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As Congress moves toward potential Medicaid cuts, expansion grows more unlikely in Mississippi

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mississippitoday.org – Sophia Paffenroth – 2025-02-26 12:27:00

As Congress moves toward potential Medicaid cuts, expansion grows more unlikely in Mississippi

Hundreds of thousands of poor, disabled or pregnant Mississippians could lose health care coverage if Congress slashes funding for Medicaid. 

Although President Donald Trump has vowed Medicaid won’t be “touched,”  the U.S. House of Representatives passed a budget resolution Tuesday that instructs the committee that oversees Medicaid and Medicare to cut $880 billion over 10 years. The cuts will help pay for Trump’s agenda on tax cuts and border reform.

The talk of such dramatic changes to the federal-state program has Mississippi lawmakers concerned – and hesitant to push expansion this year.

Proposals for Medicaid budget cuts nationwide include lowering the rate at which states are reimbursed for Medicaid services, capping the amount of money states can get per enrollee, and imposing block grants – meaning states would receive a fixed dollar amount for the program, regardless of need. 

Mississippi, the poorest state in the nation, could suffer the most under some of these proposals, according to health policy experts. 

Despite the state having some of the strictest eligibility requirements in the nation, pervasive poverty and poor social health determinants mean that more than 650,000 Mississippians – about half of whom are children – rely on the program for basic health care. More than half of births in Mississippi are funded by Medicaid. 

“Mississippi has a relatively small population, with the lowest per capita annual income in the country, rates of chronic conditions that are consistently higher than the national average, and with around 60% of Mississippians living with multiple chronic conditions,” explained John Dillon Harris, a health care systems and policy consultant at the Center for Mississippi Health Policy. “… The result is a large Medicaid population that is very expensive to treat.” 

Democratic lawmakers are also sounding the alarm about deep cuts to Medicaid. Rep. Omeria Scott, D-Laurel, said it’s something Mississippians “ought to really be afraid of.”  

“If they are talking about cutting $880 billion out of the budget, Mississippi is going to be on its knees,” she said at the Democrats’ legislative press conference Tuesday. 

However, since Mississippi is one of only 10 states not to expand Medicaid and draw down billions in additional federal funds, some proposed cuts wouldn’t directly affect the state’s current budget – though they would affect future enrollment. 

“Mississippi isn’t drawing down as much, so that’s not going to be a direct cut to your current budget, but it’s an opportunity cost,” said Joan Alker, Medicaid expert and executive director of Georgetown University’s Center for Children and Families. 

House Speaker Jason White brings the House of Representatives to order at the beginning of the new legislative session at the State Capitol, Tuesday, Jan. 7, 2025 in Jackson.

Threats to slash Medicaid spending have already scared away Mississippi lawmakers from attempting expansion this year – though they have passed “dummy bills,” void of details, to keep the issue alive “should something transpire,” House Speaker Jason White said. 

After a decade of squelching any debate on the issue, Mississippi House GOP leaders in 2024 pushed for legislation that would expand Medicaid to 200,000 low-income adults, as 40 other states have done. While the bills died after a saga of partisan politics, advocates were hopeful that the historic session created enough momentum to get the policy through the finish line in 2025. 

Now, lawmakers fear they may have bigger problems on their hands. 

“Unfortunately, we’re hearing more about what may be cuts or block grants to the Medicaid program in general that we will have to deal with as a state because there’s no denying we have a large Medicaid population – so I don’t know the chances,” White said when asked about the likelihood Medicaid expansion would be brought up this year.

Others are more certain the issue is dead this year.

“In a most practical sense, I’d say we probably won’t be doing anything this year,” Senate Medicaid Chairman Kevin Blackwell told Mississippi Today, though he added that if anything changes, lawmakers could suspend the legislative rules and bring a bill back to life late in the session. 

Click the dropdown to learn more about the specific proposals that would reduce Medicaid funding:

Reducing the federal match rate

The federal government could reduce the federal matching rate, or FMAP, which determines the percentage of Medicaid costs the federal government pays to each state. How much this would affect Mississippi would depend on the language of the proposed cut. 

Mississippi currently has the highest FMAP in the country at 76.9% – meaning the federal government pays for nearly 80% of Mississippians’ Medicaid coverage, while the state makes up the rest – because of the state’s high poverty rate. 

One of the proposals would take away the FMAP floor. As it stands, all states receive at least a 50% FMAP, even if they “should” be receiving less, according to the per capita income formula. If that floor was removed, richer states would be affected, as their FMAP would drop below 50%. Mississippi would likely not suffer from this proposal. 

Another proposal would remove the increased federal match rate of 90% that the federal government offered to newly-expanded states in the last few years. Without the increased match rate, expansion would not hold the financial favor that has made it politically palatable to Republicans in the state. 

Capping benefits per enrollee

The feds could also impose what’s called a “per capita cap,” limiting the amount a state could spend on Medicaid per person. If the caps were implemented, Medicaid would only receive a certain amount of money from the federal government to cover the care of a beneficiary – regardless of his or her medical needs. States would be locked into a fixed amount based on what they have historically spent.

The fact that Mississippi has one of the lowest per person Medicaid spending would count against the state – locking it into a lower fixed budget. 

Alker, the Medicaid expert from Georgetown University, says pushing expansion legislation through this year could make Mississippi more likely to receive a higher per capita budget – though it’s no guarantee. 

“I’ve seen proposals that look at taking away the American Rescue Plan Act incentives, which is extra funding for states that newly come to expansion … I have seen some chatter about how one proposal is to take away those incentives, but to not take them away from states that were counting on them,” explained Alker. 

“In other words, sort of grandfathering in North Carolina and South Dakota (states that expanded Medicaid in the past two years). So, if anything, it might be smart for Mississippi to do the expansion this session and lock that in.”

Imposing a block grant

Imposing block grants would be similar to per capita caps, but arguably more punishing for states since funding wouldn’t change based on enrollment growth.

Block grants would limit states’ abilities to respond to emergencies, and would especially hurt rural areas, research says.

Limiting provider tax

Mississippi is currently almost maxed out on the tax it’s allowed to impose on hospitals, which helps the state pay for its share of Medicaid spending. One option being discussed in Congress is to lower the limit of or eliminate the tax, which would mean hospitals would be reimbursed at a lower rate and there would be less state money to fund the Medicaid program.

The proposal is less likely to garner support, explained Harris, the policy consultant at the Center for Mississippi Health Policy. 

“It’ll be difficult to move this particular reform through Congress since such a large number of states, both red and blue, rely on this tax to pay for their programs,” he said.

But if it did go into effect, the impact would be profound.

“The state would have to get really creative in figuring out what to tax and how in order to maintain the current level of support hospitals receive through these supplemental payments,” Harris said.

Imposing work requirements

Work requirements have long been discussed as a means of making Medicaid expansion more palatable to conservatives who view the program as “welfare.” Now, Congress may decide to impose work requirements on the regular Medicaid population. 

As it stands, Mississippi has one of the country’s strictest income requirements for Medicaid. Childless adults don’t qualify, and parents must make less than 28% of the federal poverty level, a mere $7,000 annually for a family of three, to qualify. More times than not, that means that working a full-time job counts against an individual. 

If the state were to keep its strict income requirements while also imposing a work requirement, it would be difficult for Mississippians to qualify for the health care program. 

The red tape that a work requirement would create would also likely deter eligible Mississippians from enrolling or staying on the program.

Lt. Gov. Delbert Hosemann said Mississippi lawmakers have “a leg up” since the state’s former Medicaid director recently landed a spot in Washington leading the federal Medicaid division under Trump. Hosemann has yet to say what, if anything, Snyder has told lawmakers so far, but said he expects to have “a direct commentary into the area of Medicaid” through Snyder.

Lt. Gov. Delbert Hosemann discusses a legislative tax reform plan for the state, during a press conference held at the State Capitol, Wednesday, Feb. 12, 2025.

Regardless of what action the federal government decides to take, cuts of this magnitude would affect millions of low-income people across the country, not just in Mississippi. 

“States will be forced to deeply cut eligibility, benefits and reduce provider rates,” Alker said in a statement published online in response to the House budget resolution outlining Medicaid costs. “These cuts will especially harm rural communities who are more reliant on Medicaid, and where hospitals are already operating on tighter margins.” 

Taylor Vance, Geoff Pender and Michael Goldberg contributed to this report.

Mississippi Today receives grant support from The Bower Foundation, as does the Center for Mississippi Health Policy.  Donors do not in any way influence our newsroom’s editorial decisions. For more on that policy or to view a list of our donors, click here.

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

Mississippi Today

On this day in 1966

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mississippitoday.org – Debbie Skipper – 2025-03-19 07:00:00

On this day in 1966

March 19, 1966

The 2006 movie, “Glory Road” recreated events leading up to and including the famous game, where five Black starting players defeated the top-ranked, all-white University of Kentucky team.

Texas Western, the first NCAA championship basketball team to have five Black starters, defeated the top-ranked, all-white University of Kentucky team. 

The starters were Orsten Artis, Harry Flournoy, Bobby Joe Hill, David Lattin and Willie Worsley. They were basketball’s David facing the mighty Goliath in the form of Kentucky and its vaunted coach Adolph Rupp, whose teams had already secured four national championships. 

Before the game began, coach Don Haskins told his players that Rupp had vowed five Black starters would never beat his team. They took that personally and imposed their will on Kentucky with tough defense, steals and slam dunks. 

“It was a violent game,” recalled Kentucky player Pat Riley. “I don’t mean there were any fights — but they were desperate and they were committed and they were more motivated than we were.” 

The victory helped to end racist stereotypes in basketball and change the game for good. 

Nolan Richardson, who played for Texas Western under coach Dan Haskins, said of the game: “What a piece of history. If basketball ever took a turn, that was it.” 

Soon, schools that had long closed the door to Black athletes began to offer sports scholarships. Over the next two decades, the average number of Black players on college teams nearly doubled. The 2006 movie, “Glory Road,” recreated events leading up to and including the famous game.

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

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Mississippi Today

Senate and House pass revised plans to eliminate income tax, increase gasoline tax

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mississippitoday.org – Michael Goldberg and Taylor Vance – 2025-03-18 18:17:00

The GOP-controlled House and Senate passed competing “compromise” plans on Tuesday to eliminate the state income tax and raise gasoline taxes — but the Senate only narrowly passed its plan with the help of four Democrats. 

The proposals advanced by each chamber continue a debate over the potential risks and rewards of drastically altering the tax structure in the poorest state in the country as federal spending cuts loom. 

Tuesday’s Senate vote raises the question of whether that chamber could pass a more aggressive income tax elimination proposal even if the Republican Senate leadership reaches and agreement with House leaders.

The legislative dynamics 

The state Constitution requires a three-fifths majority of lawmakers to approve tax bills, so if Democrats Sarita Simmons of Cleveland, Juan Barnett of Heidelberg, Gary Brumfield of Magnolia and Angela Turner Ford of West Point had not joined the Republican majority to support the measure, it would have failed. 

“You know what they call a medical school student who finished last in his class? A doctor,” Senate Finance Chairman Josh Harkins told reporters after the close vote. 

Only a couple of votes could have derailed the bill in the Senate because four Republican senators voted against the measure, and four Republicans voted “present.”

Harkins said the razor-thin margin shows how fragile the coalition of support is in the 51-member chamber and how there isn’t an enormous appetite to accelerate the income tax elimination rapidly as the House proposes. 

Some Democratic senators, including Minority Leader Derrick Simmons, appeared frustrated that four of their colleagues broke from them to ensure the measure’s passage.

“Time and time again, I’ve seen where (Democrats) have had the ability to exert our power, yet we have fallen short by not voting in solidarity with the working people of Mississippi,” Simmons told Mississippi Today. 

Ahead of a Tuesday evening deadline, the House also passed an updated version of its original tax reform package in a 91-27 vote, with 11 Democrats crossing party lines in the Republican-controlled chamber to support the bill. Unlike the Senate, every Republican in the House chamber has voted to eliminate the income tax. 

Debate centers on slashing state budget as federal cuts loom

Republican House Ways and Means Trey Lamar said the House proposal slashes state revenues to give working people tax cuts. 

“This bill is the most substantial tax cut for Mississippians that this state has ever known or seen,” Lamar said.  

House Democratic Leader Robert Johnson called the bill “grossly irresponsible” and “dangerous,” arguing it would hollow out the state’s budget at a time when the federal government is considering vast spending cuts to programs Mississippi relies on. 

“We are the poorest state in the union, the lowest per capita income in the country … They are getting ready to put you in a situation where it doesn’t matter how much money they put back in your pockets,” Johnson said. “Be cognizant of the fact that you elected people to come in here and gut your public services, gut your public education, gut your public safety and gut your public health.” 

Experts have told Mississippi Today that deep federal spending cuts, along with the elimination of the state income tax, could reduce Mississippi’s ability to fund services. Some also warn the shift to a more regressive form of taxation would hit poor and low-income Mississippians hardest.

Mississippi is perennially among the most federally dependent states, receiving nearly a 3-1 return for every dollar in federal taxes it pays. Both Republican and Democratic lawmakers have expressed fear of the economic impact of federal cuts.

The focus of future negotiations 

Now that the two chambers have passed alternative tax cut plans, six lawmakers will likely try to work out a final agreement in a conference committee. 

Going forward, the Senate is unlikely to accept a deal that increases the state sales tax and does not change the structure of the Public Employees Retirement System. The Senate is pushing a “hybrid” retirement plan to shore up the system financially by cutting benefits for future employees.

House Speaker Jason White said he plans to press the Senate to move off its “hard condition” of overhauling PERS. His caucus wants a dedicated stream of revenue for the retirement system. The House has proposed diverting most of the state’s lottery proceeds to PERS, or he suggested for the first time Tuesday that revenue from legalizing online sports betting could also help the system.

“The spot we’ve identified for additional revenue is mobile sports betting, where we’re losing to illegal gambling now,” White said. If (the Senate) wants to keep the amount of either gas tax or sales that has to be raised to offset this income tax (cut), then we should look at that as a valid place to look.” 

Legalizing mobile sports betting has been another wedge between the chambers. The House has passed legislation this session to legalize the practice but the measure faces opposition in the Senate.

A look at the latest tax proposals  

The new House Plan would:

  • Fully eliminate the state income tax by 2037. The elimination would begin phasing in after the state next year finishes implementing another income tax cut it approved in 2022. The phase-in period would take a decade, beginning with a reduction from 4% to 3.5% and then lowering further from there.
  • Cut about $2.2 billion from the state’s current $7 billion general fund. The state would also raise about $750 million through tax increases. But much of collected through tax increases would go to the general fund.
  • Increase the state’s net sales tax from 7% to 8%. The revenue from this tax increase would provide $48 million annually to pay for infrastructure improvements via the State Aid Road Fund. The remaining money would go into the state’s general fund.
  • Add a new 15-cents-a-gallon excise tax on gasoline. The tax increase would be phased in at 5 cents a year over three years. This would be added to the current 18.4-cents-a-gallon excise Mississippi motorists currently pay.
  • Cut the sales tax on groceries from 7% to 5%.
  • Increase the state’s “use yax,” which is imposed on goods purchased outside the state or online, from 7% to 8%.
  • Create a new fund that gives those over the age of 65 property tax credits of $200 a year. The fund would be paid for by revenue from the use tax increase referenced above.
  • Transfer $100 million per year from the state lottery system into the public employee retirement system. 

The new Senate plan would: 

  • Decrease the 4% income tax rate by .25% each year from 2027 to 2030 and leave it at 3% in 2030.
  • After it reaches 3%, the income tax would be reduced with “growth triggers” or at a proportional rate depending on the difference between the state’s revenue and spending plans that year. 
  • Reduce the sales tax on groceries from 7% to 5%.
  • Increase the 18.4-cents-a-gallon gasoline tax by 9 cents over three years, for a total of 27.4 cents, then this would increase automatically based on the cost of road construction.
  • Change benefits for government employees hired after March 2026 to a “hybrid” retirement that includes part-defined benefit and part-defined contribution.

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

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Mississippi Today

Doctors, advocates rally at Capitol: ‘Defend and expand Medicaid’

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mississippitoday.org – Sophia Paffenroth – 2025-03-18 15:16:00

Dozens of advocates, doctors and spiritual leaders gathered outside the Capitol Tuesday to call for the “defense and expansion of Medicaid.” 

“Medicaid is not just an insurance program – it is a lifeline for 707,000 Mississippians,” said Sonya Williams Barnes, the state policy director for Southern Poverty Law Center. “Medicaid ensures that 315,000 children receive the health care they need … Make no mistakes: A cut to Medicaid directly harms our most vulnerable.”

Despite having some of the strictest eligibility requirements for the program, Mississippi has one of the largest Medicaid populations in the country as a result of the state’s poverty. 

With federal changes threatening already-existing health care programs, defending Medicaid for vulnerable groups such as those who are pregnant, elderly or disabled has become the new goal  for Mississippi advocates. Expanding Medicaid – arguably the biggest issue of the historic 2024 legislative session – has taken a backseat. 

But some urge it’s as important as ever. 

“In this moment we cannot shift gears, after all these years, and only beg our elected officials to save Medicaid,” the Rev. Jason Coker said. “We can’t give up that ground at a moment when we need to be gaining ground. We’ve got to keep pushing for Medicaid expansion, while we demand and pray for Medicaid to continue uncut.” 

Key lawmakers have said expanding Medicaid in Mississippi is all but dead this year – though a vehicle for expansion is still alive in the Legislature. 

“In a most practical sense, I’d say we probably won’t be doing anything this year,” Senate Medicaid Chairman Kevin Blackwell told Mississippi Today.

Mississippi is one of 10 states not to expand Medicaid, which would give health insurance to hundreds of thousands of low-income working Mississippians who can’t afford private health insurance and don’t qualify for subsidies that make marketplace insurance affordable.

“What kind of society are we to compound suffering with catastrophic costs to those in our congregations and so many across our state who fall within that coverage gap?” Coker asked. 

Dr. Randy Easterling, former president of the Mississippi State Medical Association, recounted a story of an uninsured patient who was diagnosed with multiple myeloma, a kind of cancer, around the same time that Easterling’s insured relative was also diagnosed with the disease. The uninsured patient, Jimmy, died, while Easterling’s relative is now in remission. 

“Is this what we boil down to?” Easterling asked. “If you have insurance, you live, if you don’t, you die? Let me tell you something, folks: That’s not what I signed up for when I went to medical school.”

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

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