4.4952 7.0859 4.6 3.1363 6.1308 5.5 4.4647 6.5664 6.1 4.5445 7.6304 5.7 3.3376 7.9811 6.0 4.6861 7.2886
Female 52.1 49.6805 54.5728 52.5 48.6879 56.2681 52.2 50.1416 54.2799 51.9 49.5647 54.2637 53.2 49.714 56.7237 52.2 50.2394 54.2016
Male 47.9 45.4272 50.3195 47.5 43.7319 51.3121 47.8 45.7201 49.8584 48.1 45.7363 50.4353 46.8 43.2763 50.286 47.8 45.7984 49.7606
Less than
HS
15.5 13.4482 17.6095 22.8 19.1831 26.4024 17.3 15.4637 19.0746 13.9 11.9977 15.7193 18.2 14.9782 21.3735 14.9 13.2655 16.4795
HS Grad
or Equiv
29.4 27.1435 31.6658 33.2 29.6979 36.6569 30.3 28.4002 32.2169 29.0 26.8689 31.2116 34.6 31.333 37.8202 30.3 28.5162 32.1647
Some
college
34.4 32.0691 36.7570 31.1 27.5834 34.5838 33.6 31.6451 35.5857 34.7 32.3785 36.9605 33.2 29.848 36.568 34.3 32.4054 36.2471
College
Grad
20.7 19.0669 22.2400 13.0 11.0897 14.8029 18.8 17.5261 20.0877 22.4 20.8038 24.0598 14.0 12.0851 15.994 20.5 19.1396 21.782
Less than
$15K
15.1 13.2308 17.0298 22.6 19.2158 25.9841 16.9 15.2348 18.5539 10.0 8.1833 11.7532 10.9 7.9928 13.7024 10.2 8.6454 11.6913
$15K to
$24,999
22.3 19.9749 24.5412 26.9 23.0337 30.7597 23.4 21.3824 25.3247 14.5 12.6925 16.3664 14.5 11.868 17.024 14.5 12.9768 16.0442
$25K to
$34,999
12.1 10.2128 13.8825 11.5 9.0977 13.8595 11.9 10.4027 13.4238 16.8 14.8059 18.7168 23.1 19.6211 26.5147 18.2 16.4937 19.8997
$35K to
$49,999
13.0 11.2779 14.7527 12.1 9.6586 14.4475 12.8 11.3452 14.2309 14.6 12.7478 16.3553 14.7 11.973 17.4659 14.6 13.0617 16.1179
$50K or
more
37.6 35.1031 39.9943 27.0 23.4493 30.4942 35.1 33.0107 37.0909 44.2 41.579 46.7999 36.9 32.9729 40.8652 42.5 40.3342 44.7352
APPENDIX E: URBAN-RURAL DEMOGRAPHICS, 2017 & 2021
Page 56
2017 2018 2019 2020 2021
Urb an
8.1 8.2 7.7 7.8 8.8
Rur al
8.9 9.2 9.4 1 0 .5 9.5
St ate 8.3 8.5 8.1 8 .5 9.0
0.0
2.0
4.0
6.0
8.0
1 0 .0
12.0
Prevalence (%)
History of Heart Disease (MS BRFSS)
Urb an Ru ral State
2017 2018 2019 2020 2021
Urb an
4.4 4.8 4.8 5.2 5.6
Rur al
5.7 5.0 5.8 6.0 5.4
St ate
4.7 4.8 5 .0 5.4 5.6
0.0
2.0
4.0
6.0
8.0
Prevalence (%)
History of Stroke (MS BRFSS)
Urb an Rural State
2017 2018 2019 2020 2021
Urb an 5.1 6.1 6.2 5.7 6.4
Rur al 6.2 5.8 6.7 5.4 7.0
St ate 5.4 6.0 6.3 5.6 6.6
0.0
2.0
4.0
6.0
8.0
1 0 .0
Prevalence (%)
History of Skin Cancer (MS BRFSS)
Urb an Ru r al St ate
2017 2018 2019 2020 2021
Urb an 7.1 7.0 6.7 6.5 8.0
Rur al 7.2 7.5 6.5 7.1 7.6
St ate 7.1 7.1 6.6 6.7 7.9
0.0
2.0
4.0
6.0
8.0
1 0 .0
Prevalence (%)
History of Other Types of Cancer (MS BRFSS)
Urb an Rural State
2017 2018 2019 2020 2021
Urb an 7.8 9.2 9.1 8.4 8.6
Rur al 9.4 11.4 1 0 .3 9.3 1 0 .5
St ate 8.2 9.7 9.4 8.6 9.1
0.0
2.0
4.0
6.0
8.0
1 0 .0
12.0
1 4 .0
Prevalence (%)
History of COPD (MS BRFSS)
Urb an Rural State
2017 2018 2019 2020 2021
Urb an 35.2 38.3 4 0. 5 37.9 38 .2
Rur al 43.9 43.3 42.1 4 5. 2 4 1 .9
St ate 37.3 39.5 4 0.8 39 .7 39.1
0.0
1 0 .0
20. 0
30.0
4 0. 0
5 0. 0
6 0. 0
Prevalence (%)
Current Obesity (MS BRFSS)
Urb an Rural State
APPENDIX F: HEALTH CONDITIONS GRAPHS
Mississippi State Department of Health | Rural Health Plan Page 57
2017 2018 2019 2020 2021
Urb an
20. 1 21. 7 20.6 20.8 20.2
Rur al
22.5 21.8 20.7 21.1 1 9 .4
St ate
20. 7 21.7 20.6 20.9 20.1
0.0
1 0 .0
20. 0
30.0
Prevalence (%)
History of Depressive Disorder (MS BRFSS)
Urb an Rural State
2017 2018 2019 2020 2021
Urb an
13.2 13.5 1 4 .5 13.8 1 4 .9
Rur al
17.2 17.0 1 5 .9 17.3 1 6 .4
St ate
1 4 .2 1 4 .4 1 4 .8 1 4 .6 1 5 .2
0.0
5.0
1 0 .0
1 5 .0
20. 0
25. 0
Prevalence (%)
History of Diabetes (MS BRFSS)
Urb an Rural State
2017 2018 2019 2020 2021
Urb an
23.4 22.3 22.0 1 8 .9 21.3
Rur al
31.1 26.8 28.7 23.2 26.5
St ate
25. 3 23.3 23.6 1 9 .9 22.5
0.0
5.0
1 0 .0
1 5 .0
20. 0
25. 0
30.0
35.0
Prevalence (%)
Self-Reported Fair/Poor Health Status (MS
BRFSS)
Urb an Rural State
2017 2018 2019 2020 2021
Urb an
1 5 .5 1 4 .5 13.0 9 .8 12.6
Rur al
1 9 .9 1 8 .2 17.0 11.8 13. 9
St ate
1 6 .6 1 5 .4 1 4 .0 1 0 .3 12.9
0.0
5.0
1 0 .0
1 5 .0
20. 0
Prevalence (%)
14+ Days of Poor Physical Health in Past 30
Days (MS BRFSS)
Urb an Rural State
2017 2018 2019 2020 2021
Urb an
1 5 .1 1 5 .3 17.7 1 4 .8 1 5 .0
Rur al
1 8 .3 1 6 .2 1 5 .9 13.1 13.6
St ate
1 5 .9 1 5 .5 17.3 1 4 .4 1 4 .7
0.0
5.0
1 0 .0
1 5 .0
20. 0
Prevalence (%)
14+ Days of Poor Mental Health in Past 30
Days (MS BRFSS)
Urb an Rural State
Page 58
APPENDIX G: DIFFERENCES IN HEALTH BEHAVIORS
RURAL-URBAN
2017 201 8 2019 2020 2021
Urb an
21.5 20.0 20.0 1 9 .9 1 8 .9
Rur al
24.6 22.4 21.9 20.8 21.7
St ate
22.2 20.5 20.4 20.1 1 9 .6
0.0
5.0
1 0 .0
1 5 .0
20. 0
25. 0
30.0
Prevalence (%)
Current Smoking (MS BRFSS)
2017 2018 2019 2020 2021
Urb an 1 4 .3 13.2 13.9 1 4 .1 13.2
Rur al 7.2 11.2 12.0 11.2 1 0 .4
St ate 12.6 12. 7 13.4 13.4 12.5
0.0
4.0
8.0
12.0
1 6 .0
Prevalence (%)
Current Binge Drinking (MS BRFSS)
2017 201 8 2019 2020 2021
Urb an
6 8. 9 6 9. 3 63.7 7 0 .8 7 0 .4
Rur al
6 0. 1 63.9 5 7 .6 67.5 6 5.0
St ate
6 6. 9 6 8. 0 62.3 7 0 .0 6 9.1
0.0
20. 0
4 0. 0
6 0. 0
8 0. 0
10 0. 0
Prevalence (%)
Physical Activity Outside of Job in Past 30
Days (MS BRFSS)
2017 2018 2019 2020 2021
Urb an
35.7 32.8 39.4 4 1 .7 37.5
Rur al 34 .2 32.4 39 .5 39.9 38.4
St ate 35.4 32.7 39.4 4 1 .3 37.7
0.0
1 0 .0
20. 0
30.0
4 0. 0
5 0. 0
Prevalence (%)
Received Flu Vaccine in Past 12 Months
(MS BRFSS)
2017 2018 2019 2020 2021
Urb an
72.2 7 0 .5 67.5 6 8.1 63.3
Rur al 7 0 .6 6 4.3 6 4.3 62.4 63.0
St ate 71. 8 6 8. 7 6 6. 6 6 6. 6 63.2
0.0
20. 0
4 0. 0
6 0. 0
8 0. 0
10 0. 0
Prevalence (%)
Received Pneumonia Vaccine in Past 12 Months -
Age 65+ Years Only (MS BRFSS)
2017 201 8 2019 2020 2021
Urb an 83.0 8 3.2 82.8 82.5 8 9. 1
Rur al 8 1 .9 8 6. 1 8 1 .6 83.0 9 1 .1
St ate 82.8 83.9 82.5 82.7 8 9. 6
0.0
20. 0
4 0. 0
6 0. 0
8 0. 0
10 0. 0
Prevalence (%)
Has Health Care Coverage - All Ages (MS
BRFSS)
Mississippi State Department of Health | Rural Health Plan Page 59
APPENDIX G: DIFFERENCES IN HEALTH BEHAVIORS
RURAL-URBAN
2017 2018 2019 2020 2021
Urb an
7 9 .3 7 9 .1 7 8 .5 7 8 .1 8 6. 3
Rur al
77.6 8 1 .8 76.0 7 8 .3 8 8. 0
St ate
7 8 .9 7 9 .7 77.9 7 8 .2 8 6. 7
0.0
20. 0
4 0. 0
6 0. 0
8 0. 0
10 0. 0
Prevalence (%)
Has Health Care Coverage - Age 18-64
Years Only (MS BRFSS)
2017 201 8 2019 2020 2021
Urb an 18 .3 17.6 1 6 .6 13.3 12.7
Rur al 1 8 .0 17.5 1 9 .2 1 5 .8 1 4 .1
St ate 1 8 .2 17.6 17.2 13.9 13.1
0.0
5.0
1 0 .0
1 5 .0
20. 0
25. 0
Prevalence (%)
Could Not See Doctor Due to Cost in Past 12
Months (MS BRFSS)
2017 201 8 2019 2020 2021
Urb an 6 9.5 76.7 7 9 .1 7 8 .6 7 9 .4
Rur al 7 0 .8 7 8 .0 77.3 77.9 8 0.0
St ate 6 9. 8 77.0 7 8 .7 7 8 .4 7 9 .5
0.0
20. 0
4 0. 0
6 0. 0
8 0. 0
10 0. 0
Prevalence (%)
Had Routine Check-Up in Past 12 Months
(MS BRFSS)
2017 201 8 2019 2020 2021
Urb an 7 5 .2 72.4 73.0 7 5 .4 82.8
Rur al 8 0.4 7 9 .0 7 5 .8 7 8 .5 8 5.4
St ate 76.5 7 4 .0 73.6 76.1 83.4
0.0
20. 0
4 0. 0
6 0. 0
8 0. 0
10 0. 0
Prevalence (%)
Has a Personal Doctor or Health Care
Provider (MS BRFSS)
