JACKSON, Miss. (AP) — Mississippi doesn’t have the medical workforce to address a wide range of poor health outcomes, from high rates of maternal and infant mortality to severe cases of diabetes that require the amputation of limbs, the state’s top health officer said.

Dr. Daniel Edney, who leads the Mississippi State Department of Health, told lawmakers Thursday that the state health department is short 150 nurses and low health care access in the state’s impoverished Delta region is becoming “scary.” The challenges have placed Mississippi near the bottom of national rankings that track the performance of state health care systems.

“We may be at the bottom today, but we don’t have to stay there,” Edney said. “I’m just begging for partners to help us … because we have too many Mississippians who are dying prematurely. We have too many who are aging with poor health and we have too many people struggling for access to care.”

Edney appeared before the lawmakers at a budget hearing to request an additional $14.6 million in state general funds for the year that begins July 1, which would be a 42% increase from the general funds for the current fiscal year. About $9.2 million in new funds would be used to hire an additional 100 nurses to work in county health departments across the state, according to a health department budget document.

A nurse shortage accelerated during the COVID-19 pandemic and the exodus has added further strain on the health care system in Mississippi. A spokesperson for the health department, Liz Sharlot, said 54% of rural hospitals are in danger of closure or downgrading existing services.

The Greenwood Leflore Hospital in the Delta has been teetering on the edge of permanent closure for months, in part because it can’t pay competitive wages to retain experienced nurses. Its potential closure threatens access to maternal health care just as the state is expecting more births each year as a result of the U.S. Supreme Court decision last year that eliminated nationwide legal protections for abortion.

Nursing shortages have not been limited to Mississippi, but the state has the nation’s highest fetal mortality rate, highest infant mortality rate, highest pre-term birth rate and is among the worst for maternal mortality. Black women are nearly three times more likely to die due to pregnancy-related illness than white women in Mississippi, according to the Center for Mississippi Health Policy.

Edney said the agency is shifting its attention from COVID-19 response back to its “core responsibilities.” He outlined three issues in need of more attention: maternal mortality, diabetes and the opioid crisis.

Half of diabetics in Mississippi don’t know they have it, and the Delta has one highest amputation rates in the country. An increase in diabetes screening would help reverse the trend, Edney said. For maternal care, the department needs more funds to stand up a new at-home nursing program for mothers. But these efforts require more skilled health workers.

“I can’t do it with my current workforce,” Edney said. “I don’t have enough.” He said county departments have borne the brunt of the state’s health challenges.

“Honestly, I’m shocked to hear you say this,” said Sen. Angela Hill, a Republican from Picayune. “I think part of it is people don’t know where to go for services.”

About 80% of the department’s funding is federal, but those dollars are more inflexible than state dollars.

“That’s why the state appropriations for us is precious,” Edney said. “The very modest ask that we have is not to expand the agency, but it is to strengthen the safety net.”

Legislators are supposed to complete a state budget by late March.

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Michael Goldberg is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Follow him on Twitter at twitter.com/mikergoldberg.