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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states using work requirements, but under the Biden administration, the federal agency has not approved requests and rescinded the ones that had been approved.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.

The post House agrees to work requirement, Senate concedes covering more people in Medicaid expansion deal appeared first on Mississippi Today.

House and Senate Republicans continued to haggle over Medicaid expansion proposals Sunday, and the state budget process hit a snag after leaders couldn’t reach final agreements by a Saturday night deadline on how to spend $7 billion.

House Speaker Jason White on Sunday told his chamber that Medicaid expansion negotiators from the House and Senate had been meeting and he expected a compromise “will be filed by Monday or Tuesday at the latest.”

House Medicaid Chairwoman Missy McGee said the Senate had delivered another counter proposal on expansion Sunday evening but declined to provide details. Her Senate counterpart, Medicaid Chairman Kevin Blackwell, declined comment on Sunday. The two leaders met in McGee’s office on Sunday evening following a Saturday afternoon meeting.

READ MORE: House, Senate close in on Medicaid expansion agreement

Lawmakers have for the past couple of months been debating on how to expand Medicaid coverage for poor Mississippians and help the state’s flagging hospitals. The House initially voted to expand coverage to an estimated 200,000 people, and accept more that $1 billion a year in federal dollars to cover the cost, as most other states have done. The Senate initially passed a far more austere plan, that would cover about 40,000 people, and would decline the extra federal money to cover costs.

Since those plans passed, each has offered counter proposals, but no deal has been reached.

A group of about 50 clergy, physicians and other citizens who support full expansion showed up at the Capitol on Sunday to sit in the Senate gallery and deliver letters to key leaders who are negotiating a final plan.

“When we stand before the Lord, he’s not going to ask how much money did you save the state. He’s going to ask you what you did for the least of these,” Monsignor Elvin Sounds, a retired Catholic priest, said outside the Senate gallery on Sunday.

READ MORE: A solution to the Republican impasse on Medicaid expansion

Lawmakers hit an impasse on setting a $7 billion state budget and missed Saturday night’s deadline for filing appropriations bills. This will force the legislature into extra innings, and require lawmakers to vote to push back deadlines. Lawmakers had expected to end this year’s session and leave Jackson by early this week. But House Speaker Jason White told his chamber on Sunday they should expect to continue working through Friday, “and possibly through Saturday or Sunday.

White later said of the budget impasse, “When you get to haggling over spending $7 billion, folks are going to have disagreements.”

Lt. Gov. Delbert Hosemann, who presides over the Senate, said “things are fluid. But everybody is working.”

He looked at his watch and said “It is 5 o’clock. By 6 o’clock what I tell you will have changed.”

White said one reason for the session having to run extra innings is that when he became speaker he vowed to House members that he would not continue the practice of passing much of the state budget last-minute, late at night or in the wee hours of the morning with little or no time for lawmakers to read or vet what they are passing.

He said the House was prepared early Saturday night to file budget bills with agreed-upon numbers, but not to file “dummy bills” with zeros or blanks and continue haggling a budget late into the night.

“I made a promise that we are not going to keep them up here until midnight, then plow through all these budget bills,” White said. “We had had a gentleman’s agreement (between the House and Senate) earlier in the session to negotiate a budget by April 15. That didn’t happen … We are not going to do everything last minute with no time for our members to read things and ask questions. We are not going to do it in the middle of the night.”

READ MORE: Senate negotiators a no-show for second meeting with House on Medicaid expansion

The post Lawmakers negotiate Medicaid expansion behind closed doors, hit impasse on state budget appeared first on Mississippi Today.

Legislation that strips significant power from the board that governs the state’s public employee pension program has passed both chambers of the Legislature.

Under the legislation set to go to Gov. Tate Reeves during the final days of the 2024 session, the Public Employees Retirement System Board would no longer have the authority to increase the contribution rate levied on governments (both on the state and local level) to help pay for the massive retirement system.

The legislation, which passed both chambers in recent days, was a reaction to the decision by the board to increase by 5% over a three-year period the amount local governments contribute to each employee’s paycheck for their retirement. Under the PERS Board plan, the employer contribution rate would have been increased to 22.4% over three years, starting with a 2% increase on July 1.

The board said the increase was needed to ensure the long-term financial stability of the system that pays retirement benefits for most public employees on the state and local levels, including staff of local school districts and universities and community colleges.

City and county government officials in particular argued that the 5% increase would force them to cut government services and lay off employees.

Under the bill passed by the Legislature there still would be a 2.5% increase over five years — a .5% increase in the employer contribution rate each year for five years.

In addition, legislative leaders said they plan to put another $100 million or more in state tax dollars into the retirement system in the coming days during the appropriations process.

Under current law, the PERS Board can act unilaterally to increase the amount of money governmental entities must contribute to the system. But under the new bill that passed both chambers, the board can only make a recommendation to the Legislature on increasing the employer contribution rate.

The PERS Board also would be required to include an analysis by its actuary and independent actuaries on the reason the increase was needed and the impact the increase would have on governmental entities.

In the 52-member Senate, 14 Democrats voted against the bill. Only one House member voted against the proposal.

Sen. David Blount, D-Jackson, said the bill failed to address the financial issues facing the system. He said a permanent funding stream is needed.

Blount said, “You are moving in the wrong direction and weakening the system” with the bill the Legislature approved. “Is it painful? Is it going to cost more money? Yes, but we need to do it” to fix the system.

The system has assets of about $32 billion, but debt of about $25 billion. But Sen. Daniel Sparks, R-Belmont, and others argued that the debt was “a snapshot” that could be reduced by strong performance from the stock market. The system depends on its investments and contributions from employers and employees as sources of revenue.

The system has about 360,000 members including current public employees and former employees and retirees.

The legislation states that no changes would be made for current members of the system. The legislation does reference looking at possibly changing the system for new employees. But that would be debated in future legislative sessions.

The bill does not include an earlier House proposal to dissolve the PERS Board, which consists primarily of people elected by the members of the system, and replace them with political appointees.

The post Legislation to strip key power of PERS Board passes both chambers appeared first on Mississippi Today.

Kathleen O’Beirne knocked loudly on Sen. Kevin Blackwell’s office door in the basement of the Mississippi State Capitol on Saturday morning.

O’Beirne, a Ridgeland resident and mother of two boys, has been closely tracking the back-and-forth debate on Medicaid expansion, which Blackwell, as chairman of the Senate Medicaid Committee, is leading for the Senate. She and a group of other concerned citizens simply wanted a word with the Republican leader.

But there was no answer at the door, and there would be no conversation. So O’Beirne and the others took blank sheets of copy paper and began writing letters. When they finished writing, they taped the letters to Blackwell’s door.

“I’m here because of the human cost of not expanding health care coverage to poor Mississippians,” O’Beirne said outside Blackwell’s office. “But I’m also here because I’m a taxpayer. And I see that our senators are about to pass up literally billions in federal tax dollars that you and I and most other Mississippians already pay. We have the chance to bring all of that money back to the state of Mississippi, but we’re about to walk away from it for no good reason.”

As O’Beirne and other Mississippians have closely followed, Blackwell has been as dug-in as any lawmaker during the Medicaid expansion fight. This week, after agreeing to hold public conference committee meetings to debate Medicaid expansion, he refused to meet a second time with his House counterparts. He has seldom engaged with House Republican leaders in private, either.

He did, however, choose to speak to a gaggle of reporters on Friday after the Senate sent a compromise plan to the House for consideration. In the interview, he drew hard lines against any additional compromise with the House, specifically around a work requirement, and even doubted whether his own plan had the necessary support from his Republican Senate colleagues.

READ MORE: Blackwell says Senate won’t budge on Medicaid work requirement

Blackwell and some Republican senators have long maintained that any expansion deal must include a requirement that Medicaid recipients work, which is a conservative policy desire that the federal government has struck down in 13 previous expansion states. Including a stringent work requirement, health care advocates and legal scholars believe, would effectively kill any expansion plan.

But in the plan the Senate put forward on Friday, they would still mandate the requirement. It would also force the state’s attorney general to sue the feds over any rejection and hope that a conservative 5th Circuit Court of Appeals allows the work requirement to go into effect. Unless a work requirement was granted by either the federal Medicaid agency or the federal courts, expansion could not go into effect under the Senate plan.

READ MORE: The unlikely Mississippi politician who could tank Medicaid expansion

However, an earlier House proposal also included a work requirement but would allow expansion to go into effect if the state could not convince the federal government to allow it. House leaders have not yet publicly responded to the Senate plan they received on Friday, but the work requirement piece has been the main topic of deliberations on that side of the building. 

The House and Senate Republican remained at an apparent impasse as of midday Saturday and adjourned for the day without giving any public updates on expansion negotiations. Both chambers were working into the evening Saturday and will work again Sunday to hammer out final agreements on a $7 billion state budget.

None of that sat right with O’Beirne, inspiring her to come back to the Capitol on Saturday and make the unannounced visit to Blackwell’s office. When asked what message she was trying to deliver to Blackwell, she said: “Well, a compromise.”

O’Beirne then summed up what she wrote in her note to Blackwell:

“I’m a recovering lawyer, so I’m used to resolving litigation. I think there’s a very obvious compromise that the Senate and the House could come to if they were willing to do the work. 

My suggestion is to keep the Senate’s work requirement. Keep the provision that says if CMS kicks back the work requirement, then the AG has to sue the feds. But also, keep the House provision that will allow Medicaid expansion to go into full effect, even if CMS kicks back the work requirement.

So you go on and you start pulling down those billions of federal dollars that help the state and people get health care coverage. Then in the meantime, let the lawyers and government officials sort out the work requirement business. To me, that’s a win-win-win. 

Now, I’m sure Lt. Gov. Hosemann, Sen. Blackwell and other leaders are mulling that over. Maybe they’ve already had that thought. To me, it’s such an obvious compromise that takes full advantage of our tax dollars. It’s not wasting our tax dollars. It’s helping communities. It’s helping hospitals. It’s helping doctors. It’s helping needy patients. It is just an all around win that I sure hope they can get to.”

Kathleen O’Beirne

Such a compromise would require some careful drafting of the legislation, experts say, and whether it checks enough boxes for Blackwell and the hard-line senators is anyone’s guess. But O’Beirne, a self-described “pragmatist,” felt led to share it with Blackwell on Saturday.

“I really do think there’s a path here,” O’Beirne said. “It seems like a very simple solution right under our noses that Senate leaders are about to pass up. How frustrating would it be to come all this way to get nothing?”

READ MORE: These Republicans wanted a Medicaid work requirement but couldn’t get approval. So they got creative.

The post A solution to the Republican impasse on Medicaid expansion appeared first on Mississippi Today.

A new school funding formula has been approved by the Legislature that, like the long-standing Mississippi Adequate Education Program, will rely on an objective mechanism to determine how much state funding is needed to operate schools.

The push to replace MAEP has been one of most contentious issues facing legislators in the final days of the 2024 session. There have been efforts for years to replace the formula by those who say the state could not afford it.

On Saturday the 52-member Senate with three dissenting votes passed on to the governor a compromise proposal to replace MAEP. The House had unanimously passed it late Friday.

“The whole point of us doing this is to make certain our school districts are treated as fairly and as best we could,” said House Education Chair Rob Roberson, R-Starkville. He said the new formula will provide additional money for poor districts and for low-income and special-needs students.

Roberson’s original bill did not include an objective funding formula, which had been the hallmark of MAEP. Senate Education Chairman Dennis DeBar, R-Leakesville, who was reluctant to rewrite MAEP, finally acquiesced, but was insistent that any rewrite include an objective formula that took out of the hands of politicians – namely legislators – the amount of money needed for the operation of local school districts.

On Saturday, DeBar told senators that if the Senate had not insisted on an objective funding formula, the Legislature could have “willy nilly” decided the level of education funding.

“This formula will allow for predictability over time. Whereas the House bill did not,” DeBar said. “It (the House plan) was a one-year thing where the Legislature could come in and decide to increase or decrease funding for education. This will hold our feet to the fire in the Legislature and ensure our schools are funded.”

House Education Vice Chairman Kent McCarty, R-Hattiesburg, told House members that the objective funding formula made the original House proposal stronger.

“I think this is a good addition to the bill,” he said. Like MAEP, the formula will be recalculated every four years and in the intervening years there will be an inflation factor added to the funding.

Under the new formula, schools will receive per student the average teacher salary divided by 14, which represents the average student-teacher statewide ratio. In addition schools will get another 20% of that amount for administrative costs, 30% for ancillary costs and money for operations and maintenance based on the three-year, per-square-foot average of the school district’s operations and maintenance costs.

On top of that, the school districts will receive additional funds for students in certain categories, such as for special-education students, those living in poverty, or living in areas of high poverty and for students who do not speak English as their primary language. The additional money provided to categories of students was a key component of the original House bill.

Like MAEP, local school districts will be required to pay a portion of the cost. But wealthier districts will be required to pay more than districts with a smaller local property tax base. No district will be mandated to pay more than 27% of the cost.

Sen. Hob Bryan, D-Amory, one of the architects of MAEP in 1997, was one of the three no votes.

While Bryan said there appeared to be good features to the new funding plan, more time was needed to study it.

“It is simply not possible to enact a funding formula for public education in this legislative session where we know what we are doing,” he said. “We don’t have enough time for people to look at the new proposal, consider alternatives.”

Bryan pointed out that if MAEP was unpredictable for school districts it was because of the Legislature’s refusal to fully fund it. He said it is possible – even likely – that the same will occur with the new formula.

MAEP had language saying the formula “shall” be fully funded, But the full funding mandate was ignored every year since the program was fully enacted in 2003 except for twice.

Under the first year of the new formula, which goes into effect with the beginning of the new fiscal year on July 1, K-12 education is supposed to receive an additional $230 million.

The additional funding will bring the education budget to $2.94 billion – about $50 million less than MAEP would have provided if fully funded.

DeBar said that based on inflation it will take about $50 million more in funds to fully fund the new formula next year.

The new formula will be called simply the Mississippi Student Funding Formula.

Sen. Angela Hill, R-Picayune, voted against the proposal because she feared that like MAEP the new formula would make a commitment over time the state could not afford. Plus, she said she was concerned about the money going to educate students who spoke English as a second language. Hill said she wanted more details on that feature of the bill.

The post Lawmakers send MAEP education funding formula rewrite to governor appeared first on Mississippi Today.

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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.

The post Blackwell: Senate won’t budge on Medicaid work requirement appeared first on Mississippi Today.

Senate leaders have agreed to expand Medicaid coverage to people earning up to 138% of the federal poverty level or about $20,000 annually as is allowed under federal law.

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

The House passed a bill earlier this session to cover those earning up to 138% of the federal poverty level. It is estimated the House bill would cover at least 200,000 Mississippians. The Senate, on the other hand, passed legislation to cover those earning less than 100% of the federal poverty level or about $15,000 per year. Senate leaders estimated their plan would have covered about 40,000 people.

During open negotiations earlier this week, House Medicaid Chair Missy McGee, R-Hattiesburg, urged her Senate colleagues to agree to expand Medicaid coverage that would result in drawing down maximum federal funds.

On Friday, Lt. Gov. Delbert Hosemann, who presides over the Senate, announced his leadership team was agreeing to cover those earning up to 138% of the federal poverty level.

Earlier this week, McGee offered a compromise where those earning less than 100% of the federal poverty level would be covered through traditional Medicaid. But those earning between 100% and 138% would be covered through private insurance policies through the federal marketplace exchange.

But the cost of those policies would be paid through state funds and federal Medicaid funds. The federal government pays 90% of the cost for those covered through Medicaid expansion, estimated to be about $1 billion a year for Mississippi. In addition, the federal government is providing incentives to expand Medicaid for the 10 states that have not. Those incentives would provide about $700 million additional funds to Mississippi over a two year period.

The original Senate plan would not have been considered ACA Medicaid expansion and would not have qualified for the increased federal funding.

In a news release, the Senate leaders said they would be willing to cover people earning up to 138% of the federal poverty level using the private insurance policies to cover those earning between 100% and 138%.

While the Senate’s willingness to provide Medicaid coverage to those up to 138% of the federal poverty level is a major step, there are still issues to be resolved as the session nears an end before Medicaid expansion is a reality in Mississippi.

Senate officials said they are still insistent that the expansion plan include a stringent work requirement and monitoring system for those covered through expansion. The Senate proposal would instruct the state Attorney General to file a lawsuit to try to overturn the federal government’s expected denial of the work requirement.

A news release from Hosemann’s office said a work requirement is “a non-negotiable element.” Under the Senate offer, Medicaid would not be expanded until the work requirement is approved either through the federal Medicaid officials or through the federal courts.

House leaders said they also want a work requirement, and included one in the original House proposal. However, should the federal government deny it — as expected — the program would still go into effect — a pragmatic move, House leaders said.

In the news release, Hosemann added, “We are hopeful a compromise is on the horizon. When people are healthy, they are working, raising their families, and contributing to their communities. Access to healthcare is a critical component of economic and workforce development efforts in Mississippi—and reforming healthcare is the right thing to do.”

The work requirement is one obstacle that must be resolved. In addition, Gov. Tate Reeves has said he would veto any bill expanding Medicaid. It would take a two-thirds vote by both chambers to override a veto. The House is expected to easily muster more than a two-thirds vote. But Reeves has been lobbying Senators hard against expansion, and the vote there is less assured.

Under current law, Medicaid in Mississippi covers the disabled, poor children and poor pregnant women, certain primarily caregivers living in extreme poverty and certain segments of the elderly population.

The Senate, when it delivered its compromise offer, also called for the House to reconsider its initial plan, which had passed the Senate by a two-thirds margin.

Senate leaders also called for the House to consider changes to the state’s original Medicaid program that the Senate had proposed earlier in the session. These changes include making it easier for severely disabled children to receive Medicaid coverage and preserving changes made last year to the hospital tax which provides additional federal money for hospitals.

Mississippi Today reporter Taylor Vance contributed to this story.

The post House, Senate close in on Medicaid expansion agreement appeared first on Mississippi Today.

National studies and experts in Medicaid expansion states refute concerns voiced in Mississippi’s legislative conference committee that costs to the state would exceed projections.

Among those dispelling that fear are experts and a former governor in Kentucky – one state Mississippi conferee and Senate Medicaid Chairman Kevin Blackwell referred to as an example of where expansion has been expensive.

One study in the National Bureau of Economic Research that analyzed state budget data over an eight-year period found that changes in state spending were “modest and non-significant” after Medicaid expansion, and “state projections (of cost) in the aggregate were reasonably accurate, with expansion states projecting average Medicaid spending from 2014-2018 within 2 percent of the actual amounts, and in fact overestimating Medicaid spending in most years.”

Senate negotiators on Tuesday said they fear more people than estimated would enroll in Medicaid under expansion, and that this would result in higher-than-estimated costs to the state. 

House Medicaid Chairwoman Missy McGee, R-Hattiesburg, reiterated that multiple studies – including one done this month on expansion’s potential impact in Mississippi by a nonpartisan research organization – found that traditional expansion would result in savings to the state, not increased costs.

The study found that traditional expansion – insuring those making up to 138% of the federal poverty level or about $20,000 annually for an individual – would cost the state nothing in the first four years of implementation, and roughly $3 million the following year. It would stimulate the economy, putting about $1.2 billion into circulation that the state would not see otherwise and creating 11,000 new jobs in Mississippi, in addition to providing health insurance for poor working people and cutting acute care hospitals’ uncompensated care costs by $164 to 191 million annually.

While Medicaid enrollment after expansion could exceed projections, that possibility was taken into account by Hilltop’s report, which estimated 95% of enrollees would be newly eligible. According to the study, about 200,000 Mississippians would enroll in Medicaid post-expansion. 

Sen. Brice Wiggins, R-Pascagoula, said he believes the Senate’s original plan is a pragmatic proposal that offers savings – “whereas 44 other states have not been that,” he said, referencing the 40 – not 44 – expansion states. The original Senate plan covers fewer people than the House plan, includes a stringent work requirement unlikely to be approved by the federal government, and doesn’t qualify for increased federal funding.

Blackwell also made a similar comment, asking his House counterpart “Have any of (the states) – I guess how many exceeded the number of population they estimated at onset? I think 40.”

Blackwell later offhandedly told a reporter he heard from a fellow lawmaker in Kentucky expansion had been expensive.

Asked what their sources were regarding their statements about Medicaid expansion costs, Wiggins referred questions to fellow conferee Sen. Nicole Boyd, R-Oxford, who declined to comment. Blackwell said he was unable to provide any sources because they “are still working on the bill” and suggested the reporter read an opinion piece by a conservative columnist whose past views have aligned with those of Gov. Tate Reeves, a Medicaid expansion opponent. 

Dr. Ben Sommers, a health economist and primary care physician based in Boston, is the author of the National Bureau of Economic Research study that found minimal changes in state spending in expansion states. He shared three additional publications with Mississippi Today that show there is no evidence of expansion negatively impacting state budgets.  

“There’s a difference between saying that enrollment was higher than expected and that the state budget impact was worse than expected. More people enrolling than projected doesn’t mean that states lost money … expansion states were able to bring in 90% federal funding which often replaced things like behavioral health and uncompensated care spending that the state was previously paying for with 100% state dollars,” Sommers told Mississippi Today.

Morgan Henderson, one of the authors on the Hilltop report, echoed Sommers. And even with a lower matching rate from the federal government in current years, Henderson, who has a PhD in economics, believes the costs to states are still offset by other benefits.  

“Higher enrollment than expected in the expansion group can lead to higher costs than expected, but this relationship likely won’t be one-for-one. More new enrollees can also mean more cost offsets – such as premium tax revenue and other state tax revenue due to the increased economic activity in the state – which significantly mitigate the costs of expansion,” he told Mississippi Today.

Experts and a former governor in Kentucky – one state Blackwell referred to as an example of where expansion has been costly – said that Sommers’ and Henderson’s characterizations are accurate for what their state experienced post-expansion. 

A study published by the University of Louisville Commonwealth Institute of Kentucky found that while Kentucky did experience an increase in its Medicaid budget, the increase has been offset by other benefits, such as savings in general state funds “related to care for vulnerable groups who were ineligible for Medicaid prior to expansion.” 

Expansion funneled $2.9 billion into the state’s health care system within the first two years, which reduced costs of charity care and collections for medical debts, the study said.

Even if the number of enrollees is higher than originally estimated, that doesn’t necessarily bode poorly for the state’s budget, Sommers said. On top of the 90% federal match and the increased federal incentives for newly expanded states, the leftover portion the state is responsible for under expansion is mitigated by increased tax revenue, reduced uncompensated care costs to hospitals, and other program cost offsets, Sommers explained.

While the state does put up a small amount of money for each new enrollee under expansion, it is less expensive than the amount of money the state pays pre-expansion to cover uninsured individuals who seek care in emergency rooms and inpatient hospital settings – the most expensive places to receive care and often the only option for uninsured people.

Mississippi hospitals incur around $600 million in uncompensated care annually. Kentucky’s hospitals saw a 64% decrease in uncompensated care costs from 2013 to 2017, according to the Center on Budget and Policy Priorities. 

“Everybody’s got heartburn over people ‘getting something they don’t deserve,’” Dr. Dustin Gentry, a rural physician from Louisville, Mississippi, and self-described conservative, said. “But they’re getting it anyway. They go to the ER, they get free care, they don’t pay for it, but that doesn’t bother anybody. But if they get Medicaid, which will actually pay the hospitals for the work they do, all of a sudden everybody’s got heartburn.”

One report estimates that nearly half of all Mississippi’s rural hospitals are at risk of closure.

And while the original House and the Senate plans both cover those in the coverage gap – those making too much to qualify for Medicaid currently but too little to afford private insurance plans – the House proposal would draw down $1 billion federal dollars the original Senate plan would not, since it is not considered true “expansion” according to the Affordable Care Act. That means the state would have to shell out more money, receiving its typical 77% federal match instead of 90%, and would not qualify for the additional funds that would make expansion free to the state for the first four years under the House plan. 

In the last 10 years, as 40 states have chosen to expand Medicaid to cover the working poor, the poorest and sickest state has held out. 

After leaving House conferees alone at the negotiating table Thursday afternoon, the Senate announced its own compromise plan Friday morning. The option extends coverage to those making up to 138% of the federal poverty level and draws down the maximum amount of federal dollars available.

Lawmakers have until Monday to pass a final bill, according to current deadlines.

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