A Medicaid expansion bill in Mississippi died in negotiations between the Mississippi House and Senate, primarily over the inclusion of work requirements in the final version, resulting in its failure to pass before the session deadline on May 2, 2024.

The Mississippi House of Representatives passed House Bill 1725 on February 28, 2024, with a bipartisan vote of 98-20. The bill would have required the Mississippi Division of Medicaid to apply for a waiver from the federal Centers for Medicare and Medicaid Services (CMS) to require eligible individuals to work 20 hours a week, be a full-time student, or enroll in a workforce training program. It would have expanded Medicaid coverage to households with incomes lower than 138% of the federal poverty line—approximately 200,000 Mississippians—even if CMS rejected the work requirement.

The Mississippi Senate passed the House Bill with amendments on March 28, 2024. The Senate version increased the work requirements to 120 hours per month and would have applied to households lower than 100% of the poverty line—thus not meeting the federal criteria for Medicaid expansion. This scaled-back version would have covered 40,000 individuals, while refusing $1 billion in federal Medicaid funds. The bill would also be repealed if CMS rejected the work requirement waiver.

During conference committee negotiations, Lt. Governor Delbert Hosemann and Republican colleagues in the Senate called for the inclusion of the work requirement. Senate Medicaid Chairman Kevin Blackwell (R) repeated several times during negotiations, “no work requirement, no expansion.” Governor Tate Reeves (R), moreover, expressed opposition to Medicaid expansion, meaning that any legislation would have needed to pass by a two-thirds vote in each chamber to override his expected veto.

House Medicaid Committee Chair Missy McGee (R) stated, “I’m disappointed that we couldn’t close the deal. I’m disappointed that for many, winning an ideological debate was more important than helping Mississippians. I’m disappointed some of those who have long advocated for Medicaid expansion let ‘perfect’ be the enemy of ‘good.’”

The Biden administration in 2021 directed CMS to withdraw the Medicaid work requirement waivers approved in 13 states during the Trump administration, though Georgia’s work requirement remained in effect following a court ruling. CMS under the Biden administration has not approved any Medicaid work requirement waivers as of May 15.

Additional reading:

Supplemental Nutrition Assistance Program work requirements

Supplemental Nutrition Assistance Program work requirements during the Biden administration