Back-and-forth: House, Senate swap Medicaid expansion proposals, counter offers

After lawmakers in the House and Senate compromised on several points of the Medicaid expansion bill, there remains one major hurdle to be cleared: the necessity of a work requirement.

Any bill that makes expansion contingent on the approval of a work requirement will likely be null and void, due to federal regulations that have banned work requirements.

The House and Senate last week compromised on one major point of contention between the two chambers, income eligibility: the Senate conceded to cover people making up to 138% of the federal poverty level, about $20,000 for an individual, and the House agreed to having those who make more than 99% of the federal poverty level enrolled in subsidized private insurance – rather than straight Medicaid – which would be made affordable by state-federal Medicaid funds. 

They are still far apart on the details of a work requirement. Monday afternoon, the House proposed a counter offer to the Senate’s stringent work requirement, one in which Medicaid would be expanded either way, but Mississippi would be mandated to reapply for the work requirement every year, and would be required to immediately adopt a work requirement if the federal government ever changed its policy.

READ MORE: House, Senate leaders swap Medicaid expansion proposals as Monday night deadline nears

Here’s a breakdown of the various expansion plans proposed this session to provide health insurance for low-income, mostly working, people in the poorest and unhealthiest state in the country. 

Original House bill, Feb. 28

House Bill 1725, authored by Speaker Jason White and Medicaid Chairwoman Missy McGee, R-Hattiesburg, was originally written as a mostly-traditional expansion bill, similar to programs most other states have adopted. It would:

• cover income-eligible adults making up to 138% of the federal poverty level, about $20,000 for an individual.
• include a work requirement that would be removed if the federal government did not approve it.
• draw down $1 billion federal dollars by increasing the federal match rate.
• qualify Mississippi for a two-year bonus of $650 million offered to newly-expanded states – which would make the program free to the state for a total of four years.

It overwhelmingly passed the House 98-20 at the end of February. 

Original Senate proposal, March 28

In late March, the Senate Medicaid committee passed House Bill 1725 with a strike-all, and replaced the original bill’s language with its own language, which Medicaid Chairman Kevin Blackwell, R-Southaven, referred to as “expansion lite.” 

The plan proposed:

• covering working Mississippians making up to 99% of the federal poverty level, about $15,060 annually for an individual. 
• leaving out those making between 100% and 138% of the federal poverty, and as a result, would turn down the $1 billion in federal dollars 
• calling for quarterly proof of employment, leaving experts worried that the plan would be administratively burdensome and costly – as well as confusing for enrollees. That’s if the federal government approved the waiver necessary for the work requirement – an unlikely scenario under the Biden administration, which has rescinded such waivers previously granted under the Trump administration and has not approved new ones. 

This austere version of expansion passed the full Senate at the end of March with a veto-proof majority – an important detail since Gov. Tate Reeves has indicated he will veto any expansion bill that comes to his door. 

House’s response to the Senate’s strike-all, April 3

The House invited the Senate to conference in early April to hash out the details of House Bill 1725. 

House leadership countered the Senate’s austere version of expansion with a compromise: a “hybrid model” which would cover those making up to 138% of the federal poverty level, but would put those making between 100% and 138% on private health insurance policies through the federal exchange. 

The cost of these policies would be subsidized through federal-state Medicaid funds. 

Senate’s response to the House’s compromise, April 26

Senate conferees sent the House a plan with a “hybrid model,” similar to what the House pitched, but maintained a firm stance on a work requirement — although they dropped the quarterly employment verification to annually.

The following Sunday, Senate conferees retracted the requirement in their initial proposal that Mississippi sue the federal government if the Centers for Medicaid and Medicare Services doesn’t approve the work requirement waiver. 

Democrats in the House reportedly said they would not vote for any measure with the latter provision. 

If initially turned down on the work waiver by the federal government, the new Senate proposal would require the state to appeal again to the agency if any other state gets a similar program approved later.

The latest offer from the House, April 29

House conferees countered the Senate’s strict work requirement plan on Monday with a plan that would expand Medicaid with or without the work requirement, but would require the state to apply for the waiver initially and continue to do so once a year. It would also include a “trigger law,” similar to North Carolina’s, mandating that if the federal government ever changed its policy on allowing states to implement a work requirement, Mississippi would move to implement one immediately.