Mississippi: Welp. Medicaid expansion dies due to Senate GOP work reporting demand

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.

February 28th:

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

Unfortunately, as reported in the Mississippi Free Press on March 28th:

...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.

April 30th:

NEW: The Mississippi House & Senate have reached a compromise to expand Medicaid. But it includes a mandatory work requirement — something the Biden admin will never approve. It requires the state to keep applying each year until CMS approves it with the work requirements.

...Even if the work requirement *was* approved, it contains a provision killing Medicaid expansion if a future administration comes in and tries to strip work requirements.

— Megan Messerly (@meganmesserly) April 30, 2024

From the text of the bill itself:

(i) Employed for at least one hundred (100) hours per month in a position for which health insurance is not paid for by the employer;
(ii) Enrolled as a full-time student in secondary or post-secondary education;
(iii) Enrolled full-time in a workforce training program;
(iv) Enrolled for at least six (6) credit hours, or its equivalent, as a student in secondary education, post-secondary education, or a workforce training program and is employed for at least sixty (60) hours per month in a position for which health insurance is not paid for by the employer;
(v) The parent or guardian and the primary caregiver of a child under six (6) years of age;
(vi) A person who is physically, mentally or intellectually unable to meet the requirements of subparagraphs (i) through (iv) of this paragraph (a) as documented by a medical professional; or
(vii) The primary caregiver for a disabled child, spouse or parent, provided that such disabled person qualifies for  Medicaid coverage in accordance with the federal Social Security  Act.

As has been pointed out time and time again, the vast majority of those enrolled in Medicaid expansion already fall into one of those categories, so it's really a work reporting requirement, which has been proven to involve massively complicated administrative costs for the state to track and a huge administrative burden for the enrollees, thus causing enrollment to be a tiny fraction of what it would otherwise be, which mostly defeats the entire point of the program.

Had the final version of the bill passed (with a veto-proof margin, since GOP Governor Tate Reeves is still opposed to it even with the work requirements), it would have put the Biden Administration in quite a bind, as they would've been forced to either....

  • Approve the waiver including the work requirement provision, which would set a precedent for every other GOP-controlled state to pounce on as well (including those whose existing expansion waivers expire over the next few years); or...
  • Shoot down the work reporting requirement provision of the bill, which would allow Mississippi Republicans to then try to pin the blame on him for expansion not happening.

HOWEVER, in the end this was all moot:

Medicaid expansion effort collapses in Republican-led Mississippi Legislature

JACKSON, Miss. (AP) — Medicaid expansion efforts fizzled and died Thursday in Republican-led Mississippi because top lawmakers could not agree on a final proposal to send to the House and Senate.

...House and Senate negotiators released a proposal Monday to expand Medicaid to tens of thousands more people, but it included a work requirement. House Democrats balked before the plan could come up for a vote, saying it was Medicaid expansion in name only because the federal government has blocked several states from having such mandates.

The House offered a new proposal Thursday to would put two questions on the ballot this November: Should Mississippi expand Medicaid? If so, should the expansion include a work requirement?

This was actually a perfectly reasonable idea, and I give White praise for doing so. Unfortunately...

Hosemann said the proposal to put Medicaid expansion on the ballot “was not well received” by Senate leaders. He said senators were firm about having a work requirement “with necessary exceptions.”

Annnnd that's that until 2025.

Stay tuned...