Mississippi Medicaid Expansion Stalls Amid Federal Cuts, Reeves Veto

JACKSON, Miss. (AP) — Mississippi's push to expand Medicaid coverage under the Affordable Care Act has collapsed, according to Senate Medicaid Chairman Sen. Kevin Blackwell, R-Southaven. 'There is no expansion,' Blackwell told the Mississippi Free Press, blaming changes to federal funding from President Donald Trump's 'One Big Beautiful Bill Act.' The legislation altered Medicaid financing, making expansion unfeasible despite prior momentum.

The state House passed HB 1725 in 2024 by a 99-20 veto-proof majority, directing the Division of Medicaid to seek a Section 1115 waiver for expansion starting Jan. 1, 2025. The plan targeted adults ages 19-64 earning up to 138% of the federal poverty level — roughly $20,000 for an individual — who work, attend school full-time or join workforce training. It included hospital assessments to fund the state share and a fallback State Plan Amendment if the waiver failed by Sept. 30, 2024, but required the federal match rate to stay at 90%.

Efforts faltered in conference amid disputes over work requirements, which the Biden administration was unlikely to approve. Similar bills like HB 546 and HB 1591 surfaced in 2025, proposing health savings accounts and studies on work reporting impacts, but none advanced. A temporary federal incentive from the American Rescue Plan — boosting the match by 5 points for two years — had lured states like North Carolina, with KFF estimating a $690 million benefit for Mississippi if enacted earlier.

Gov. Tate Reeves has opposed traditional expansion, praising its recent blockage amid a $390 million budget hole for FY2027. Lawmakers appropriated over $200 million more, pushing state funding past $1 billion and total program costs above $8.5 billion with federal dollars. Meanwhile, SB 2212 extends postpartum coverage to 12 months, offering a smaller win as 200,000 Mississippians — many in rural Delta counties — remain uninsured.