Mississippi lawmakers poised to vote on Medicaid expansion plan with work mandate

Mississippi lawmakers are expected to vote this week on a proposal that would expand Medicaid coverage to tens of thousands more people, but it includes a work requirement that might not win federal approval.

The state House and Senate passed separate expansion plans earlier this year. With the four-month legislative session pushing into its final days, negotiators from the two chambers submitted a compromise moments before a Monday night deadline. They declined to answer questions after emerging from a closed-door meeting, but the proposal was filed in legislative clerks’ offices.

The plan would require the new 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.

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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.

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.

Mississippi is one of the poorest states in the U.S., and advocates say covering tens of thousands more people with Medicaid could help them manage chronic health conditions such as asthma and diabetes.

The federal health overhaul signed by then-President Barack Obama in 2010 allowed states to expand Medicaid, largely to people who work low-wage jobs without insurance. Mississippi is among the 10 states that have resisted expansion.

Republican Gov. Tate Reeves has said for years that he does not want to put more Mississippi residents on government programs. But dynamics in the Republican-controlled Legislature changed this year with the selection of a new House speaker, Jason White, who said expansion could help some of Mississippi's financially struggling hospitals.

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.