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House Democrats unveil Mississippi’s first major Medicaid expansion plan

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Democratic representatives will file a bill to expand Medicaid eligibility to working-class Mississippians — after years of failed attempts and as rural hospitals reach their breaking point.

Though Democrats have fought for years to expand Medicaid, they hope their more pragmatic proposal this session and the new House speaker’s pledge to seek a bipartisan solution on health coverage will finally yield a realistic plan to expand coverage.

“I think a majority of people in Mississippi would like to see … coverage for working Mississippians who don’t have coverage and providing the uncompensated care funding that hospitals need to stay open,” House Democratic Leader Robert Johnson III said.

The bill, the first major Medicaid expansion proposal this year, would expand traditional Medicaid coverage eligibility and includes a private insurance option for Mississippians who make up to twice as much as the federal poverty level.

There’s also a component that would help subsidize premiums for people who are on or are offered insurance through their jobs. 

It’s a plan that, Democrats say, favors women and small businesses. It would cover more people than traditional expansion because it’ll be easier to qualify for coverage, but more people would be partially paying premiums in a tiered system, dependent on income.

The Affordable Care Act passed in 2010, increased health insurance coverage for millions of low-income people across the country by expanding eligibility to qualify for Medicaid, a federal-state program that provides health coverage to millions of people.

Since 2014, states have had the option to expand Medicaid eligibility even further to the working poor. In states that have not done so, it’s challenging to qualify for Medicaid coverage solely based on income. In Mississippi, non-disabled adults without children are not eligible for Medicaid coverage, regardless of their income. Parents in Mississippi are eligible only if their incomes don’t exceed 24% of the federal poverty level — for context, that’s at most $587 monthly for a family of four, according to the Mississippi Division of Medicaid website.

Mississippi is one of 10 states that has not expanded Medicaid coverage to the working poor. Meanwhile, the state’s hospitals are foundering. 

One report puts nearly half of Mississippi’s rural hospitals at risk of closure, largely due to uncompensated care costs, or money spent treating patients who are uninsured. Because emergency rooms cannot legally turn down patients, regardless of their insurance status, it’s often the only resort for health care for uninsured people.

That means without health insurance, preventative care is generally out of reach.

Research shows expansion would insure the approximately 250,000 people who fall into the state’s coverage gap, meaning they make too much to qualify for Medicaid now but too little to afford private insurance. The policy’s adoption would also generate billions of dollars for Mississippi, directing much-needed money to the state’s struggling hospitals, and allow for more timely health care, likely improving health outcomes in one of the country’s sickest states

Despite most Mississippians’ support of Medicaid expansion, Republican Gov. Tate Reeves and former Republican House Speaker Philip Gunn staunchly opposed the policy over the last four years. Even as medical experts sounded the alarm over the financial future of hospitals, Reeves has ignored the policy’s benefits, reducing expansion to “welfare.”

Democratic Rep. Zakiya Summers of Jackson said that Mississippi’s abysmal health outcomes are well documented, and the state cannot afford to “kick the can down the road” any further on expanding coverage to more people.

“I think we’ve heard a lot of talk about wanting to do something around Medicaid expansion, but we haven’t actually seen pen being put to paper,” Summers said. “What we have developed is a really good opportunity to say, ‘Here is something that we can take a look at and have conversations about.’”

But the Democrats’ latest plan is not a typical Medicaid expansion bill.

The measure both expands eligibility for traditional Medicaid coverage and includes a private insurance option for people who fall into a certain federal poverty level threshold. If passed, the hybrid policy would cover more Mississippians than a traditional Medicaid expansion bill, which usually covers people up to 138% of the federal poverty level.

“Our program is going to incorporate people up to 200% of the federal poverty level,” Johnson said.

Rationalizing the private option, he said, “Asking the government to pay all of the funds to make sure we cover people up to 200% of the poverty level is I don’t think reasonable and I don’t think it’s acceptable or winnable.”

The bill would:

  • Expand Medicaid coverage eligibility for all adults who are at or below 95% of the federal poverty level. In 2024, that is $14,307 gross annual income for a childless individual.
  • Allow adults with no children who make more than that, up to 200% of the federal poverty level or $30,120 gross annual income, to qualify for private health plans through the federal marketplace or offered by the state.
  • If they’re employed and make between 96% and 200% of the federal poverty level, their premiums would be covered at varying degrees by the division. 

Democratic leaders are hopeful the plan — which includes incentives to join the workforce — will gain traction in the Capitol, but they know the Republicans who hold a supermajority in both chambers won’t outright adopt their bill in the coming weeks.

Instead, Johnson hopes that Republicans will at least realize the minority party’s proposal is sensible and include portions of it in a final version and pass it. 

“If it ever gets passed in its final form, it’ll probably have my name nowhere near it,” Johnson said. “But if it means that we get a plan that really provides coverage to people in the state of Mississippi, I don’t care what they call it or whose name is on it.”

The person who wields the most immediate power over the Legislature’s solution to giving health insurance to more Mississippians is House Speaker Jason White, a Republican whose rural district is majority-white and financially disadvantaged.

The speaker has been candid about the need for Mississippi, one of the poorest and sickest states in the country, to consider expanding Medicaid and has said state Republicans deserve criticism for refusing to debate the merits of the program. 

Johnson told Mississippi Today that he and the speaker have maintained an open dialogue this session about Medicaid policy, and he believes White truly wants to shepherd meaningful legislation through the House. 

White told Mississippi Today last week that he and other House leaders are forming a Medicaid plan of their own, but he intends to examine Johnson’s plan to see where the two parties can agree.

“I think we’ll find bipartisanship,” White said. “I’m going to be disappointed if we don’t.”

Arkansas in 2013 voted to adopt a version of Medicaid expansion that includes a private insurance option. As other Southern states consider expansion, the Arkansas model is often referenced.

Though echoes of Arkansas’ version of Medicaid expansion are obvious in the Democrats’ proposal, Johnson said their bill caters to Mississippi’s specific health care and population factors.

Adam Searing, an associate professor at Georgetown University’s McCourt School of Public Policy’s Center for Children and Families whose work focuses on Medicaid, said the Democrats’ bill is a “perfectly reasonable starting place.”

“Expanding Medicaid is a political debate,” he said. “In states that haven’t already done it, there are going to be some compromises.”

Searing said that while Georgia’s initial attempt at expansion only covered part of the population in their coverage gap — subsequently making them ineligible for full federal financial rewards — Mississippi’s bill takes everyone into account.

The federal government will pay 90% of the cost to expand Medicaid to people who are at or below 138% of the federal poverty level, and for people up to 200%, they will pay the federal medical assistance percentage match of the expansion costs. Mississippi has the highest FMAP in the country at 76.9% because of the state’s high poverty rate.

Additionally, the federal government would pay Mississippi more than $600 million over two years as an incentive for expanding Medicaid.

There’s no estimate yet for how much the Democrats’ plan would cost the state because the bill hasn’t made it to the Legislative Budget Office, but researchers estimate that Medicaid expansion would generally bring in $1 billion a year in federal money to Mississippi. 

“What I look for in these plans, what makes this one nice, is that the goal is to cover everyone in the coverage gap,” Searing said. “This is where you want to start. I think it’s exciting that someone is putting in a plan, and it’s realistic.”

A significant part of this coverage gap is small business owners who sometimes cannot afford to provide health insurance to their employees.

Democratic Rep. Bryant Clark, D-Pickens, believes if the proposal were to become law, it would save business owners in his district, most of which is in the impoverished Delta, from paying hundreds of dollars each month in an employer-sponsored health plan.

“That might not mean much to Amazon or Nissan, but for a mom-and-pop business, that can make a difference in whether you’re in the black or in the red,” Clark said. “If you raise the limit up to 200% in my district, that will probably cover the vast majority of people that are employed in District 47.”

Democrats said their proposal gives special consideration to women’s health.

Mississippi is one of the most dangerous states in the country to give birth, both for mothers and their babies. A lack of timely preventative and prenatal care is a driving cause of these abysmal outcomes.

Democrats say upwards of 20,000 more women would be eligible for Medicaid under their plan compared to traditional Medicaid expansion.

“Instead of only addressing women’s health when it comes to taking away their choice, or saying the issues they face aren’t real, let’s come together on a bipartisan level and say we’re going to prioritize women this time … and make sure they have their needs met in this state,” Summers said. “We want to make sure women don’t just survive in Mississippi, but they thrive in Mississippi.”

As evidenced by the Medicaid expansion bill, maternal, infant and reproductive health remain a top issue for lawmakers. But the head of Medicaid, an agency under Reeves’ purview, and other political allies have tried to thwart those efforts.

An additional bill the Democrats are filing could shift that power — the legislation seeks to establish a commission that would manage the agency, allowing it to be run in a way that’s “apolitical,” Johnson said.

The proposal is currently being vetted by attorneys in the Legislature. Once the bill is introduced, the speaker will refer it to a legislative committee for consideration. 

It’s unlikely legislative leaders will embrace the Democrats’ plan, and White has suggested Republicans will introduce a Medicaid plan of their own. The process for the House and Senate to agree on a final Medicaid expansion bill will likely take months if they agree at all.

Mississippians’ health and financially bleeding hospitals can’t wait much longer, Johnson said.

“It’s a broken record, but we have the worst health outcomes in the country … we ought to be flooded with doctors because there’s such a need,” he said. “We’re losing population and losing opportunity.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Mississippi Legislature approves DEI ban after heated debate

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mississippitoday.org – @MSTODAYnews – 2025-04-02 16:34:00

Mississippi lawmakers have reached an agreement to ban diversity, equity and inclusion programs and a list of “divisive concepts” from public schools across the state education system, following the lead of numerous other Republican-controlled states and President Donald Trump’s administration.  

House and Senate lawmakers approved a compromise bill in votes on Tuesday and Wednesday. It will likely head to Republican Gov. Tate Reeves for his signature after it clears a procedural motion.

The agreement between the Republican-dominated chambers followed hours of heated debate in which Democrats, almost all of whom are Black, excoriated the legislation as a setback in the long struggle to make Mississippi a fairer place for minorities. They also said the bill could bog universities down with costly legal fights and erode academic freedom.

Democratic Rep. Bryant Clark, who seldom addresses the entire House chamber from the podium during debates, rose to speak out against the bill on Tuesday. He is the son of the late Robert Clark, the first Black Mississippian elected to the state Legislature since the 1800s and the first Black Mississippian to serve as speaker pro tempore and preside over the House chamber since Reconstruction.

“We are better than this, and all of you know that we don’t need this with Mississippi history,” Clark said. “We should be the ones that say, ‘listen, we may be from Mississippi, we may have a dark past, but you know what, we’re going to be the first to stand up this time and say there is nothing wrong with DEI.'”

Legislative Republicans argued that the measure — which will apply to all public schools from the K-12 level through universities — will elevate merit in education and remove a list of so-called “divisive concepts” from academic settings. More broadly, conservative critics of DEI say the programs divide people into categories of victims and oppressors and infuse left-wing ideology into campus life.

“We are a diverse state. Nowhere in here are we trying to wipe that out,” said Republican Sen. Tyler McCaughn, one of the bill’s authors. “We’re just trying to change the focus back to that of excellence.”

The House and Senate initially passed proposals that differed in who they would impact, what activities they would regulate and how they aim to reshape the inner workings of the state’s education system. Some House leaders wanted the bill to be “semi-vague” in its language and wanted to create a process for withholding state funds based on complaints that almost anyone could lodge. The Senate wanted to pair a DEI ban with a task force to study inefficiencies in the higher education system, a provision the upper chamber later agreed to scrap.

The concepts that will be rooted out from curricula include the idea that gender identity can be a “subjective sense of self, disconnected from biological reality.” The move reflects another effort to align with the Trump administration, which has declared via executive order that there are only two sexes.

The House and Senate disagreed on how to enforce the measure but ultimately settled on an agreement that would empower students, parents of minor students, faculty members and contractors to sue schools for violating the law.

People could only sue after they go through an internal campus review process and a 25-day period when schools could fix the alleged violation. Republican Rep. Joey Hood, one of the House negotiators, said that was a compromise between the chambers. The House wanted to make it possible for almost anyone to file lawsuits over the DEI ban, while Senate negotiators initially bristled at the idea of fast-tracking internal campus disputes to the legal system.   

The House ultimately held firm in its position to create a private cause of action, or the right to sue, but it agreed to give schools the ability to conduct an investigative process and potentially resolve the alleged violation before letting people sue in chancery courts.

“You have to go through the administrative process,” said Republican Sen. Nicole Boyd, one of the bill’s lead authors. “Because the whole idea is that, if there is a violation, the school needs to cure the violation. That’s what the purpose is. It’s not to create litigation, it’s to cure violations.” 

If people disagree with the findings from that process, they could also ask the attorney general’s office to sue on their behalf.

Under the new law, Mississippi could withhold state funds from schools that don’t comply. Schools would be required to compile reports on all complaints filed in response to the new law.

Trump promised in his 2024 campaign to eliminate DEI in the federal government. One of the first executive orders he signed did that. Some Mississippi lawmakers introduced bills in the 2024 session to restrict DEI, but the proposals never made it out of committee. With the national headwinds at their backs and several other laws in Republican-led states to use as models, Mississippi lawmakers made plans to introduce anti-DEI legislation.

The policy debate also unfolded amid the early stages of a potential Republican primary matchup in the 2027 governor’s race between State Auditor Shad White and Lt. Gov. Delbert Hosemann. White, who has been one of the state’s loudest advocates for banning DEI, had branded Hosemann in the months before the 2025 session “DEI Delbert,” claiming the Senate leader has stood in the way of DEI restrictions passing the Legislature. 

During the first Senate floor debate over the chamber’s DEI legislation during this year’s legislative session, Hosemann seemed to be conscious of these political attacks. He walked over to staff members and asked how many people were watching the debate live on YouTube. 

As the DEI debate cleared one of its final hurdles Wednesday afternoon, the House and Senate remained at loggerheads over the state budget amid Republican infighting. It appeared likely the Legislature would end its session Wednesday or Thursday without passing a $7 billion budget to fund state agencies, potentially threatening a government shutdown.

“It is my understanding that we don’t have a budget and will likely leave here without a budget. But this piece of legislation …which I don’t think remedies any of Mississippi’s issues, this has become one of the top priorities that we had to get done,” said Democratic Sen. Rod Hickman. “I just want to say, if we put that much work into everything else we did, Mississippi might be a much better place.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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House gives Senate 5 p.m. deadline to come to table, or legislative session ends with no state budget

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mississippitoday.org – @MSTODAYnews – 2025-04-02 16:13:00

The House on Wednesday attempted one final time to revive negotiations between it and the Senate over passing a state budget.

Otherwise, the two Republican-led chambers will likely end their session without funding government services for the next fiscal year and potentially jeopardize state agencies.

The House on Wednesday unanimously passed a measure to extend the legislative session and revive budget bills that had died on legislative deadlines last weekend. 

House Speaker Jason White said he did not have any prior commitment that the Senate would agree to the proposal, but he wanted to extend one last offer to pass the budget. White, a Republican from West, said if he did not hear from the Senate by 5 p.m. on Wednesday, his chamber would end its regular session. 

“The ball is in their court,” White said of the Senate. “Every indication has been that they would not agree to extend the deadlines for purposes of doing the budget. I don’t know why that is. We did it last year, and we’ve done it most years.” 

But it did not appear likely Wednesday afternoon that the Senate would comply.

The Mississippi Legislature has not left Jackson without setting at least most of the state budget since 2009, when then Gov. Haley Barbour had to force them back to set one to avoid a government shutdown.

The House measure to extend the session is now before the Senate for consideration. To pass, it would require a two-thirds majority vote of senators. But that might prove impossible. Numerous senators on both sides of the aisle vowed to vote against extending the current session, and Lt. Gov. Delbert Hosemann who oversees the chamber said such an extension likely couldn’t pass. 

Senate leadership seemed surprised at the news that the House passed the resolution to negotiate a budget, and several senators earlier on Wednesday made passing references to ending the session without passing a budget. 

“We’ll look at it after it passes the full House,” Senate President Pro Tempore Dean Kirby said. 

The House and Senate, each having a Republican supermajority, have fought over many issues since the legislative session began early January.

But the battle over a tax overhaul plan, including elimination of the state individual income tax, appeared to cause a major rift. Lawmakers did pass a tax overhaul, which the governor has signed into law, but Senate leaders cried foul over how it passed, with the House seizing on typos in the Senate’s proposal that accidentally resembled the House’s more aggressive elimination plan.

The Senate had urged caution in eliminating the income tax, and had economic growth triggers that would have likely phased in the elimination over many years. But the typos essentially negated the triggers, and the House and governor ran with it.

The two chambers have also recently fought over the budget. White said he communicated directly with Senate leaders that the House would stand firm on not passing a budget late in the session. 

But Senate leaders said they had trouble getting the House to meet with them to haggle out the final budget. 

On the normally scheduled “conference weekend” with a deadline to agree to a budget last Saturday, the House did not show, taking the weekend off. This angered Hosemann and the Senate. All the budget bills died, requiring a vote to extend the session, or the governor forcing them into a special session.

If the Legislature ends its regular session without adopting a budget, the only option to fund state agencies before their budgets expire on June 30 is for Gov. Tate Reeves to call lawmakers back into a special session later. 

“There really isn’t any other option (than the governor calling a special session),” Lt. Gov. Delbert Hosemann previously said. 

If Reeves calls a special session, he gets to set the Legislature’s agenda. A special session call gives an otherwise constitutionally weak Mississippi governor more power over the Legislature. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Amount of federal cuts to health agencies doubles

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mississippitoday.org – @MSTODAYnews – 2025-04-02 14:48:00

Cuts to public health and mental health funding in Mississippi have doubled – reaching approximately $238 million – since initial estimates last week, when cancellations to federal grants allocated for COVID-19 pandemic relief were first announced.

Slashed funding to the state’s health department will impact community health workers, planned improvements to the public health laboratory, the agency’s ability to provide COVID-19 vaccinations and preparedness efforts for emerging pathogens, like H5 bird flu. 

The grant cancellations, which total $230 million, will not be catastrophic for the agency, State Health Officer Dr. Daniel Edney told members of the Mississippi House Democratic Caucus at the Capitol April 1. 

But they will set back the agency, which is still working to recover after the COVID-19 pandemic decimated its workforce and exposed “serious deficiencies” in the agency’s data collection and management systems.

The cuts will have a more significant impact on the state’s economy and agency subgrantees, who carry out public health work on the ground with health department grants, he said. 

“The agency is okay. But I’m very worried about all of our partners all over the state,” Edney told lawmakers. 

The health department was forced to lay off 17 contract workers as a result of the grant cancellations, though Edney said he aims to rehire them under new contracts. 

Other positions funded by health department grants are in jeopardy. Two community health workers at Back Bay Mission, a nonprofit that supports people living in poverty in Biloxi, were laid off as a result of the cuts, according to WLOX. It’s unclear how many more community health workers, who educate and help people access health care, have been impacted statewide.

The department was in the process of purchasing a comprehensive data management system before the cuts and has lost the ability to invest in the Mississippi Public Health Laboratory, he said. The laboratory performs environmental and clinical testing services that aid in the prevention and control of disease. 

Mississippi State Health Officer Dr. Dan Edney addresses lawmakers during the Democratic caucus meeting at the State Capitol in Jackson, Miss., on Tuesday, April 1, 2025. The discussion centered on potential federal healthcare funding cuts.

The agency has worked to reduce its dependence on federal funds, Edney said, which will help it weather the storm. Sixty-six percent of the department’s budget is federally funded. 

The Centers for Disease Control and Prevention pulled back $11.4 billion in funding to state health departments nationwide last week. The funding was originally allocated by Congress for testing and vaccination against the coronavirus as part of COVID-19 relief legislation, and to address health disparities in high-risk and underserved populations. An additional $1 billion from the Substance Abuse and Mental Health Services Administration was also terminated. 

“The COVID-19 pandemic is over, and HHS will no longer waste billions of taxpayer dollars responding to a non-existent pandemic that Americans moved on from years ago,” the Department of Health and Human Services Director of Communications Andrew Nixon said in a statement.

HHS did not respond to questions from Mississippi Today about the cuts in Mississippi.

Democratic attorneys general and governors in 23 states filed a lawsuit against the U.S. Department of Health and Human Services Tuesday, arguing that the sudden cancellation of the funding was unlawful and seeking injunctive relief to halt the cuts. Mississippi did not join the suit. 

Mental health cuts

The Department of Mental Health received about $7.5 million in cuts to federal grants from the Substance Abuse and Mental Health Services Administration. 

Phaedre Cole, president of the Mississippi Association of Community Mental Health Centers, speaks to lawmakers about federal healthcare funding cuts during the Democratic caucus meeting at the State Capitol in Jackson, Miss., on Tuesday, April 1, 2025.

Over half of the cuts were to community mental health centers, and supported alcohol and drug treatment services for people who can not afford treatment, housing services for parenting and pregnant women and their children, and prevention services. 

The cuts could result in reduced beds at community mental health centers, Phaedre Cole, the director of Life Help and President of Mississippi Association of Community Mental Health Centers, told lawmakers April 1. 

Community mental health centers in Mississippi are already struggling to keep their doors open. Four centers in the state have closed since 2012, and a third have an imminent to high risk of closure, Cole told legislators at a hearing last December. 

“We are facing a financial crisis that threatens our ability to maintain our mission,” she said Dec. 5. 

Cuts to the department will also impact diversion coordinators, who are charged with reducing recidivism of people with serious mental illness to the state’s mental health hospital, a program for first-episode psychosis, youth mental health court funding, school-aged mental health programs and suicide response programs. 

The Department of Mental Health hopes to reallocate existing funding from alcohol tax revenue and federal block grant funding to discontinued programs.

The agency posted a list of all the services that have received funding cuts. The State Department of Health plans to post such a list, said spokesperson Greg Flynn.

Health leaders have expressed fear that there could be more funding cuts coming. 

“My concern is that this is the beginning and not the end,” said Edney.  

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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