Medicaid expansion discussions could fall apart in Republican-led Mississippi
JACKSON, ma’am. — The first serious attempt by Mississippi’s Republican-led Legislature to expand Medicaid appeared to crumble Thursday as leaders argued over whether to let voters decide the issue.
Under pressure in the final days of a four-month session, House and Senate negotiators released a proposal Monday to allow Medicaid coverage for tens of thousands of low-income people, but it would include a work requirement.
House Democrats balked before the plan could be voted on, saying it was a Medicaid expansion in name only because the federal government has blocked several states from getting such mandates.
Mississippi is one of the poorest states and has some of the worst health outcomes. Some business leaders, clergy and health care advocates are lobbying for Mississippi to join 40 other states in expanding Medicaid, as allowed under the health care overhaul law signed by then-President Barack Obama in 2010.
After further negotiations Wednesday, House Speaker Jason White said his chamber would submit a new proposal Thursday. It would put two questions on the November ballot: Should Mississippi expand Medicaid? If so, should the extension include a work requirement?
“For years, the response to Medicaid expansion was not just no, but complete rejection; With this ballot referendum, Mississippians will now have a seat at the table on how we can improve health care outcomes in our state,” White said in a statement.
Republican Lt. Gov. Delbert Hosemann said Wednesday night that the proposal to put Medicaid expansion on the ballot “was not well received” by Senate leaders.
“We are disappointed with the outcome this year, but appreciate the discussions that took place this session – the first time this Legislature has seriously considered health care reform in our state,” Hosemann said. “I remain committed to finding ways to expand access for working Mississippians who otherwise do not have the resources for a simple checkup or an extended hospital stay.”
Hosemann said Senate leaders are adamant about imposing a work requirement “with appropriate exceptions.”
Even if lawmakers agree on a plan, they are likely to face a veto from Republican Gov. Tate Reeves, who calls Medicaid “welfare” and says he doesn’t want more people to rely on the insurance program funded by federal and state governments.
The proposal introduced Monday evening would require new Mississippi Medicaid recipients to work at least 100 hours a month in a job that does not provide private health insurance. Otherwise, they must fit into other categories, such as being a full-time student or being the parent of a child under the age of six.
If the federal government rejects Mississippi’s work requirement, the state’s Department of Medicaid would have to continue seeking approval every year — an acknowledgment that another federal government could reach a different decision.
Georgia is the only state with a Medicaid work requirement and is suing the federal government to keep the mandate. The work requirement was approved by then-President Donald Trump’s administration, but the Biden administration announced in December 2021 that it would withdraw the approval. Georgia has filed a lawsuit.
The House voted by a wide bipartisan margin in late February to expand Medicaid coverage to about 200,000 people earning up to 138% of the federal poverty level, or $20,120 a year for one person. Mississippi has a population of about 3 million and its Medicaid program covered 374,823 people in March.
In late March, the Senate passed its own pared-down version, which would expand eligibility to people earning up to 100% of the federal poverty level, just over $15,000 for one person. Senate Medicaid Committee Chairman Kevin Blackwell, a Republican from Southaven, said about 80,000 people would qualify for coverage.