Health insurance in Mississippi
- Mississippi utilizes the federally run exchange, with residents enrolling through Healthcare.gov.
- Open enrollment for 2019 coverage in Mississippi ended on December 15, but enrollment is still possible for residents who have qualifying events.
- Short-term health plans are available in Mississippi with initial plan terms up to 364 days.
- One insurer is offering coverage through the Mississippi exchange.
- The average individual-market premium is mostly unchanged for 2019.
- Mississippi exchange has the nation’s highest percentage of enrollees receiving premium subsidies and CSR.
- About 84,000 enrolled in 2018 coverage through the Mississippi exchange.
- Mississippi has refused to accept the ACA’s Medicaid expansion.
Mississippi’s health marketplace
Mississippi uses the federally run exchange for individual-market plans, so residents who buy their own health insurance enroll through HealthCare.gov. But the state runs One Mississippi, which is the SHOP exchange for small businesses.
Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for residents who have qualifying events.
The average rate increase for plans sold in the exchange is only 0.27 percent for 2019. The cost of CSR is still being added to premiums for plans at all metal levels; Mississippi is one of just three states using that approach for 2019 (in most states, the cost of CSR is added only to silver plan rates, resulting in larger premium subsidies). Outside the exchange, BCBSMS has implemented a very slight rate decrease for 2019.
Mississippi’s exchange has the highest percentage of enrollees receiving premium subsidies and cost-sharing reductions (CSR) in the nation. In Mississippi, 96 percent of exchange enrollees were receiving premium subsidies in 2018, versus 87 percent nationwide. And 86 percent were receiving CSR, versus 53 percent nationwide (CSR is only available to enrollees with income up to 250 percent of the poverty level).
Mississippi enrollment in qualified health plans
During the ACA’s 2014 open enrollment period, 61,494 Mississippians enrolled in qualified health plans (QHPs). Ninety-four percent of those selecting QHPs qualified for financial assistance, and the average premium after tax subsidies was $23 a month.
During the 2016 open enrollment period, 108,672 Mississippians selected private health plans through Mississippi’s federally facilitated health insurance exchange, but that number dropped to 88,483 during the 2017 open enrollment period (lower enrollment was common for 2017 in states that use HealthCare.gov, due in part to the incoming Trump Administration’s decision to reduce advertising and outreach in the final days of open enrollment).
By early 2017, effectuated enrollment (ie, paid-up and in force) in Mississippi’s exchange stood at 67,203. Most of those enrollees — 94 percent — were receiving premium subsidies that averaged $380/month, and 80 percent were receiving cost-sharing reductions that lowered their out-of-pocket costs.
Open enrollment for 2018 coverage was only half as long as previous open enrollment periods had been. But enrollment for 2018 still reached nearly 95 percent of the prior year’s enrollment, with more than 83,600 people signing up for 2018 coverage. By early 2018, effectuated enrollment stood at nearly 75,000 people. 96 percent of them were receiving premium subsidies, and 86 percent were receiving cost-sharing reductions. In both cases, those are the highest percentages in the nation, indicating a lower average income for Mississippi’s exchange enrollees, as well as a willingness to select silver plans, since cost-sharing reductions are only available with silver plans.
The fact that Mississippi hasn’t accepted federal funding to expand Medicaid also contributes to the high percentage of enrollees receiving premium subsidies and CSR, since enrollees with income between 100 and 138 percent of the poverty level are eligible for subsidies in the exchange, whereas they’d be eligible for Medicaid instead if the state had expanded Medicaid.
Read more about Mississippi’s health marketplace.
Mississippi Medicaid and CHIP eligibility
Mississippi did not expand Medicaid through the Affordable Care Act. The state’s decision leaves 99,000 individuals in what is known as the coverage gap – about 28 percent of the state’s uninsured population.
Without Mississippi Medicaid expansion, non-elderly, non-disabled adults without children are not eligible for Medicaid. Adults with dependent children qualify for Medicaid only if the family’s income is 23 percent or less of the federal poverty level (FPL), which works out to under $5,000 in total annual income for a family of three in 2018. Pregnant women are eligible for Medicaid with a household income up to 194 percent of the poverty level. Medicaid eligibility for Mississippi children varies by age and ranges from 133 percent to 194 percent of FPL.
Due to the state’s decision not to expand, average monthly Medicaid enrollment is virtually unchanged (an increase of fewer than 1,200 people, versus a Medicaid population of more than 638,000 people) since 2013. Although it’s noteworthy that by late 2016, average enrollment was up 9 percent, and has dropped since then. Nationwide, average enrollment in Medicaid/CHIP increased by 27 percent from 2013 to 2018.
If Mississippi receives federal approval for the Medicaid work requirement that the state has proposed, some of the low-income parents who are currently eligible for Medicaid will have to work in order to maintain eligibility for Medicaid. The state projects that 5,000 people could lose access to Medicaid each year, due to non-compliance with the work requirement or with related reporting requirements. The waiver proposal was still pending CMS approval as of November 2018.
Read more about Mississippi and Medicaid.
Short-term health insurance in Mississippi
Mississippi defaults to the new federal rules for short-term plans. That means plans sold in the state can have initial terms of up to 364 days, and total duration, including renewals, of up to 36 months.
Read more about short-term health insurance in Mississippi.
Mississippi health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance ranks the 50 states and DC in terms of overall health. Again in 2017, Mississippi maintained its bottom of the barrel, 51st place ranking. The Magnolia state came in last in the categories of Avoidable Hospital Use & Cost, as well as Equity, and was in 50th place for Prevention & Treatment, and Healthy Lives.
After placing last in the United Health Foundation’s America’s Health Rankings for 2014, Mississippi improved to 49th in 2015, but dropped back to 50th place in the 2016 ranking. Mississippi faces challenges related to physical inactivity, a high premature death rate, a high prevalence of tobacco use, low birth weight, and children living in poverty. America’s Health Rankings has been issued since 1990, and Mississippi has consistently been ranked among the bottom three states ever since the first edition.
To learn more about Mississippi’s health as a state, see Key Health Data About Mississippi from the 2016 edition of Trust for America’s Health. Data from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin allow you to compare the health of counties within Mississippi.
Has Obamacare helped Mississippi?
Mississippi uses the federally run exchange for individuals, at HealthCare.gov. But the state runs its own Small Business Health Options Program (SHOP) exchange, which is called One, Mississippi. The state has not accepted federal funding to expand Medicaid under the ACA.
96 percent of Mississippi exchange enrollees were receiving premium subsidies in 2017, and 86 percent were receiving cost-sharing reductions (CSR), which is the highest percentage in the nation (nationwide, 53 percent of exchange enrollees receive CSR benefits). These benefits serve to make individual health insurance and health care more affordable and accessible for Mississippi residents than they would be without the ACA.
Mississippi’s uninsured rate dropped by about 30 percent under the ACA, falling from 17.1 percent in 2013 to 12 percent in 2017. But the state’s uninsured rate remains higher than the national average, and the 2017 uninsured rate is a little higher than it was in 2016, when it had dropped down to 11.8 percent (nationwide, the uninsured rate crept up slightly in 2017, after the Trump Administration took office).
For many residents, the ACA made coverage in the individual insurance market both affordable and accessible, with premium subsidies, cost-sharing subsidies, and guaranteed-issue coverage (ie, medical history is no longer a factor in eligibility). About 96 percent of Mississippians enrolled in plans through the state’s federally facilitated exchange receive subsidies, versus 87 percent of all exchange enrollees nationwide.
But Mississippi has not accepted the ACA’s federal funding to expand Medicaid. The uninsured rate would be considerably lower if they had, and there are an estimated 99,000 people in the Medicaid coverage gap in Mississippi due to the state’s rejection of federal funding for Medicaid expansion.
And instead of expanding coverage, Mississippi has asked the federal government to approve a work requirement for some of the people who are already eligible for Medicaid. If it’s approved, very low-income parents would have to work in order to maintain eligibility for Medicaid, and the expectation is that the work requirement would result in about 5,000 people losing their Medicaid coverage each year.
Mississippi lawmakers and the ACA
Mississippi’s Senators are both Republican: Roger Wicker and Cindy Hyde-Smith. Both are opposed to the ACA, and support Mississippi’s decision to reject federal funding to expand Medicaid. Hyde-Smith was nominated by Gov. Phil Bryant in April 2018 to fill the seat vacated by Thad Cochran, who resigned for health reasons after 40 years in the Senate. She ran for re-election in 2018, but since no candidate got a majority of the vote, a run-off election between Hyde-Smith and Democrat Mike Espy is set for November 27, 2018. Hyde-Smith has been plagued by scandal during the election.
Hyde-Smith believes the ACA should be repealed, and Wicker proudly touts his record that includes numerous votes to repeal or defund the ACA.
In the Mississippi state legislature, Republicans have a strong majority in both chambers.
Does Mississippi have a high-risk pool?
Before the ACA’s reforms to the individual health insurance market, eligibility for private coverage was contingent on medical history. People with pre-existing conditions were often unable to purchase private plans, or could only buy policies that excluded their pre-existing conditions.
The Mississippi Comprehensive Health Insurance Risk Pool (the “Association” or MCHIRPA) was established in 1992 as a means of providing coverage for people who were unable to purchase comprehensive plans in the private market because of pre-existing conditions.
Now that the ACA has brought guaranteed issue coverage to the private individual market, high risk pools are largely obsolete. Mississippi’s Association remained operational through 2016, with a message on its homepage reassuring members that the ACA was not bringing any immediate changes to their existing coverage. But by 2017, the website simply said “these policies are no longer being offered.” People with pre-existing conditions can instead obtain coverage in the individual market in Mississippi, since medical history is no longer a factor in determining premiums or eligibility for coverage.
In 2018, Mississippi enacted HB1196, which states that “upon the cessation of operations” by MCHIRPA, the distribution of any remaining funds held by the association will have to be approved by the Commissioner of Insurance.
Medicare enrollment in the state of Mississippi
About 77 percent of the state’s Medicare beneficiaries qualify for coverage based on age alone, and 23 percent qualify due to disability – tied with Kentucky and Alabama for the highest percentage in the country (nationwide, an average of 16 percent of Medicare beneficiaries are eligible based on a disability). Medicare spent an average of $10,441 per Original Medicare enrollee in Mississippi in 2015. Mississippi was one of only four states where average Medicare spending exceeded $10,000 per person.
In 2015, about 14 percent of Mississippi Medicare recipients selected a Medicare Advantage plan instead of Original Medicare, compared with 31 percent of total U.S. Medicare beneficiaries. About 57 percent of Mississippi Medicare beneficiaries enrolled in stand-alone prescription drug coverage through a Medicare Part D plan in 2015.
State-based health reform legislation
Scroll to the bottom of the page for s a summary of recent Mississippi legislation related to healthcare reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.