With minutes to spare before a Monday-night deadline, House negotiators conceded a Senate demand that Medicaid expansion would include a strict work requirement for those covered — a requirement not likely to be approved by the federal government.

The Senate had already backed off its initial proposal that would only cover the poorest of the poor, would still leave tens of thousands of poor working Mississippians uninsured and would have turned down billions in federal money to cover the costs. 

House and Senate negotiators agreed to a deal that would expand Medicaid to about 200,000 people who make up to 138% of the federal poverty level, roughly $20,000 for an individual. It would require recipients to prove they work for at least 25 hours a week.  

The plan will be a “hybrid,” as first proposed by the House. People up to 99% of the federal poverty level would be covered by traditional Medicaid. Those making 100% to 138% of FPL would be covered with subsidized private insurance plans from the federal exchange.

Neither House Medicaid Chair Missy McGee, a Republican from Hattiesburg, nor Senate Medicaid Chair Kevin Blackwell, a Republican from Southaven, answered questions from reporters at the Capitol about the agreement on Monday night. 

“A compromise requires concessions between the chambers,” Republican Lt. Gov. Delbert Hosemann said in an earlier statement. “The Senate requires a real work requirement, but our plan now covers individuals up to 138 percent of the federal poverty level.” 

The Affordable Care Act, the federal legislation that allows states to expand Medicaid coverage, does not authorize work requirements. However, states can seek a federal waiver from the Centers for Medicare and Medicaid Services to implement them. 

CMS under the Trump administration did sign off on some states using work requirements, but under the Biden administration, the federal agency has not approved requests and rescinded the ones that had been approved. 

The House’s original plan directed state officials to seek a waiver for work requirements, but would have expanded Medicaid even if the federal agency denied it. House leaders previously pointed out that people with income above the federal poverty level are likely working.

The Senate, however, drew a hard line that it would only agree to an expansion plan that contained work requirements — a stance that could at the least delay expanded coverage, perhaps for years, or prevent it from ever happening.

READ MORE: House, Senate leaders swap Medicaid expansion proposals as Monday night deadline nears

If CMS denies Mississippi’s waiver for a work requirement, the compromise proposal directs the state Division of Medicaid to apply for a work requirement waiver each year the first denial. 

It also directs state officials to immediately apply for a waiver if CMS starts approving work requirements in other states.   

Senate leaders have expressed optimism that the Biden administration will be so pleased with longtime Medicaid expansion holdout Mississippi making an effort that it would approve a work requirement, or that the conservative federal 5th Circuit Court would approve it if litigated.

Work requirements in states that previously had them proved to be costly and ineffective, with a large amount of costs going into administration of the work requirements instead of medical services.

The agreed proposal will likely bring an end to several days of House and Senate negotiators trading proposals back and forth with one another behind closed doors. 

Right up to the 8 p.m. Monday deadline, it was unclear if legislative leaders would reach a compromise. They signed the agreement with only minutes to spare.

Reporters, lobbyists and advocates gathered at the Capitol waiting to see if lawmakers could broker a deal to establish what many believe could be the most transformative state policy since Gov. William Winter’s Education Reform Act of 1982.

But despite earlier vows by House and Senate leaders to negotiate Medicaid expansion in public, the final details were worked out behind closed doors and negotiators declined comment Monday night.

Now that the negotiators have signed off on an agreement, the Capitol’s two chambers have until Wednesday to either approve the proposal, reject it or send it back to negotiators for further work. The 2024 legislative session is expected to end within days, although lawmakers have already had to push back deadlines for agreeing to a state budget.

The Medicaid expansion proposal places a 3% tax on managed care organizations to cover the state’s costs, and the Legislature’s rules require a three-fifths majority of the lawmakers in both chambers to approve bills that enact taxes. 

But the actual threshold the two chambers likely need to achieve is a two-thirds majority, needed to override a potential veto from Republican Gov. Tate Reeves, a longtime opponent of expansion. 

Passage of the compromise, particularly by a wide margin, may be difficult in both chambers. House Democrats, who support Medicaid expansion, have threatened to oppose any bill with a work requirement. Any expansion measure is a tough sell in the Senate, and its earlier more austere plan barely garnered a two-thirds vote.

Senate Minority Leader Derrick Simmons, D-Greenville, on Monday night said he was glad the two chambers came to an agreement and he looks forward to seeing more details.

“I am grateful we are finally at a point where we are working to provide access to health care to Mississippians who desperately need it and have been waiting for it for a long time,” Simmons said.

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