After skipping out on Thursday’s meeting to discuss Medicaid expansion in Mississippi, Senate conferees have expressed willingness to work with the House of Representatives to draft a proposal that would provide federal healthcare coverage to the working poor.
Lawmakers in both chambers had been in a state of gridlock over preferred expansion plans and it appeared that nothing was going to be accomplished this legislative session. However, the Senate has since opened the door for the two parties to reach an agreement before sine die.
The Senate’s initial proposal would cover those up to 100% of the federal poverty level but hinged on approval from the Centers for Medicare and Medicaid Services (CMS) to instill a 30-hour per week work requirement. Under the Senate’s plan, the federal government would cover 77% of the cost to facilitate the program with the state footing the other 23% of the bill.
The House’s Medicaid expansion plan would provide coverage for those up to 138% of the federal poverty level with a tentative work requirement attached to draw down the maximum amount of federal dollars possible. The proposal would cover an estimated total nearing 200,000 Mississippians.
To cover those up to 138% of the federal poverty level, House conferees offered a compromise for individuals between 0-99% of the federal poverty level to remain under the scope of managed care organizations. People between 100% and 138% of the federal poverty level would remain on the federal insurance exchange. Under this approach, the federal government would cover 90% of the cost of expanding Medicaid in Mississippi and the state would only be required to pay the remaining 10%.
CMS would have until September 30 to approve Mississippi’s bid, under the House’s proposal, to require people to work 20 hours a week for an employer who does not offer insurance if they want to receive government-provided coverage. If CMS denied the application, full-force Medicaid expansion would then go into effect.
Though the Senate appeared to be deadset on its version of expansion as no compromise was reached during the initial conference meeting on Tuesday and conferees missed Thursday’s gathering, a compromise may be looming.
“The House asked the Senate to come to the table with a plan which included Mississippians up to 138 percent of the federal poverty level to pull down the 90 percent match from the federal government,” Senate Medicaid chairman Kevin Blackwell said. “The hybrid plan we submitted to the House does just that — or we offer the original Senate version for consideration.”
The new Senate compromise proposal requires the Mississippi Division of Medicaid to apply for a waiver to cover people making less than 100% of the federal poverty level to be covered by a managed care organization. Medicaid would also cover people between 100% and 138% of the federal poverty level through the federal health insurance exchange.
The waiver, if approved by CMS, would allow the state to draw down 90% in federal match money, but would also require the state to pay 10%, of the cost of coverage through 138% of the federal poverty level. The program would be largely paid for through an assessment on managed care organizations and an increased insurance premium tax on exchange plans provided to the eligible Medicaid beneficiaries.
Senate leaders have maintained that a work requirement is a non-negotiable element for either plan, though the compromise proposal does have language directing the state’s Attorney General to appeal to federal court if CMS denies the waiver.
“We are hopeful a compromise is on the horizon. When people are healthy, they are working, raising their families, and contributing to their communities,” Lt. Governor Delbert Hosemann said. “Access to healthcare is a critical component of economic and workforce development efforts in Mississippi—and reforming healthcare is the right thing to do.”
The House can now weigh the Senate’s initial proposal or its altered one. The chamber will have the chance to make amendments to its bill of choice, pass one of the pieces as-is, or discard both and restart the process.
Mississippi is one of just 10 states that has not expanded Medicaid coverage. However, Governor Tate Reeves, an ardent foe of expansion, announced a round of Medicaid reimbursements back in September. Both legs of the governor’s plan were approved by CMS, freeing up around $818 million to be given to hospitals statewide amid a healthcare crisis.
Any Medicaid expansion proposal that could pass both chambers would likely have to be veto-proof.
