Medicaid expansion dies in Mississippi Legislature

Despite months of work from both House and Senate lawmakers to expand Medicaid, the legislation that could have given about 200,000 working poor Mississippians healthcare has died.

After House and Senate negotiators agreed on a compromised iteration of House Bill 1725 Monday, and after both chambers sent the bill back for further negotiations on Wednesday, the Senate members did not sign the House's final proposal that was hand delivered Thursday morning.

That inaction killed the bill by an 8 p.m. Thursday legislative deadline.

That final version was presented to the Senate Thursday morning after House Speaker Jason White announced his team was submitting a voter referendum to the Senate, which would have allowed lawmakers to put Medicaid expansion on the November election ballot. It also would have included an option for voters to decide if that program should include a work requirement.

However, that idea was met with a cold shoulder from Lt. Gov. Delbert Hosemann, who said about an hour later that the idea was shot down by several members of the Senate.

White said he was disappointed by the Senate's inaction, and he said that he had not heard back from any Senate leadership regarding the voter referendum as of Thursday around 5 p.m.

"I had my doubts about it, but I was told they were receptive, potentially, to this route," White said. "Mississippians could once and for all weigh in on the issue. I'll admit, that intrigued us and it certainly was a road I was willing to go down. Certainly healthcare is still a priority. Unless you will see a change or some difference, I don't see a path forward today."

House Medicaid Committee Chairwoman Missy McGee, R-Hattiesburg, told the Clarion Ledger she had heard nothing from Senate Medicaid Committee Chairman Kevin Blackwell, R-Southaven, at all regarding the new proposal.

McGee also alluded to an erosion of support for the bill after House Democrats said they would not vote for the current expansion that both Senate and House negotiators agreed to on Monday.

"I just think it's disappointing that we have not been able to get this across the finish line," McGee said. "We filed a conference report on Monday that we obviously both agreed on, because we both filed it and believed that we had the votes. Then our Democrats decided that they could not support it, which was very surprising to us on that day. All I can say is it's disappointing, but I can leave here saying that we gave it everything that we absolutely had."

On Thursday morning, Hosemann told reporters the legislation was dead and that he hopes to bring it back up next year. That move will leave between thousands of people without Medicaid and the state's voters without an opportunity to vote on the issue themselves.

"In my mind, we've left 74,000 people working that could have had health care coverage in Mississippi," Hosemann said. "We didn't give him that. So, Bill No. 1 coming back here, that's going to be that."

Where Medicaid debates went throughout the 2024 session

Since early in the session, the House and Senate had two different approaches in expanding Medicaid.

The House originally passed a bill expanding Medicaid coverage for those making up to 138% the federal poverty line, or about $20,000 per year. The proposal would have also brought a $600 million per year incentive from the federal government, as well as 90% to 10% funding match to implement the program.

The plan also included a 20 hour per week work requirement, but if the Centers for Medicare and Medicaid Services did not approve of it, the state would expand Medicaid anyway.

The Senate later passed a version of HB 1725 that only expanded Medicaid for those making up to 99% FPL, or about $15,000 per year for one person, and it also included 120 hour per month work requirement. No federal incentives would be given to that plan.

Those two plans eventually came to a middle ground by Monday night after several different proposals had been swapped. The plan covered people making up to 138% FPL, utilized federal match funds and would have expanded Medicaid for possibly up to 200,000 people.

It also included a provision that would make the Mississippi Division of Medicaid reapply for work requirement waiver from CMS every year until it was approved.

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After the compromise had been reached to keep Medicaid expansion alive Monday night, House Democrats, who had long voiced opposition to a work requirement, said they would vote against any expansion plan with one.

In a rare time when Democrats wielded enough power to prevent a two third veto proof majority and three fifths necessary vote to pass in the Senate, Republican leadership could not come to a final agreement.

House Minority Leader Robert Johnson told the Clarion Ledger that they preferred the Medicaid negotiators to either come back with a compromise that Democrats would vote for, or he would rather see the legislation fail this year.

read about House opposition MS House Speaker wants voters to choose whether to expand Medicaid

That compromise would have either removed the provision for MDM to keep applying for a work requirement so the bill would die and lawmakers can try again next year, or a removal of the work requirement in HB 1725.

Hosemann's Deputy Chief of Staff Leah Smith said in a statement Thursday evening that with the opposition of House Democrats, Hosemann's attempt to whip more votes for expansion died on the vine.

"The Senate was working to secure the votes, but that effort stalled when House Democrats indicated they did not support the bill," Smith said.

What happens next with Medicaid expansion

Both Hosemann and McGee expressed interest in continuing the Medicaid discussion in the off season, which runs from May through December.

"I will still support Medicaid expansion," McGee said.

White, however, said there were other legislative priorities to consider over the next few years. Whether that will be Medicaid expansion is not clear, he said.

"We'll reassess the entire session in the coming days and figure a path forward," White said. "There are lots of other things that the House Republican caucus wants to do over the next three years that don't include Medicaid expansion. At some point, the caucus is going to pivot to those priorities and those things."

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: Medicaid dies in MS Legislature