The only surviving Medicaid expansion bill in the Legislature passed the Senate Medicaid Committee Wednesday and is headed to the full Senate for a vote. 

But the proposal, as it passed the Senate committee, is not considered traditional “expansion” under the Affordable Care Act, and therefore would not qualify for the enhanced federal funding the law grants to newly-expanded states. It would leave the cost of the expanded coverage up to the state.

The Senate committee passed the House Republican bill with a strike-all, meaning it replaced the bill's original language with its own plan, which Medicaid Committee Chairman Kevin Blackwell, R-Southaven, refers to as “expansion light.”

Blackwell estimated about 80,000 people would be eligible under this version of expansion, and half of that would apply. The House plan was expected to cover more than 200,000 people.

When a draft of the Senate's bill was leaked on March 20, Blackwell stressed to Mississippi Today that he and Senate leaders were still tweaking parts of the legislation. However, the legislation that passed the committee is essentially the same as what was outlined in the leaked draft. 

The Senate proposal would:

• Cover working Mississippians up to 99% of the federal poverty level. For an individual, that would be an annual income up to $15,060. For a family of four, that would be an annual income up to $31,200.
• Not cover those making between 100% and 138% of the federal poverty threshold — not even through a private-care option. A plan that doesn't cover people making up to 138% is not considered “expansion” under the Affordable Care Act, meaning Mississippi wouldn't qualify for the 90% federal match rate that the Affordable Care Act grants to new expansion states, nor the additional, two-year 5% increase in match rate the federal government provides to newly-expanded states under pandemic relief spending passed by Congress. Instead, as was the case with Georgia, Mississippi would only get its regular federal Medicaid rate of about 77%.
• Leave the health insurance exchange, the online marketplace that offers federally subsidized plans to people who make between 100% and 138% of the federal poverty level, intact. The Senate plan, unlike Arkansas' Medicaid expansion, would not provide extra subsidies from the state's federal Medicaid money available from the ACA.
• Include a work requirement mandating at least 120 hours of employment a month in a position for which health insurance is not paid for by the employer. That's more stringent than Georgia's plan, which mandates 80 hours a month. There are several exemptions, such as for full-time students or parents who are the primary caregiver of a child under six years old.
• Go into effect 30 days after the federal Centers for Medicare and Medicaid Services approves a waiver necessary for the work requirement. That's unlikely to happen under the Biden administration, which has rescinded work requirements previously approved for other states during the Trump administration and has not approved new ones. If the federal government denies the waiver, Mississippi would have to wait until a new administration took office, or sue the Biden administration. Georgia remains in litigation with the federal government over the work requirement issue, and has suffered low enrollment and missed out on millions in federal funds by not fully expanding coverage.
• Require anyone who voluntarily dropped private insurance to wait 12 months before applying for Medicaid coverage.

Senate Democrats voiced several concerns about the administrative burden of the work requirement and the 120 hour a month minimum, which is even stricter than Georgia's plan – currently the strictest expansion plan in the country. 

Sen. David Blount, D-Jackson, asked Blackwell about the enhanced match from the federal government.

“So the federal government paying our match for two years and 90% after the two years – we would not qualify for that?” Blount asked.

Blackwell said that is correct, and they would leave that money on the table.

Sen. John Horhn, D-Jackson, introduced two amendments: one to decrease the recertification requirements from four times a year to twice a year, and the other to reduce the work requirement hours from 120 hours a month to 80 hours a month. 

Both amendments were voted down by Republicans, who make up a majority of the committee's membership. Despite their amendments getting shot down, the Democrats still voted in favor of the bill. Only three Republican senators in the committee voted against the plan. 

When asked about the administrative burden of enforcing the work requirement, Blackwell said he is not worried and believes the Division of Medicaid has enough employees for its implementation. 

But Georgia, the only state currently with a work requirement in its expansion plan, has spent $26 million taxpayer dollars to ensure a mere 3,500 people to date. More than 90% of that has gone to administrative and consulting costs. 

The bill is expected to be taken to a floor vote as early as Thursday, with a deadline of April 10. 

Since the Senate plan is drastically different than the House proposal – which is a mostly-traditional expansion plan insuring those who make up to 138% of the federal poverty level and would go into effect whether or not the federal government approves a work requirement waiver – a final version will likely be hammered out later in the session in a conference committee.

Any final plan would realistically need a two-thirds majority from both chambers to show it has the potential to override a potential veto from Republican Gov. Tate Reeves, who has privately told lawmakers he plans to veto any Medicaid expansion bill.

Reeves on Tuesday night hosted around 20 state senators at the Governor's Mansion in downtown Jackson where he, again, reiterated his opposition to any form of Medicaid expansion, according to multiple people familiar with the situation. 

At the Tuesday night event, Reeves said he would veto the Senate's expansion plan if it reached his desk, though he reportedly said he approved the Senate's work requirement provisions. 

Shortly after the committee passed the expansion legislation, Reeves posted on social media that the Senate plan is “still bad policy” and he will oppose it.

“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,” Reeves said.  

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.