Senate leaders this week are trying to drum up votes for a Medicaid “expansion light” proposal that would cover far fewer uninsured Mississippians — about 49,000 less — than a House-passed bill and would leave hundreds of millions of federal dollars on the table.

Joan Alker, executive director of Georgetown University’s Center for Children and Families and a Medicaid expert, told Mississippi Today that the Senate’s approach would do little to address Mississippi’s need for a healthy workforce and very few people who need health insurance coverage to protect them from high medical bills would get it.

“It is also a very fiscally irresponsible approach for Mississippi’s taxpayers as the state would be turning down $690 million that the federal government has put on the table for Mississippi’s health care system,” Alker said.

A draft of the Senate proposal was provided to Mississippi Today on Wednesday. Senate leaders have said for weeks they had a Medicaid plan forthcoming, but it has yet to be made public or presented for a committee vote. The House passed its HB1725 expansion bill in February.

The Senate draft proposal would:

• Cover working Mississippians up to 99% of the federal poverty level. For an individual that would be an annual income up to $15,060. For a family of four that would be an annual income up to $31,200.
• Not cover those making between 100% and 138% of the FPL — not even through a private-care option. A plan that doesn’t cover people making up to 138% is not considered “expansion” under the Affordable Care Act, meaning Mississippi wouldn’t qualify for the 90% federal match rate that the ACA grants to new expansion states, nor the additional, two-year 5% increase in match rate the federal government provides to newly-expanded states under pandemic relief spending passed by Congress. Instead, as was the case with Georgia, Mississippi would only get its regular federal Medicaid rate of about 77%.
• Leave the health insurance exchange, the online marketplace that offers federally subsidized plans to people who make between 100% and 138% of the FPL, intact. The Senate plan, unlike Arkansas’ Medicaid expansion, would not provide extra subsidies from the state’s federal Medicaid money available from the ACA.
• Include a work requirement mandating at least 120 hours of employment a month in a position for which health insurance is not paid for by the employer. That’s more stringent than Georgia’s plan, which mandates 80 hours a month. There are several exemptions, such as for full-time students or parents who are the primary caregiver of a child 6-years-old or younger.
• Go into effect 30 days after CMS approves a waiver necessary for the work requirement. That’s unlikely to happen under the Biden administration, which has rescinded work requirements previously approved for other states during the Trump administration and has not approved new ones. If CMS denies the waiver, Mississippi would have to wait until a new administration took office, or sue the Biden administration. Georgia remains in litigation with the federal government over the work requirement issue, and has suffered low enrollment and missed out on millions in federal funds by not fully expanding coverage.
• Require anyone who voluntarily dropped private insurance to wait 12 months before applying for Medicaid coverage.

Senate Medicaid Committee Chairman Kevin Blackwell, a Republican from Southaven who authored the proposal, declined to comment on the substance of the proposal, but he stressed to Mississippi Today that he and Senate leaders are still tweaking parts of the legislation.

Since the Senate let its own Medicaid bill — which was a “dummy” with no details — die, the House measure is the only expansion still alive this session. The Senate Medicaid Committee is expected to insert the Senate proposal as a “strike-all” amendment.”

While House Bill 1725 – which overwhelmingly passed the House – also has a work requirement, it is only a “best-case scenario.” The bill has a provision that if federal authorities do not approve the waiver necessary to allow a Mississippi work requirement by Sept. 30, 2024, Medicaid would still be fully expanded to people up to 138% of the federal poverty level, starting in January 2025. That means under the House plan, Mississippi would receive the 90% federal match, as well as an additional nearly $700 million that would make expansion free to the state in the first two years of its adoption.

Since the Senate plan is drastically different than the House proposal, a final version would almost certainly be hammered out later in the session in a conference committee.

Blackwell’s proposal would insure less people, but his plan could be a way to convince more Republican senators, who have been more skeptical about expansion than their House counterparts, to vote in favor of the legislation.

READ MORE: Inside Mississippi’s coverage gap, workers say health care is a ‘pipe dream’ or ‘whimsical idea’

The realpolitik is any final plan would have to pass the House and Senate by a two-thirds majority to show it has the potential to override a potential veto from Republican Gov. Tate Reeves.

Reeves has privately told senators that he plans to veto a Medicaid expansion bill if it reaches his desk and has been a vocal opponent of expanding Medicaid coverage.

The deadline for the bill to pass Senate committee is April 2, with an April 10 deadline to pass the Senate floor.

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