Medicaid expansion in Mississippi is in limbo, for now, as lawmakers table discussions

The Magnolia State remains one of the few in the U.S. yet to adopt Medicaid expansion — a provision in the Affordable Care Act passed more than a decade ago that expands coverage for more low-income Americans. Proponents argue the move could significantly improve health care access for thousands of uninsured residents in a state marked by the nation’s highest poverty rate, struggling rural hospitals and racial health disparities. 

Mississippi came close to adopting Medicaid expansion last year, which would have extended coverage to around 200,000 low-income residents, but the effort was kneecapped in the final moments of the 2024 legislative session over disagreements around work requirements. 

But despite a desire from most legislators to get a bill across the finish line during this session, lawmakers have been hesitant to commit, tabling conversations around a new bill and citing concerns over costs, implementation challenges and uncertainty of the future political landscape under President Donald Trump. 

“It’s not going to solve all problems, but it will give people the opportunity to have insurance coverage,” Mitchell Adcock, executive director of the Center for Mississippi Health Policy, a group that supports expansion, said. “So if they need medical services, they can get access to those services.” 

Currently, an estimated 74,000 Mississippians fall into the “coverage gap” — earning too much to qualify for Medicaid but not enough to afford marketplace insurance. There is no coverage gap in states that have expanded Medicaid. Instead, a single person making up to 138% of the poverty level — around $20,000 a year — can enroll in Medicaid. People making more than that can access subsidies for private health insurance.

Adcock said other states’ experiences with Medicaid expansion can provide valuable insights for Mississippi, citing successful expansion efforts in Arkansas, Georgia, Louisiana and Tennessee. 

Roy Mitchell, executive director of the Mississippi Health Advocacy Program, agrees, emphasizing that Mississippi has much to gain from expansion. It not only helps residents, but he said it can also fuel economic growth, create jobs and strengthen the state’s health care system. 

“We have the most to gain and the most to lose,” Mitchell said. “And the nation will be watching how Mississippi handles Medicaid expansion.”

A key point of debate in Mississippi’s Medicaid expansion discussions involves work requirements for recipients. 

Last year, republicans in the State Senate were adamant that anyone who wants health benefits has to work a minimum number of hours to qualify. The federal government, however, would have had to approve an expansion plan with a work requirement — something former President Joe Biden did not do during his administration. 

Georgia’s program incorporated these stipulations, leading to administrative complexities and reduced enrollment. Adcock said that while such requirements may decrease Medicaid participation, they could simultaneously encourage marketplace insurance enrollment. 

“There’s a lot of administrative stress and cost on the program, and it decreases enrollment numbers,” Adcock noted. “But Georgia had a tremendous number of sign-ups for their federal marketplace insurance program.” 

Mitchell was more critical of the approach, pointing to the inefficiencies in Georgia’s model. 

“Work reporting requirements are very cumbersome and expensive,” he said. “They greatly reduce the number of people who can get covered. When people are covered, the state gets more money.” 

Given Mississippi’s conservative political landscape, work requirements appear likely to be a cornerstone of any expansion effort moving forward. 

“Providing health care coverage for the working poor who can’t afford coverage is a focus,” Adcock said. “Leadership in the state is interested in ensuring individuals receiving services are making an effort to work and not just holding on to receiving Medicaid."

National policy changes further complicate Mississippi’s Medicaid expansion trajectory. 

With federal leadership transitions under the Trump administration and shifting health care priorities, state leaders are adopting a cautious stance. Congressional confirmation of TV personality Dr. Mehmet Oz, Trump’s pick to run the Center for Medicare and Medicaid Services (CMS), is also playing a role in policy discussions at the state level. 

“Mississippi, being a very conservative state, is waiting to see what changes come at the federal level before implementing anything,” Adcock said. “They’re waiting for guidance and confirmation of new policies.” 

Mitchell also pointed out the impact of federal uncertainty. 

“Our policymakers have continually said that Mississippi is a unique place, that we need to come up with our own policy solutions rather than deferring to the federal government,” he said. “But now, it seems they’re waiting for federal leadership to provide direction when this is an immediate issue.”

Beyond expansion, Mississippi faces systemic health care challenges, including provider shortages and health literacy. Adcock said many residents eligible for Medicaid are unaware of how to access services, highlighting the need for educational outreach. 

Improving health care access also requires addressing both coverage gaps and the distribution of providers. “There are issues in the number of providers and locations around Mississippi,” Adcock said. “Medicaid expansion is important, but it’s just one piece of the puzzle.” 

Mitchell agreed, emphasizing the potential to improve rural health care access. 

Timing also poses significant hurdles. Slow-moving federal decisions risk delaying state-level action for another year. 

“For those supporting Medicaid expansion, it’s going to turn around very quickly in the next four to six weeks,” Adcock said, adding that getting confirmations at the federal level could take up to three months — and by then the Mississippi legislative session will be over. 

“For anything to happen in Mississippi, it'll almost have to wait until next year,” he said. “These few months are really critical.”

This story was produced by the Gulf States Newsroom, a collaboration between Mississippi Public Broadcasting, WBHM in Alabama, WWNO and WRKF in Louisiana and NPR. Support for health equity coverage comes from The Commonwealth Fund.