Medicaid expansion to cover primarily the working poor is not gaining much traction during the 2020 session of the Mississippi Legislature.
While Delbert Hosemann indicated during his successful 2019 campaign for lieutenant governor that he would be willing to consider the issue, he has not – at least publicly – expended much political capital to place Medicaid expansion on the front burner during the early stages of his tenure as the Senate’s presiding officer. That is not surprising since Medicaid expansion does not seem likely to occur at this point with both Gov. Tate Reeves and House Speaker Philip Gunn expressing opposition.
So, there is not much time spent on the issue during the legislative process since the perception is that advocating for Medicaid expansion is almost like tilting at windmills. But the issue came up almost accidentally during a recent meeting of the Senate Public Health Committee where a federal lawsuit that could result in the takeover of the state’s mental health system was discussed.
Diana Mikula, executive director of the Department of Mental Health, was explaining to the members of the Senate committee that the 14 community mental health centers, which are key in ultimately resolving the federal lawsuit, are funded in large part through Medicaid payments.
The issue, she explained, is, if a person receiving services from a community mental health center is not on Medicaid or does not have private insurance, then the cost of the treatment is normally paid through state funds.
At that point, Sen. David Blount, D-Jackson, almost thinking out loud, said the state could save money if more of the almost 120,000 people treated at the community mental health centers across the state were covered by Medicaid.
Of course, that might happen if the state expanded Medicaid – a federal-state health care program. The federal government would pay 90 percent of the cost for the treatment at the community mental health centers for those covered by the expansion while right now the state is paying 100 percent of the costs. So, with expansion the state could be paying 10 percent of the costs for some patients opposed to the 100 percent it currently is paying.
Blount said he wants to try to ascertain the number of people the state is currently paying for to receive treatment at the community mental health centers who would qualify for an expanded Medicaid program.
The state’s traditional Medicaid program provides coverage for poor children, pregnant women, certain groups of the elderly and the disabled.
With expansion, people earning up to 138 percent of the federal poverty level ($17,609 for an individual or $36,156 for a family of four) would qualify for Medicaid. Medicaid expansion is part of the federal Patient Protection and Affordable Care Act or Obamacare.
It is reasonable to assume that some people being treated at the community mental health centers with no ability to pay would be covered if the state expanded Medicaid.
“I want to find exact numbers,” Blount said.
Help for the community mental health centers is one of the many areas where some believe Medicaid expansion would be beneficial. Mississippi is one of 15 states that have not expanded Medicaid.
Reeves and Gunn have said the state cannot afford Medicaid expansion and have argued that they oppose growing the state’s welfare apparatus as Medicaid expansion would do. Reeves also has said if the state had expansion people would abandon more costly private insurance for Medicaid. He said that was a bad thing.
While Medicaid expansion came up on the periphery, the Senate Public Health hearing was held to discuss the lawsuit that alleges the state is violating federal law by not doing enough to provide treatment for those with mental health issues in their communities instead of in institutions. Essentially, U.S. District Judge Carlton Reeves of the Southern District of Mississippi has found that the care provided through the 14 community mental health centers is not consistent. In some areas, it might be adequate, perhaps even excellent, but it is not consistently adequate.
Senate Public Heath Chair Hob Bryan, D-Amory, said he believes there will be efforts during the ongoing session to provide additional state funds to the community mental health centers in response to the federal lawsuit.
The community mental health centers currently receive $44.4 million annually in state funding – not counting the funds they receive for patients they treat in the traditional Medicaid program.
With Medicaid expansion, it is safe to assume that more of the centers’ funding would be paid by the federal government.
Perhaps that is something that the state leaders would want to know more about. Blount said he would.
But perhaps finding out would be like tilting at windmills.