Mississippi Medicaid expansion bill likely heading to added committee for compromise

As of Thursday afternoon, the Mississippi Senate and House have passed different versions of Medicaid expansion, and the Senate's amended bill is expected not to be accepted by House members, Legislative leadership told the Clarion Ledger on Friday.

House Speaker Jason White, R-West, said that despite key differences between the House and Senate plan, it took 10 years just to have the current debates in the Republican-dominated Legislature and that expanding Medicaid for some people is better than expanding for no one, noting a 120,000-person gap between the House and Senate version.

The debate between lawmakers in Mississippi also mirrors a struggle within the North Carolina Legislature, which also has a Republican majority. That legislative body passed Medicaid expansion last March.

"I think any coverage for any Mississippians who are without it in a way that does not cost the taxpayers or cost the taxpayer very little, is notable and worth exploring," White said.

After North Carolina voted to expand its Medicaid program last March, the program went into effect in December. According to the North Carolina Department of Human Services, people ages 19 to 64 who make up to 138% of the federal poverty line, or about $20,000 per year for one person, are eligible to receive Medicaid.

As a part of North Carolina plan, 600,000 additional people were expected to enroll as a result, a large difference from Mississippi's plan, which accounts for 80,000 people, Sen. Kevin Blackwell, R-Southaven, said Wednesday.

Rep. Donny Lambeth, a Republican serving in the North Carolina House of Representatives, said he pushed for Medicaid expansion for years, and what finally convinced other GOP members to finally agree was a mixture of legislation in 2021 to improve the state's Medicaid program after the onset of the COVID-19 pandemic and gubernatorial support.

"We've worked on this for 10 years … It didn't happen overnight," Lambeth said. "That's something I've tried to tell other states is that you got to be patient. It does take time, because we had to answer a lot of questions and concerns to get our general assembly to move to approve it."

Lambeth said many North Carolina lawmakers had been receiving ever-increasing support for expansion from their constituents, himself included.

"I had tree farmers from our mountains, and I've had strawberry farmers from the east (ask about Medicaid expansion)," Lambeth said. "I had people come up to me in the General Assembly, and I'd be in the cafeteria, or be walking down the hallway, and they would say, 'I'm going to lose my family farm, because I have no health insurance."

In Mississippi, that same push for Medicaid from constituents is what finally changed the minds for many lawmakers during the 2023 state elections, White said.

"This really was kind of an organic thing that came out of this last election cycle," White said. "We've got 40 out of 50 states that have (expanded). It's going to be with us. There's not another product coming down the line that's going to cover this set of low-income workers."

That support from lawmakers has resulted in both chambers passing a version of Medicaid expansion with a veto proof two-thirds majority.

What have neighboring states done with Medicaid expansion?

Several of Mississippi's surrounding states have voted to expand their Medicaid programs, including Georgia, Arkansas and Louisiana.

In Arkansas, the state expanded in 2016 for a five-year term and then again 2022 with a plan for very low-income residents. The plan actually features partnerships with private insurance companies.

In Arkansas, people making about $25,000 a year, who are between ages 21 and 65 with low income and who are physically or mentally disabled are eligible. Currently more than 200,000 people are enrolled in Arkansas' Medicaid program, according healthinsurance.org.

In Louisiana, the state expanded it's program to 138% of the federal poverty line in 2016, thanks to an executive order from former Democratic Gov. John Bel Edwards. Since expanding, the program has helped more than 600,000 Louisiana beneficiaries receive health insurance.

In Louisiana, people eligible for it's Medicaid program include those making less than $25,000 per year ages 19 to 64, pregnant women, children younger than 19 years old, parents of children less than 19 years old and disabled people who receive Social Security Administration benefits via its security supplemental income program.

Georgia, which voted to expand Medicaid in 2021, had its proposal rejected by the federal government under the President Joseph R. Biden Administration and has since sued to reinstate it. Even though Georgia won that case, the issue is still being settled in court. Georgia stands as the only state with a Medicaid Program that has a work requirement.

To be eligible in Georgia, you must be between 19 and 64 years old and work 80 hours per month or be a full-time student. Pregnant women and people with certain disabilities also are eligible.

What is the Mississippi Medicaid plan?

On Thursday, the Senate voted to send House Bill 1725 back to the House to consider several key amendments. As the Senate version stands, it would do the following:

• Cover people ages 19 to 64 making up to 99% of the federal poverty line, or about $15,000 per year, which is 39% lower than the original House version. The plan would also cost the state more than $20 million per year to implement, while the House plan would provide $1.2 billion federal aid provided to states that fully expand for the first two years of the program.

• Require people on Medicaid to work 120 hours per month, be a full-time student or in a work training program, 40 hours more than in the House plan.

• Require the Mississippi Division of Medicaid to confirm eligibility every three months, which the House plan does not account for.

• Cover about 80,000 of the state's working poor, which could be 120,000 less people than the House plan.

• Include some eligibility exceptions for parents and caregivers for children 6 years old or younger and those with proven physical or mental disabilities that prevent them from working. The House version accounted for working people who are disabled.

Read about Senate's Medicaid plan here Mississippi Senate passes Medicaid 'expansion lite,' banks on Trump victory in November

What do Mississippi House members think of the new version?

Democratic members in the House and Senate on Thursday voiced opposition to HB 1725 as it is currently written, even though they said they would vote for it anyway.

During a press conference held Thursday morning, House Democratic Caucus leader Rep. Robert Johnson, D-Natchez, said he hopes there are future changes made to the bill after the House sends it to conference, which is when one chamber disagrees with changes made to a bill, and a group of lawmakers from both the Senate and House meet to iron out a compromise or let a bill die.

"I just think after 14 years of saying no, we (will) pass a plan that says no, and that's essentially what we're doing," Johnson said. "If we really are trying to make sure we save hospitals, when we're trying to cover working people. The federal government says (to expand) at least up to 138% of poverty level, which is a single person making $25,000 a year. We got to be willing to do that."

In a press conference after the Senate voted 26-16 in favor of expansion, Sen. Derrick Simmons, D-Greenville, told reporters he will be working with Lt. Gov. Delbert Hosemann to make sure Democrats are given seats on the conference committee to make sure some of those changes happen.

"We certainly as Senate Democrats wanted to keep the bill moving," Simmons said. "We know that Mississippi is in a healthcare crisis, and Medicaid expansion is the way to go. This bill was not perfect. We would love to see more individuals covered. We would love not to have hurdles or any restrictions on additional access to health care coverage, but we did not want to lose an opportunity to keep this vehicle alive as we work through this process."

White said Friday that no matter what happens next, he believes Senate and House lawmakers will work together to expand Medicaid for at least some Mississippians.

"The fact is that they recognize just like we recognize that there is a coverage gap, and that we do have a problem in Mississippi, and so as far as changes or conference, or what we'll do, we'll get their bill back, and we'll look at it closely," White said. "If you look really closely at it, the House plan may actually cost the taxpayers of Mississippi less money than (the Senate) plan, but I'm not throwing shade on their plan, and I'm excited about the fact that they have leaders down there who recognize the need."

Read more about House Medicaid version Mississippi House passes state's first Medicaid expansion bill

Grant McLaughlin covers state government for the Clarion Ledger. He can be reached at gmclaughlin@gannett.com or 972-571-2335.

This article originally appeared on Mississippi Clarion Ledger: Mississippi Medicaid expansion struggle mirrors one in North Carolina