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Friday, August 3, 2018

Nothing Good in Mississippi’s ‘Fix’ for Medicaid Waiver

Mississippi is a state where parents must have extremely low incomes to qualify for Medicaid. And adults without kids who are not elderly cannot qualify for Medicaid at all, adults unless they have Social Security disability designation. As such, the state’s original Medicaid work requirement proposal presented a blatant trap for Medicaid-eligible parents. Parents would become ineligible for Medicaid if they earn any non-trivial income but also if they earn no income and therefore fail the work requirement.

The state has submitted a revision of its Medicaid waiver now up for federal comment.

This revised waiver would allow affected parents to retain Medicaid for up to 24 months of “transitional medical assistance” for each month that they comply with the work requirement and its associated documentation. View our 50-state map showing the status of restrictive Medicaid waivers.

The revision itself creates a dysfunctional structure on its own terms. People of the same income level are treated differently based on a previous spell of Medicaid eligibility. This sets up a perverse incentive: a narrow pathway for low-income working people to get covered in which they must be zero income for a period of time first.  This is also not a small or easily corrected design flaw. In a state that has not expanded Medicaid, in which working poor people generally go uninsured, it is simply not possible to design an incremental change which means that workers get coverage short of Medicaid expansion or a similarly comprehensive program. 

Mississippi’s revised proposal also retains all the core flaws of the work requirements approach. In the recent Stewart v. Azar decision rejecting federal approval of Kentucky’s work requirements waiver, the judge stated that the administration “never adequately considered whether Kentucky HEALTH would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid”, with medical assistance (the statutory term for Medicaid) defined as “payment of part or all of the cost of medical care and services”. 

In Kentucky and other states in which it publishes new approvals (potentially including Mississippi), the administration will likely now be attempting to, in some way, show that new eligibility requirements and documentation barriers will improve access to coverage, perhaps by increasing levels of employer-sponsored insurance.

It is critical that commenters show this is not the case—that these new requirements will reduce coverage levels and increase the number of people without health insurance.

Our core guidance to organizations regarding this new round of comments is:

  • First, that it is important to submit comments, and;
  • Second, that comments should demonstrate via quantitative, qualitative, or anecdotal evidence that Mississippi’s waiver will cause many people to lose access to health coverage and health care.

Visit the Mississippi page in our Waiver Strategy Center for additional guidelines for commenting on work requirements.