Joe Biden speaks to his supporters during a campaign event at Tougaloo College's Kroger Gymnasium Sunday, March 8, 2020. Credit: Eric J. Shelton/Mississippi Today, Report For America

President Joe Biden’s $1.9 trillion COVID-19 relief package poised to be approved by Congress offers a sizable financial incentive for Mississippi to expand Medicaid to provide health care coverage to primarily the working poor.

Mississippi Senate Public Health Committee Chair Hob Bryan, D-Amory, said if the legislation ultimately becomes law in coming days, the package would provide Mississippi roughly $300 million a year for two years if state leaders would agree to expand Medicaid. Bryan said he bases that number on estimates provided to him by the Mississippi Division of Medicaid and other health care groups.

Mississippi is one of just 12 states that hasn’t expanded Medicaid under the Affordable Care Act.

“For a number of years, the federal government has been offering us a $1 million a day to take care of sick people,” Bryan said. “Now they are offering $1 million a day to take that other $1 million a day. You can’t make this stuff up.”

The coronavirus relief bill, based on information from the American Hospital Association, would provide the incentives to expand Medicaid for the 12 states that have not by increasing the matching dollars they receive from their federal government for their traditional Medicaid program by 5%.

Mississippi, the poorest state in the nation, receives the highest matching rate from the federal government. The federal government normally has paid about 75% of the cost of treating Medicaid recipients in Mississippi with the state paying the rest.

READ MORE: Mississippi missed out on $7 billion when it did not expand Medicaid. Will that figure jump to $20 billion?

In recent times, based on language in past COVID-19 relief bills that have become law, the amount of the match the federal government pays of Mississippi’s Medicaid costs has increased to 84.5%.  The federal match rate averages 56.2% for all 50 states.

If the Biden legislation — the American Rescue Plan Act — ultimately passes Congress and is signed into law by Biden, that matching rate for the regular Medicaid program could increase to nearly 90% for two years for Mississippi if state leaders opted to expand Medicaid.

Thus far, Mississippi’s Republican political leaders, led by Gov. Tate Reeves, have been adamantly opposed to expanding Medicaid. They maintain the state cannot afford the costs.

Under current law, the federal government pays 90% of the costs for treating people covered under Medicaid expansion, and the state pays 10% of the costs. Estimates show that as many as 300,000 more Mississippians could be covered if Medicaid is expanded in the state. Many of those covered under the expansion would be people who work in jobs that do not provide private insurance and do not earn enough to afford to purchase private coverage.

“We must work to find ways to provide healthcare for all Mississippians, especially in rural areas, but Medicaid expansion is not the answer,” Reeves has said.

When Mississippi House Medicaid Chair Joey Hood, R-Ackerman, recently was asked if Mississippi might agree to the expansion if the federal match rate for the traditional Medicaid program was increased by 5% as proposed in the legislation, he said there was no need to even consider the issue until the bill becomes law.

“It still has to pass both chambers,” Hood said.

Earlier this session, the Mississippi Senate rejected Medicaid expansion on a straight party line vote with all Republicans voting no. But during a recent appearance before the Mississippi State University Stennis Institute/Capitol Press Corps, Lt. Gov. Delbert Hosemann, who presides over the Senate, indicated Medicaid expansion could be an issue studied during the summer by senators while the Legislature is not in session.

“It’s no surprise… that the delivery of health care is on my agenda for next year,” Hosemann said. “And I anticipate that we will have public hearings concerning how that will proceed.”

The current Mississippi Medicaid program covers primarily poor children, poor pregnant women, the disabled and the elderly, but generally does not cover able-bodied adults other than pregnant women and a small group of caregivers.

As of February, the Division of Medicaid website showed about 750,000 enrolled in the Mississippi Medicaid program. Another 48,200 children whose parents make too much for them to be on Medicaid are enrolled in the Children’s Health Insurance Program — another federal program.

While many state leaders argue that the state cannot afford Medicaid expansion, others claim it would save the state money while expanding the economy and aiding hospitals that are currently treating patients who have no ability to pay. The Mississippi Hospital Association has endorsed a hybrid Medicaid expansion that has been approved in other states.

“Mississippi will make money if we expand Medicaid,” Bryan said even before the added incentive in the U.S. House COVID-19 relief bill was unveiled. “There will be more money in the state treasury if we expand Medicaid than if we don’t.”

READ MORE: Could Indiana’s ‘conservative’ version of Medicaid expansion work for Mississippi?

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Bobby Harrison, Mississippi Today’s senior capitol reporter, covers politics, government and the Mississippi State Legislature. He also writes a weekly news analysis which is co-published in newspapers statewide. A native of Laurel, Bobby joined our team June 2018 after working for the North Mississippi Daily Journal in Tupelo since 1984. He is president of the Mississippi Capitol Press Corps Association and works with the Mississippi State University Stennis Institute to organize press luncheons. Bobby has a bachelor's in American Studies from the University of Southern Mississippi and has received multiple awards from the Mississippi Press Association, including the Bill Minor Best Investigative/In-depth Reporting and Best Commentary Column.