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Mississippi Senate unveils Medicaid...

Mississippi Senate unveils Medicaid expansion plan

By: Sarah Ulmer - March 27, 2024

Senator Kevin Blackwell, Chair of Senate Medicaid Committee

  • With a strike-all removing the House language, the Senate plan would require the approval of a work requirement waiver by CMS for any expansion to occur.

On Wednesday, the Mississippi Senate officially unveiled their version of a Medicaid expansion proposal.

The Senate Medicaid Committee inserted the chamber’s language in strike-all of the House bill, which differs significantly from the House’s original version.

The Senate Medicaid expansion plan hinges on the Center for Medicare and Medicaid Services (CMS) approving a work requirement waiver for individuals who could be eligible under the proposal. The House plan would have expanded Medicaid up to 138% of the Federal Poverty Level (FPL), but the Senate plan only provides for an increase of up to 99%.

The Senate plan provides coverage to individuals in the “coverage gap” who are working a minimum of 30 hours per week. Individuals are only eligible if they do not have access to a private health plan through an employer, are enrolled as a student or in a workforce development program, declared disabled by a medical professional, or are the primary caretaker of a child under the age of six.

State Senator Kevin Blackwell (R), chairman of the Senate Medicaid Committee, said it is estimated that this will increase eligibility to roughly 80,000 people and anticipates that around 40,000 will take advantage of the new Medicaid availability.

“This is the conservative approach,” said Sen. Blackwell. “It’s significantly different. We have a conservative plan over here; the House bill was basically straight up expansion.”

The Kaiser Family Foundation recently estimated that 74,000 people are in the “coverage gap” with an estimated 45 percent currently working.

When questioned why the Senate proposal increased the work hour requirement from 20 to 30 hours, Senator Blackwell said it was to get closer to a full-time job requirement.

If passed, it will be up to the Mississippi Division of Medicaid to verify and monitor that the work requirement caveat is being followed for this new population should the waiver be approved by CMS.

Blackwell said there is no timeline for when CMS must approve the waiver, but it does require the Division of Medicaid to submit the waiver request within 120 days. Sen. Blackwell said by the time the decision is made by CMS he hopes a new President will be in office, a nod to the fact that the Biden Administration has rejected work requirements.

Unlike the House plan, someone earning between 100-138 percent of the FPL would be ineligible for Medicaid under the Senate plan. Senator Blackwell said those individuals between could remain on the Affordable Care Act (ACA) exchange, participating in private health plans that are federally subsidized already. It is estimated that this group accounts for roughly 140,000 people. Blackwell said this will help hospitals long-term since a large portion of people will remain on the exchange with private plans.

“It’s going to help Mississippians; it’s also going to help hospitals because now you’ve got a new group that otherwise didn’t have insurance now will have insurance. By not taking the people off the exchange the hospitals are going to do better because the exchange pays about 40 to 42 percent better than Medicaid does,” said Senator Blackwell.

The House plan would have drawn down additional federal dollars due to a larger expansion population, but the Senate plan will not. Therefore, the FMAP for Mississippi will not change because the Senate Plan does not expand to 138 percent of the FPL. It will not draw down the enhanced federal contribution that full expansion would have, but the smaller population of new enrollees is expected to cost the state less than full expansion.

The federal government currently pays 77% to Mississippi’s 23% of Medicaid coverage.

Senate Medicaid Vice Chair Nicole Boyd (R) said the chamber is committed to looking for a solution to health insurance coverage for working Mississippians.

“We have looked at bills across the country, legislation across the country, and we feel like this is the best path to help our working Mississippians,” said Boyd.

Critics of the plan believe Medicaid should be expanded up to the 138% of the FPL and say not doing so is “money being left on the table.” However, Senator Boyd disagreed. She told reporters the federal government already supplements plans on the ACA exchange between the 100% and 138% dramatically, adding that many states who moved to expand Medicaid did so before the exchange plans were fully supplemented.

“We aren’t leaving as much money on the table as people assume we are because basically the federal government supplements those plans from 100 to 138 percent,” said Boyd.

State Senator John Horhn (D) was not fully pleased with the Senate proposal but he said what has been put forward is better than nothing. Horhn indicated in committee that if the Senate was committed to helping the “working poor,” they would start by lowering the weekly work requirement hours from 30 back to 20.

“I think we are making some progress in getting Medicaid expansion approved in the state of Mississippi but it’s not the bill I would have liked,” said Horhn, noting that if the bill is left as it is, he ultimately did not believe CMS would approve it.

Horhn believes as many as 300,000 people would be eligible if the Legislature adopted full expansion.

Governor Tate Reeves took to social media following the Senate committee meeting to reiterate his opposition to Medicaid expansion. He said the numbers he has been given would indicate that only 72,000 are in the coverage gap, with estimates indicating only 35% or 25,200 of those currently employed.

Reeves said the higher numbers come when considering the other exceptions in the bill for caregivers and disabled individuals.

“The Devil is always in the details. And the details prove that this Senate bill is not for the ‘working poor.’ It is welfare expansion to those able-bodied adults that could work but choose not to,” Governor Reeves said. “The Senate bill is still bad policy. And so I will continue to do what I told the voters I would do – fight Obamacare Medicaid Expansion with every ounce of my being.”

The legislation now moves to the full Senate for consideration.

About the Author(s)
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Sarah Ulmer

Sarah is a Mississippi native, born and raised in Madison. She is a graduate of Mississippi State University, where she studied Communications, with an emphasis in Broadcasting and Journalism. Sarah’s experience spans multiple mediums, including extensive videography with both at home and overseas, broadcasting daily news, and hosting a live radio show. In 2017, Sarah became a member of the Capitol Press Corp in Mississippi and has faithfully covered the decisions being made by leaders on some of the most important issues facing our state. Email Sarah:
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