Senate Medicaid Chairman Kevin Blackwell on Friday afternoon said the Senate will hold firm on asking House leaders to agree on a final Medicaid expansion plan that requires recipients to prove they are working at least 30 hours a week.

That’s a stance likely to delay or kill Mississippi’s efforts to provide health coverage to about 200,000 people, as the federal government has refused to approve such work requirements for Medicaid expansion.

“We’re pretty solid on that,” said Blackwell, a Republican from Southaven.

And despite offering a “compromise” to the House that he and two other Senate negotiators agreed to, Blackwell expressed doubt it could garner enough votes in the GOP supermajority Senate.

His remarks come after he and two other Senate negotiators sent House leaders a “hybrid” expansion proposal on Friday morning that would expand coverage to people earning up to 138% of the federal poverty level, or about $20,000 a year. The proposal would use traditional Medicaid for the poorest and subsidized private insurance on the federal exchange for those making from 100% to 138% of poverty level — a compromise House leaders had previously pitched.

House leaders had asked the Senate on Tuesday if they would be receptive to a hybrid expansion model, and the Senate negotiators were noncommittal. Now, Blackwell is agreeing to the House’s hybrid suggestion with a strict work requirement.

“They asked for (a hybrid plan), and we felt obliged to try and accommodate them,” Blackwell said of the House negotiators. 

The movement by Senate leaders to cover those earning up to 138% of the federal poverty level is a major step toward an agreement on a Medicaid expansion program as 40 other states have done to cover primarily the working poor.

But it’s unclear if the Senate even has the necessary votes to pass its own proposal on the Senate floor, much less with a veto-proof two-thirds vote needed to override a threatened veto from Republican Gov. Tate Reeves. 

Blackwell said “only three senators,” meaning the three Senate negotiators, had viewed the counter-proposal. The DeSoto County lawmaker also said he had not tried to convince his Senate colleagues to vote for the plan and had left that job up to the lieutenant governor’s office. 

House leaders are reviewing the Senate’s counteroffer, but had not publicly responded to it by late Friday. Lawmakers are expected to meet through the weekend in the final days of this year’s legislative session.

House leaders have said they, too, want work requirements for expanded Medicaid coverage. But the federal Centers for Medicare & Medicaid Services under the Biden administration have denied waivers for states to implement work requirements.  The House’s proposal called for seeking a waiver, but expanding the coverage whether or not one is granted.

In the House’s original plan, it contained a 20-hour per week work requirement for recipients, but if CMS denied the work requirement waiver, it would have still gone into effect. 

A potential avenue for compromise is for the chambers to include, as North Carolina did, a  “trigger law,” of sorts, to mandate that if the federal government ever changed its policy on allowing states to implement a work requirement, Mississippi would move immediately to adopt one. 

If CMS denies the work requirement waiver, the Senate’s plan directs Attorney General Lynn Fitch’s office to file a federal suit to appeal the denial. 

Senate leaders have said that despite CMS refusing to approve work requirements for Medicaid coverage, they hold out hope that the agency might be so pleased that longtime holdout Mississippi is expanding the program that it makes an exception. Beyond that, they hope the state could prevail in a lawsuit against the federal government filed in the conservative 5^th Circuit federal court to force approval of work requirements.

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