A new initiative headed for the 2022 Mississippi ballot would expand Medicaid in the state

For years, lawmakers, healthcare providers, and a variety of interested parties have argued back and forth about whether or not to expand Medicaid. Mississippi currently spends over $900 million of its state budget on Medicaid expenditures.  Now, one group is taking it to the people in an attempt to see a ballot initiative move the measure forward.

Tim Moore, President of the Mississippi Hospital Association, said it is no secret that the group has attempted to expand Medicaid for the last 10 years. The Mississippi Cares program proposed in 2019 essentially fell on deaf ears in the Legislature.  He said expanding Medicaid now would provide healthcare to roughly 130% of the poverty level.

“This is an alternative. We have worked as many of you know for a long time with state leadership and legislators to move this forward. For whatever reason it has not moved forward,” said Moore. “This is another option. It allows the people to step up and determine which direction we need to go.”

Moore said on Friday, April 9, the Board of Governors for the Hospital Association voted to partner with Healthcare for Mississippi, a separate 501-c4 that is tasked with moving the initiative forward.

He said states who have embraced expansion under the Affordable Care Act have seen widespread coverage and economic improvement. This year in particular provides added support for states who choose to expand with the Americans Recovery Act. Moore said those dollars created a secondary revenue source for Mississippi of nearly $300 million a year for the first two years. He says that is just additional federal money or state savings.

Moore referenced the 2019 economic impact study that was done by The Perryman Group, which showed a conservative perspective on expansion of Medicaid.

“In Mississippi’s particular situation it projected potentially $200 million a year going forward with the expansion of Medicaid,” said Moore.

He questioned those in opposition to the expansion on the grounds that the state cannot afford it. He said even with the hospitals proposal to fund the state match portion, or the state paying for itself, it would bring in additional funding. The federal match has increased to 95%.

But there are real concerns among conservative policy makers about what happens after the enhanced Medicaid match from the federal government wanes.  States like New York have had their longer term budgets exacerbated by the expansion of Medicaid years after making that move.  Also, the Biden administration swiftly moved to limit the ability of states to have work requirements for Medicaid recipients in Arkansas.

There is real concern from conservative lawmakers that if the state dives into expansion now and the federal government chooses to decrease that match in the future, or that the number of Medicaid beneficiaries expands far beyond projections, it could leave the state in a large hole financially. Moore said no data indicates that the federal government will ever do that.

Tim Moore, President of the Mississippi Hospital Association

“I don’t think anyone is going to be able to show us where the federal government has done that where you’ve actually dropped it,” said Moore. He used the comparison of Medicaid expansion to the CHIP program for well-children whose parents cannot afford healthcare coverage. He said this expansion would be a well-adult program for individuals who can’t afford healthcare from another means.

Currently, 50 percent of the state’s budget is federally funded. Moore questioned whether nor the state would choose not to provide healthcare just because the federal government pulled back in the future.

Moore said the goal is to get this initiative on the 2022 ballot. The ballot initiative has been filed with the Secretary of State’s office. Next, they will be required to obtain at least 106,000 signatures spanning over the 4 Congressional districts. Moore said he intends to get more than that due to the discrepancies of Mississippi’s previous five congressional district model.

“You almost have to plan, in our situation to cover both of those,” said Moore. “That would mean we would probably endeavor to collect a whole lot more signatures than 106,000 that are expected.”

There has been some polling in the past from a local Democrat polling firm, Chism Strategies, that asserts that a majority of Mississippians want to see Medicaid expansion. Moore said he has a hard time understanding why expansion is not happening when the means are there and it will help the working individuals of the state.

Moore said it’s time to move forward.

“This is not a party issue. It shouldn’t be Republican or Democrat or Independent or whoever else. We should be talking about Mississippians and what we can do to help them. Oh, and by the way, in this particular situation we are going to help our hospitals and our state,” said Moore.

Some of the hardest hit healthcare entities during the pandemic were Mississippi’s rural hospitals. While they received money from the CARES Act, those dollars were very specific as to where they can be used. For hospitals that maybe did not see a large influx of COVID-19 patients, that money would go back to the federal government, and Moore says they will be in exactly the place they were before.

One hospital administrator told Moore just a week ago, that the uncompensated care at his facility has gone up 44% during the pandemic.

“If you could use all the money that came through the CARES Act it would be an entirely different conversation,” said Moore. However, those dollars have specified spending limitations and measures attached.

Moore did complement the Legislature on the Medicaid Tech bill passed by the Legislature this year and the help it provided to rural hospitals. However, he says the one thing that would have helped them all would be to expand Medicaid.

Going into the 2022 Legislative session Moore and his organization hope to see lawmakers move on Medicaid expansion. He said he would like to see lawmakers step up and make this move without the need to put it in the state constitution but the three-year repealer added by the Mississippi House in the Medicaid Tech bill definitely pushed them to look into an initiative.

“With that said, the ballot initiative is a legitimate lawmaking move that when you can’t get things done any other way that’s the process you take,” said Moore.