Mississippi has not expanded Medicaid under the Affordable Care Act (ACA), although the state medical association came out in support of expansion in August 2016, hoping to push lawmakers towards expanding coverage. Non-disabled adults without children are not eligible for Medicaid regardless of how low their income is, and parents with dependent children are only eligible with incomes that don’t exceed 22 percent of the poverty level. This is one of the lowest eligibility caps in the country.
If Mississippi did expand Medicaid, FamiliesUSA estimates that 200,000 people would be newly eligible for coverage. Unfortunately, in the poorest, sickest state in the US, the Governor and the Legislature have opted to reject federal funds that would provide health insurance for the state’s poorest residents.
Because subsidies are only available in the exchange for people whose household incomes are at least 100 percent of poverty, there are 108,000 people in Mississippi who are in the coverage gap and have no realistic access to health insurance. They aren’t eligible for Medicaid, and they also aren’t eligible for subsidies. According to the Kaiser Family Foundation, this is 30 percent of Mississippi’s total uninsured population — the highest percentage of any of the states where Medicaid has not yet been expanded.
Rhonda White is among them. Her job pays just $8.25/hour, and she can only get about 15 hours a week. She lives with her disabled husband and mother, along with her daughter and three grandchildren – all in a two-bedroom house in rural Mississippi. And while several of them have health conditions, they can’t access medical care because Mississippi hasn’t accepted federal funding to expand Medicaid.
Who is eligible?
- Adults without dependent children are not eligible at all (this is generally the case in states that have not expanded Medicaid) unless they’re disabled.
- Adults with dependent children are only eligible if their household income doesn’t exceed 22 percent of poverty level. This is about $4,419 a year for a family of three, one of the most strict thresholds in the country.
- Infants under one are eligible for Medicaid if their household income is up to 194 percent of poverty.
- Children 1 – 5 are eligible if their household income is up to 143 percent of poverty.
- Children 6 – 18 are eligible if their household income is up to 133 percent of poverty.
- Children with household incomes above the Medicaid thresholds are eligible for CHIP if their household incomes are up to 209 percent of poverty
- Pregnant women are eligible for Medicaid if their household income does not exceed 194 percent of poverty.
How do I enroll?
- You can enroll through HealthCare.gov, either online or by phone at 1-800-318-2596.
- You can fill out the PDF version of the Mississippi Medicaid Application Form and either click the application submit button, or save the completed PDF and email it to email@example.com
- You can also print out the PDF application, complete it by hand, and fax, mail, or deliver it in person. You can fax it to 601-576-4164. You can mail it to 550 High Street, Suite 1000, Jackson, MS 39201. Or you can take it to your nearest Mississippi Division of Medicaid regional office.
Enrollment grows by 8 percent
13,779 HealthCare.gov applicants in Mississippi enrolled in Medicaid or CHIP between October 2013 and April 2014. During the second open enrollment period (for 2015), 10,699 Mississippi residents enrolled in Medicaid or CHIP. All of these enrollees were already eligible for Medicaid under the existing guidelines, but had not enrolled prior to the opening of the ACA exchanges.
Medicaid enrollment is year-round though, and people can also apply directly through the Mississippi Division of Medicaid (enrollment tends to increase during the ACA’s general open enrollment period due to outreach and education activities on the part of enrollment assisters). As of July 2016, total Medicaid enrollment in Mississippi was 8 percent higher than it had been prior to October 2013. Net enrollment increased by 49,990 people during that time period.
Prior to 2014, more than a fifth of Mississippi’s residents (22.4 percent) were uninsured. According to a Gallup poll, that number had only fallen to 20.6 percent by mid-2014, but was down to 14.2 percent by mid-2015. However, by the end of 2015, the Gallup data indicated that Mississippi’s uninsured rate had crept up slightly, to 14.7 percent. US Census data puts the state at a lower overall uninsured rate in both 2013 and 2014. The census found that the uninsured rate in 2013 was 17.1 percent, and that it had fallen to 14.5 percent by 2014. But even with the lower uninsured rate in the census data, only seven states had a higher uninsured rate than Mississippi in 2014.
Given that 30 percent of Mississippi’s remaining uninsured population is in the coverage gap, there is no doubt that Medicaid expansion would significantly reduce the uninsured rate in the state.
Missing out on billions in federal funding
As the ACA was written, it called for Medicaid expansion in every state for residents with incomes up to 133 percent of poverty (plus a 5 percent income disregard, bringing the effective eligibility threshold to 138 percent of the poverty level). But in 2012, the Supreme Court ruled that states could not be penalized for opting out of expansion, and Mississippi is one of 19 states that has not yet moved forward with Medicaid expansion.
In states that expand Medicaid, the federal government pays the full cost of expansion through 2016. After that, the state gradually starts to pay a share of the expansion cost, but the federal government will always pay at least 90 percent. As a result, states that reject Medicaid expansion are leaving billions of dollars on the table.
From 2013 through 2022, if Mississippi continues to reject Medicaid expansion, the state will give up $14.5 billion in federal funding that would otherwise have been available to the state to help provide medical care for low income residents.
And since residents in states not expanding Medicaid still have to pay federal taxes, Mississippi residents will end up subsidizing Medicaid expansion in other states. Over a decade, people in Mississippi will pay $1.7 billion in federal taxes that will be used to pay for Medicaid expansion in other states.
Hospitals in Mississippi that treat uninsured patients will be especially hard-hit, as their federal Disproportionate Share Hospital funding will start to dry up over the next few years (it was supposed to be replaced by Medicaid funding) but unless the state accepts federal funding to expand Medicaid, those hospitals will still be treating significant numbers of uninsured patients.
Will Mississippi expand coverage?
Governor Phil Byrant, a Republican, is opposed to Medicaid expansion because he claims that the state wouldn’t be able to bear the cost if the federal government were ever unable to uphold its promise to pay at least 90 percent of the cost. He’s referred to accepting Medicaid expansion as a “fool’s errand.”
But contrary to the position Mississippi politicians have taken, states that have expanded Medicaid have seen substantially smaller growth in state Medicaid spending than states that haven’t expanded Medicaid.
Mississippi’s share of traditional Medicaid costs has climbed from $763 million in fiscal year 2012 to $949 million in fiscal year 2017. Lawmakers have highlighted this as a reason for not expanding coverage, but they’re missing the point (whether purposely or not) that Medicaid expansion is funded under different rules from traditional Medicaid. Under Medicaid expansion, the cost to cover newly eligible residents is fully funded by the federal government through the end of 2016. After that, the states start to pay 5 percent of the cost, and will eventually pay 10 percent by 2020, but it will stay at that level going forward.
In June 2013, Republicans in both chambers of the Mississippi legislature voted against Medicaid expansion. They did vote to continue the state’s existing Medicaid program, which came within days of expiring and had to be dealt with in a special legislative session called by Bryant. The issue of Medicaid expansion might not have even made it to a vote except that Democrats threatened to withhold their votes for renewing the existing Medicaid program unless Republicans would agree to take the issue of Medicaid expansion to a vote. No Republicans voted for Medicaid expansion, although one, Senator Billy Hudson of Hattiesburg, said that he would eventually vote for Medicaid expansion, “but not today.”
The Mississippi State Medical Association put forth a resolution in August 2016 calling for “expanded coverage” but didn’t use the words “Medicaid expansion” in their draft, knowing that the issue is too politically charged.
It’s possible that Mississippi might pursue a modified version of expansion within the next few years, most likely relying on a waiver proposal similar to those used in a handful of other Conservative states. But for now, no concrete steps have been taken towards expansion. In the nation’s poorest state, the poorest residents have no access to health coverage at all.