MS lawmakers still can't agree on Medicaid expansion six days before deadline

Medicaid Senate and House conference committee members seem to agree on only one thing: They should keep working on a compromise to expand Medicaid in Mississippi.

With four days left to file conference committee reports in the Mississippi Legislature, House Medicaid Chairwoman Missy McGee, R-Hattiesburg, offered one compromise to the House Medicaid plan for Senate members to consider.

That change would shift the age and income criteria that are already on the table.

"The biggest obstacle for us to address is the federal poverty level as how far we can take that," McGee said. "The house is committed to drawing down the maximum federal dollars available … (This) is what we like to offer to you guys to take to your membership, your leadership. We realize there's more than one way to get to 138% FPL. I think that for today, this is our biggest the biggest obstacle."

McGee's proposal would change coverage from people ages 19 to 64 making 138% of the federal poverty line to 100%, or about $15,000 per year, while covering those from 100-138% through the federal insurance exchange. The state would also pick up the bill on copays, deductibles and premiums. Under the House plan, the federal government would also pay 90% of the cost to run the state's Medicaid program.

Any additional cost to the state in the proposed plan, Mcgee said, would be offset by a federal match of about $600 million for the first two years of expansion, as well as tax dollars collected from managed-care providers who would financially benefit from Medicaid expanding to cover those making up to 100% Federal Poverty Level.

In order to receive that federal match, lawmakers would have to expand up to 138% Federal Poverty Level. The Senate plan only expands the state's Medicaid program for those making less than 100% Federal Poverty Level.

"We hear a lot in this capitol about how we're going to run this state like a business, and I don't know of any business that wouldn't take a deal of, 'I'm going to give you 90%, and all you have give me is 10%,'" McGee said.

However, the idea was met with skepticism from Senate conferees Kevin Blackwell, R-Southaven, Nicole Boyd, R-Oxford, and Brice Wiggins, R-Pascagoula.

Blackwell said that expanding up to 100% only would ensure that the poorest of the state's poor receive the benefits, while keeping the federal exchange alone, which if changed, he and Boyd both have said would have a negative impact on insurance providers on the exchange who could lose patients that move from private insurance providers to the Medicaid program.

Blackwell said he wants to keep the eligibility low, because he fears that more people than anticipated will sign up for the program, which could potentially cost the state money.

"Every state that is expanded, they have missed the mark on the number of enrollees that they anticipate," Blackwell said. "They've also missed the mark on the cost, and that's one of the things we're trying to nail down. There has been no consistency in any of the numbers that we've got from any group."

Blackwell also compared the House's expedience of passing Medicaid expansion out of the House so quickly in the session to driving a sports car.

"Every journey begins with a single step," Blackwell said. "In the House's case, I think you guys want to jump in the sports car."

McGee said her experience was not of driving a racecar, but more akin to arriving far too late to one's destination.

"I know that we're 10 years late," McGee said. "I don't feel like we have been in a Ferrari very long, I think we have been waiting 10 years."

During the meeting, conferees from both sides of the aisle also seemed to agree that they were working from completely different sets of numbers to form their approaches to Medicaid expansion.

House conferees said they had been working from numbers provided by the Hilltop Institute, which conducted an economic impact study on how expanding Medicaid would work out in Mississippi, while Senate lawmakers took advice from state officials, a Kaiser Family Foundation Medicaid study and other state's Medicaid plan.

Hood pointed out that the Senate still was unsure how many people on the federal exchange in the state would even qualify for Medicaid upon its implementation.

"I think it's something that we need to continue (looking at) as we move through the process," Hood said.

Despite the tension, both sides agreed to keep the conversation alive, with Blackwell noting that continued dialogue could be the only chance they have in the foreseeable future to pass Medicaid expansion.

"(The Senate) is only going to get more conservative," Blackwell later told the Clarion Ledger.

Grant McLaughlin covers state government for the Clarion Ledger. He can be reached at gmclaughlin@gannett.com or 972-571-2335.

This article originally appeared on Mississippi Clarion Ledger: Mississippi lawmakers still can't agree on Medicaid expansion