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MS Leaders' Medicaid Expansion Work Requirement Still Shaky

Lieutenant Governor Delbert Hosemann, once a rare GOP voice in support of Medicaid Expansion in Mississippi, now threatens to undermine it with moralizing.


State health officer Dr. Daniel Edney sounded the alarm years ago that more than half of Mississippi’s rural hospitals—38—were on the verge of closing, a condition aggravated through a combination of the COVID-19 pandemic and Republicans’ dogged refusal to expand Medicaid.


When a hospital treats or saves the life of an uninsured patient, the patient frequently is unable to reimburse the facility for the exorbitant costs of treatment. An ambulance ride can easily cost $1,300, long before a doctor, legion of nurses, and anesthesiologists get close. This leaves stressed hospitals holding the bill for hundreds of low-income patients who default on their bills, pushing their operating costs to the breaking point. The Mississippi Hospital Association said, “The hospital crisis “has been fermenting” and “has been foreseeable for years and was indeed predicted.”


Recent federal allotments gave Mississippi hospitals a small pandemic-related bump, but that money isn’t permanent and other federal boosts are drying up as feds press states to cover uninsured patients through the national expansion. Some Mississippi hospitals benefit from Medicaid Disproportionate Share Hospital (DSH) payments to offset uncompensated care costs for uninsured patients. However, in fiscal year (FY) 2020, Mississippi received $125 million in federal DSH payments in 2020, and only $75 million in 2021.


Meanwhile, the Mississippi Hospital Association projects if legislators expand Medicaid the costs for expansion over the next five years will be “fully offset.”


“We project that state costs associated with the expansion will be approximately $956 million over this time period,” MHA claimed. “However, this will be more than offset by a total of $1.2 billion in new federal dollars ...”


Tennessee Inspector General Chad Holman told researchers it costs far more to run the TennCare fraud unit than it will ever recoup because suspects are generally low-income.

Eminent harm to state health facilities is big news, with business leaders and members of the clergy all begging GOP leaders to get on board with reversing the damage. Hosemann, an expansion supporter at the start of the state’s legislative session, is today an opponent of a bill that could finally close the state’s infamous Medicaid gap, partially because of his insistence on a work requirement.


Senators and representatives are now conferring over HB 1725, the bill potentially expanding Medicaid. On Friday, Hosemann announced the Senate had agreed to submit two conference reports back to the House. One favors the full expansion of “Mississippians up to 138 percent of the federal poverty level to pull down the 90 percent match from the federal government.” However, a press statement from the Lt. Governor’s office makes clear Hosemann insists on the problematic work requirement.


“Lt. Governor Delbert Hosemann and (Senate Medicaid Chairman Kevin) Blackwell have said a work requirement is a non-negotiable element for either plan, though the compromise proposal does have language directing the Attorney General to appeal to federal court if CMS denies the waiver,” the statement said.


The problem here is that the Biden administration has either refused or rolled back every work requirement states have tried to impose. Only Georgia currently maintains one, but that program, Georgia Pathways, expires in 2025. The state sued the Biden administration earlier this year to extend its program until 2028.


Even without staunch federal opposition, however, states are discovering that maintaining their work requirement is costly, and imperfect. KFF News reports Georgia’s alternative to Obamacare cost taxpayers at least $26 million, with more than 90% of those costs funneled toward administrative and consulting fees rather than low-income people without insurance. The program’s resulting low enrollment is also fueling bitterness. The state projected more than 25,000 new enrollees, but officials say only about 3,500 people have signed on since the project began last year.


“You’re spending money, primarily here, to put people through an extra set of hoops before they get coverage,” Harvard professor Benjamin Sommers told KFF News.


The work requirement was an albatross for other states as well. Initially, the state of Arkansas put its own people through a glitch-plagued web portal designed to monitor enrollees’ new work obligations. Thousands of state residents not only lost health coverage because of the new requirement but were locked out of reapplication for a year.


Many beneficiaries, like state resident Adrian McGonagall, had already been employed, but a series of catch-22s imposed by Arkansas' buggy new system cost them their healthcare and their jobs. McGonagall told reporters he’d failed to log his work hours correctly and lost benefits. U.S. criminal-grade healthcare costs kicked in soon after, making McGonagall’s medication unaffordable. When his health declined from lack of meds, he lost his job.


“It was going to be, like, $340 for one of the medications and, like, $80 for the other one,” McGonagall told PBS News Hour.


Critics said Tennessee’s work requirement would affect “the state's poorest mothers, as well as small towns and rural communities” the most. Other key findings determined even if parents did work more hours, the jobs they landed as cashiers and waitstaff were unlikely to offer health coverage of any value. “Only 15 percent of Tennessee adults living in poverty receive employer-sponsored insurance,” according to the Center for Children & Families (CCF) at the McCourt School of Public Policy at Georgetown University.


Worse, the loss of coverage for parents would impact their children and create a new generation of financial hardship.


The price of all that policing doesn’t come cheap, either. Aside from busting innocent people and sticking a felony label on their resume, administrative costs can take a big bite out of state budgets.

Tennessee Inspector General Chad Holman told researchers it costs far more to run the TennCare fraud unit than it will ever recoup because suspects are generally low-income.


Even if the state recovered every dollar from charges brought against beneficiaries in 2022, the total would amount to less than $900,000, KFF Health News reported. The office has a budget of $6.4 million a year.


Mississippi, which is internationally recognized as the state with the highest poverty in the U.S., can scarce afford the extra charges.


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