Note: This article is part of Mississippi Today’s ongoing Mississippi Health Care Crisis project. Read more about the project by clicking here.
Mississippi Insurance Commissioner Mike Chaney recently told members of the media he supports the expansion of Medicaid, but that the program most likely will end in 2025.
That statement is inaccurate. Robin Rudowitz, vice president and head of the Medicaid team for the Kaiser Family Foundation, said the program is not slated to end and there is nothing pending federally that would result in the demise of Medicaid expansion in 2025.
The Medicaid expansion program will continue “unless Congress changes the law,” said Rudowitz. Kaiser is a health care advocacy nonprofit and keeps close tabs on federal legislation.
Medicaid expansion is part of the Patient Protection and Affordable Care Act, commonly called Obamacare, which was passed in 2010. Under the expansion program, states can provide health care coverage through Medicaid for people — primarily the working poor — earning up the 138% of the federal poverty level, or about $18,500 annually for an individual.
Mississippi is one of 11 states that has opted not to expand Medicaid to ensure health care coverage for the working poor. Many in the Republican leadership in Mississippi, specifically Gov. Tate Reeves and House Speaker Philip Gunn, have maintained the state cannot afford to expand Medicaid and that they do not want to add to the welfare rolls by providing health insurance for the working poor.
Chaney is the only Mississippi statewide official to take a firm position in favor of expansion, though in doing so he has echoed another talking point of those who oppose expansion — that it will not last.
During the annual Hobnob in October, where the state’s political leaders speak to members of the Mississippi Economic Council, Chaney said of Medicaid expansion: “I’m not sure it would work today because it’s only got a three-year life left on the expansion part. In 2025, all the people that have been put on under expansion will be taken off and you’ve got to find a new (health care coverage) home for them unless the feds change the program. It depends on who controls the election, who controls the administration. I don’t know.”
During additional conversations in recent days, Chaney referenced programs other than the Medicaid expansion program that will end. It is true that the state’s “traditional” Medicaid rolls could be shrinking in the coming months.
As part of federal COVID-19 relief legislation, the federal contribution to each state’s Medicaid program was increased by 6.2% during the pandemic public health emergency. The increase means that this fiscal year the federal government would pay 84.06% of the cost of providing health care services for Mississippi Medicaid recipients with the state paying the rest.
As part of receiving the additional federal funds through the higher matching rate, the state has had to agree not to remove anyone from the Medicaid rolls. In Mississippi, Medicaid provides coverage for poor pregnant women, poor children, the disabled, some categories of the elderly and some caretakers of Medicaid recipients living in extreme poverty.
Medicaid expansion would provide coverage for healthy people who otherwise would not be eligible for Medicaid.
The increased matching rate has resulted in a boon in revenue for the state. According to a Kaiser study, between 2020-2022, the enhanced matching rate for the state’s current program and increased Medicaid enrollment have resulted in additional costs of $173 million in state funds. But during the same time period, the federal government has provided an additional $1.1 billion in federal funds for Mississippi Medicaid recipients.
Mississippi, as the poorest state in the nation, receives the largest matching rate from the federal government for its existing Medicaid program.
Chaney is correct that the enhanced matching rate will end and people most likely will be removed from the rolls, most likely long before 2025. But Rudowitz said the administration of President Joe Biden has said it will provide states a 60-day notice before ending the state of emergency.
At that time, as Chaney said, Mississippi and other states will have to determine if there are ways to provide health care coverage for those who are removed from Medicaid. In Mississippi, many of those who might be removed could obtain coverage by expanding Medicaid or by providing one year of Medicaid coverage for mothers of newborns.
Many of the people in Mississippi who have remained on the rolls during the public health emergency are mothers of newborns. Under Mississippi law, outside of the federal public health emergency, postpartum coverage lasts for only 60 days.
Under Medicaid expansion, the federal government pays 90% of the costs.
Rudowitz said the 90% rate “remains in perpetuity unless Congress changes the law.”
She also said there has been no talk in recent years of Republicans in Congress trying to repeal Obamacare or more specifically the Medicaid expansion program.
In fact, as part of COVID-19 relief legislation, the states that have not expanded Medicaid have been offered a financial incentive to do so. In Mississippi, it is estimated that the financial incentive would provide more than $600 million in federal funds over two years.
Rudowitz said the federal legislation does not put a time limit on how long the states have to expand Medicaid and claim the financial incentive. But the financial incentive only lasts for two years once it begins.
South Dakota citizens voted in early November to adopt Medicaid expansion. Mississippi and 10 other states, most in the Southeast, have not adopted Medicaid expansion.