Mississippi: Schrödinger's Medicaid Expansion passes MS Senate!

February 16th:

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...

...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.

Of course, as one Alabama-based advocate put it...

Mississippi better not beat us to expand.

— Jane Adams (@janeadamsid) February 16, 2024

Well, it looks like Ms. Adams may end up being disappointed...

BREAKING: The Mississippi House just passed Medicaid expansion by a 96-20 vote.
That's more than enough to overcome a veto from Gov. Tate Reeves.
It now heads to the Senate.

Background: https://t.co/exDyzFAcJX

— Ashton Pittman (@ashtonpittman) February 28, 2024

From the linked article in Pittman's tweet:

Mississippi is one step closer to what would be a landmark shift in health care policy, with the Republican-led House preparing to debate expansion of Medicaid benefits to hundreds of thousands more residents in one of the poorest states in the U.S.

The House Medicaid Committee on Tuesday advanced the bill, which would increase eligibility for Medicaid, a health insurance program that covers low-income people. Those making up to 138% of the federal poverty level, or $20,120 annually for a single person, would be eligible under the proposal. The measure could extend benefits to about 250,000 people.

...McGee touted a financial incentive for expanding Medicaid provided by Congress in the American Rescue Plan. The bonus helped with the passage of Medicaid expansion in North Carolina.

As I noted at the time, however, there's one rather large elephant in the room: The bill includes work requirements, which have consistently been a non-starter under both the Obama and Biden Administrations. There's one Trump-era approved exception to this which managed to slip through the cracks in Georgia, except that...

...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.

Annnnd sure enough, that seems to be what's going on here...except there's a couple of interesting twists.

For starters, there's this eyebrow-raising buried lede in the MS House version of the bill:

To Provide If The Waiver As Described In This Act Is Not Substantially Approved Before September 30, 2024, Or If The Waiver Is Approved But Is Subsequently Terminated, Then The Division Shall Allow For Medicaid Coverage In Mississippi For Individuals Described In The Federal Affordable Care Act, To Be Known As The Healthy Mississippi Works (hmw) Category Of Eligibility, And Shall Move With All Deliberate Speed To Submit The Required State Plan Amendments To Effectuate Medicaid Coverage For Those Individuals

In other words, under the House-approved version, Mississippi would go ahead with expanding Medicaid whether the work requirement provisions are approved or not...and since the Biden Administration is obviously opposed to work requirements, why on earth would they approve them if the state is gonna just expand Medicaid either way??

Well, cut to yesterday:

BREAKING: MS Senate passes a Medicaid expansion bill with a veto-proof majority, 37-15. While the Senate bill does not fully expand Medicaid we expect it to head to a conference committee so they can work with the House. This is BIG!

— Lucy C. Dagneau (@thelucygoose) March 28, 2024

OK, so how big is it? Well...not quite as big as Dagneau indicates, although the fact that it passed the MS Senate at all, especially by a veto-proof majority (turns out it was actually 36-16) is pretty big in & of itself.

HOWEVER...for one thing, the Senate version only expands Medicaid up to 100% of the Federal Poverty Level (instead of 138% FPL, which is what every other expansion state has done and is what the ACA generally requires for expansion approval). In Mississippi's case, according to KFF, this would mean only around 74,000 residents would become newly eliglble for Medicaid instead of 123,000. This is what Wisconsin did a decade ago; they were able to do so by not expanding the program through the ACA itself but by expanding their existing Medicaid program...which requires the state to pay around 1/3 of the cost of doing so, vs. full ACA expansion where they'd only have to pay 10%.

The second, and more damning poison pill, is once again the work requirement (or, more accurately, the proof-of-work-requirement) provision. As reported in the Mississippi Free Press:

...The Senate version would require people to work at least 30 hours per week to become eligible for expanded benefits, up from the 20-hour work requirement approved by the House. Blackwell said the Senate made that change because it ensures able-bodied adults would need to work “basically full time” to receive Medicaid.

Mississippi ranks at the bottom of virtually every health care indicator and at the top of every disparity. Hospitals are struggling to remain open. The state also has one of the nation’s lowest labor force participation rates. Expansion proponents have said the policy could help improve these conditions.

...Republican legislature leaders have said Georgia offers a model for Mississippi to pass a narrow version of Medicaid expansion.

...Georgia’s program has seen abysmal enrollment. Only 2,350 people enrolled in the program from July 1 to mid-December, far fewer than the 100,000 that Gov. Brian Kemp’s administration projected the program might cover.

Oh yeah...one more thing about Georgia's pathetic "Pathways" program:

Georgia Gov. Brian Kemp’s plan for a conservative alternative to Obamacare’s Medicaid expansion has cost taxpayers at least $26 million so far, with more than 90% going toward administrative and consulting costs rather than medical care for low-income people.

...Since July, when the program began, about 3,500 people have signed up, according to state officials. That’s a small fraction of the Georgians who could enroll if the state expanded Medicaid without such requirements.

I mean, that's an improvement over 2,300, anyway...

...The state projected that administrative costs will increase to $122 million over four years, mostly in federal spending, as it rolls out key features of the program, including the collection of premiums and verifying enrollees’ eligibility, according to an internal planning document dated December 2022 obtained by KFF Health News. The primary consultant for the project is Deloitte, which is collecting hefty fees.

...In striking contrast, North Carolina has enrolled 380,000 beneficiaries in its Medicaid expansion as of March 1, according to that state’s Department of Health and Human Services.

Oh.

Anyway, the Mississippi bill now heads to "conference" with the previously-passed state House version. The final version will presumably split the difference between the bills. The real question is whether it will include the House version's "escape hatch" wherein it goes through whether or not the work requirement provision is approved or not.

Stay tuned...