Mississippi Medicaid expansion plan could struggle for bipartisan support, Democratic leader says

JACKSON, Miss. -- A Medicaid expansion plan endorsed by leaders in the Republican-led Mississippi Legislature could struggle for bipartisan support because it includes a work requirement that is unlikely to receive federal approval, the state House Democratic leader said Tuesday.

Approving the plan could create false hope among people who want Medicaid coverage but might not receive it, Rep. Robert Johnson told reporters after his party's caucus met privately to discuss the issue.

“The Democratic Caucus in the House didn’t want to vote for a Medicaid expansion bill that was Medicaid expansion in name only,” said Johnson, of Natchez.

House and Senate leaders were working behind closed doors to secure support. They need at least a two-thirds margin in each chamber — enough to override an expected veto by Republican Gov. Tate Reeves.

Mississippi is one of the poorest states in the U.S., with some of the worst health outcomes. It is also one of 10 states that have not expanded Medicaid under the health care law that then-President Barack Obama signed into law in 2010.

Democrats have said for years that Medicaid expansion could help people receive care for chronic conditions such as asthma and diabetes, and that an infusion of federal money could give a boost to financially strapped hospitals.

Reeves said Tuesday on social media that legislators were poised to vote on “FULL Obamacare Medicaid Expansion” and that it would be “Just like Obama-Biden wanted!”

A plan filed Monday night would require new Mississippi Medicaid recipients to be employed at least 100 hours a month in a job that does not provide private health insurance. Or they could fit into other categories, such as being a fulltime student or the parent of a child younger than 6.

Georgia is the only state with a Medicaid work requirement, and it is suing the federal government to try to keep the mandate in place. The work requirement was approved by then-President Donald Trump’s administration, but the Biden administration announced in December 2021 that it was revoking the approval. That prompted Georgia officials to sue.

If the federal government rejects Mississippi’s work requirement, the state Division of Medicaid would be required to continue seeking approval each year — an acknowledgement that a different federal administration might provide a different decision.

Mississippi's previous House speaker, Republican Philip Gunn, also opposed expansion. He did not seek reelection. The new speaker selected in January, Republican Jason White, has said expansion is a priority to try to help people working low-wage jobs that don't provide insurance.

The House voted by a wide bipartisan margin in late February to expand Medicaid coverage to about 200,000 people who earn up to 138% of the federal poverty level, or $20,120 annually for one person. Mississippi has about 3 million residents, and its Medicaid program covered 374,823 people in March.

In late March, the Senate passed its own pared-down version that would extend 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 become eligible for coverage. But he thought about half that number would enroll.