Georgia has the nation’s only Medicaid work requirement. Mississippi could be next
JACKSON, ma’am. — After years of refusing to expand Medicaid, some Mississippi Republican leaders now say they are open to the policy — if they can require new enrollees to have a job. That approach could depend on presidential politics and an ongoing legal battle in Georgia.
In a statement to The Associated Press, Lt. Gov. Delbert Hosemann said Mississippi must consider all options to improve labor force participation and poor health outcomes, both of which are among the worst in the nation. Hosemann said Georgia, the only state that requires Medicaid recipients to meet a work requirement, could be a model for Mississippi.
“We need healthy working Mississippians,” Hosemann said. “Georgia’s successful implementation of a work requirement paved the way for this conversation in Mississippi.”
Georgia and Mississippi are among 10 states that have not expanded access to Medicaid to people earning up to 138% of the federal poverty level, or $20,120 per year for one person. In 2023, Georgia created a less generous program that offered expanded coverage to adults earning up to 100% of the poverty level, or $14,580 for a single person.
The Georgian program only provides comprehensive coverage to able-bodied adults if they work, volunteer, study or are engaged in vocational rehabilitation. The state developed its plan after the Trump administration allowed 13 states to impose work requirements on some Medicaid recipients.
The Biden administration rescinded all those waivers in 2021, in part because of the COVID-19 pandemic. The Centers for Medicare and Medicaid Services said people should not face barriers to getting health care. But Republican Gov. Brian Kemp’s administration won a federal court battle in 2022 to preserve Georgia’s plan, in part because it applies to new enrollees and not current Medicaid recipients.
The program will end at the end of September 2025. Earlier this month, Georgia sued the Biden administration in an attempt to keep its plan going until 2028.
A bill that would tie a work requirement to Medicaid eligibility has also passed the South Dakota Senate and is awaiting a hearing in the House of Representatives.
Even if a Republican is elected president in November, new Medicaid waivers granted by CMS could face legal challenges, said Robin Rudowitz, director of the Medicaid and the Uninsured Program at KFF, a health policy research group.
“While former President Donald Trump would likely look favorably on the work requirements, he has also pledged to try again to repeal and replace the Affordable Care Act, which would include Medicaid expansion,” Rudowitz said.
Georgia’s limited expansion of coverage with a work requirement waiver has led to limited Medicaid enrollment, far behind the coverage levels that could be achieved if the state adopted the full expansion allowed under the ACA, said Rudowitz. That’s because most Medicaid recipients work or face barriers to work, which limits enrollment, she continued.
Georgia Republican House Speaker Jon Burns signaled early in this year’s legislative session that Republicans may be open to further Medicaid expansion. But GOP lawmakers indicated Tuesday that the idea would likely be off the table by 2024.
Mississippi House Speaker Jason White, also a Republican, said in an interview that the state has shown it will refuse to expand Medicaid without a work requirement.
“I think we’ve proven to CMS and the people in Washington that we’re going to be stubborn and we’re not going to do it,” White told The AP. I may have a slightly different model here.”
The debate over Medicaid expansion has been deadlocked in Mississippi for years amid opposition from Republican leaders, including Gov. Tate Reeves. Reeves said Tuesday he still opposes expansion and shared Trump’s disdain for Obamacare.
If lawmakers vote to expand Medicaid, Reeves will likely veto the bill. Lawmakers could override his veto with a two-thirds majority of both the House of Representatives and the Senate.
Mississippi lawmakers are also considering the impact of a financial incentive for Medicaid expansion provided by Congress in the American Rescue Plan. The bonus helped pass Medicaid expansion in North Carolina. In Mississippi, the program would be paid for for about four years, even without taking into account other cost offsets such as higher tax revenues, Republican House Medicaid Committee Chairwoman Missy McGee said during a legislative hearing on Tuesday.
Morgan Henderson, a data scientist at the Hilltop Institute, a health care research organization, said expansion would be an economic boon for Mississippi, but each state has a unique program.
“If you know a state’s Medicaid program, you know that state’s Medicaid program,” Henderson said.
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AP reporters Emily Wagster Pettus in Jackson, and Sudhin Thanawala and Jeff Amy in Atlanta contributed to this report. Michael Goldberg is a staff 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.