Mississippi: We may have a winner! Or...maybe not?

Just a week ago, I posted...

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

And just a few hours ago, I posted a piece headlined, "Which Holdout State Will Be Next To Finally Expand Medicaid??"

Well, it looks like we may have our answer already. Via Ashton Pittman of the Mississippi Free Press:

A Medicaid expansion bill will arrive in the Mississippi Senate by Monday, beginning a process that could provide health care to about 230,000 working Mississippians, Lt. Gov. Delbert Hosemann says.

The Republican senate leader shared plans to introduce a bill before Monday’s legislative deadline for introducing new legislation in an interview with Mississippi Today reporter Sophia Paffenroth on Thursday. Hosemann, who has in the past expressed a preference for the term “Medicaid reform” over “Medicaid expansion,” said in the interview that the bill would likely include work requirements, as other Republican-led states have done when expanding the program. He also touted it as good for business.

Hmmmm...on the one hand, most of those prior work requirement provisions have been struck down by the courts. On the other hand, one of them slipped through in Georgia, although that version has only managed to enroll a few thousand people after over six months. I'm guessing whatever bill goes through in Mississippi would either be some other type of partial expansion or, if it fully expands the program, would be intended to challenge the Biden Administration on the work requirement provision, hoping to force him to either approve it as is (opening up the floodgates for other red states to start imposing them as well again) or shoot it down & then presumably be blamed for expansion not going through in the state at all.

The reason that Georgia's program managed to survive the courts while other states work requirement programs didn't hinged on two points:

  • The Georgia waiver had already previously been approved by the Trump Administration; and...
  • Unlike the other states, Georgia's program was making a new population eligible for coverage, as opposed to changing the eligibility rules for an existing population (bait 'n switch)

In this case, Mississippi would comply with the second bullet but not the first, so it really does sound like the Biden Administration would have to decide whether to agree to work requirements or not have Mississippi expand at all.

On a related note, Louise Norris notes a different Medicaid expansion bill has also been introduced in Mississippi which sounds a lot more acceptable to Biden officials...but likely wouldn't win over work requirement-loving Republicans:

An additional bill (HB1146) was introduced in February 2024, and takes a different approach than regular Medicaid expansion as called for in the ACA. This bill would direct the state to seek federal approval to expand Medicaid up to 100% of the poverty level (instead of 138%), and to also create a program under which the state would provide financial assistance for people enrolling in employer-sponsored health insurance or individual/family health insurance, if their household income is above the poverty level but not more than 200% of the poverty level. The assistance would help to cover some or all of the premiums and out-of-pocket costs these enrollees would otherwise face, with more assistance available to those on the lower end of the income spectrum.

It's an interesting hybrid approach which sounds a bit like what Iowa did for a few years, but since it was introduced & sponsored by four Democratic legislators I'm guessing it's DOA.