Another legislative session, another year will pass without Mississippi expanding Medicaid to provide health care coverage for the working poor.
States have had the option since 2014 to expand Medicaid to offer health care coverage to low-income workers with the federal government paying the bulk of the cost. Mississippi’s political leadership has repeatedly turned down that offer – rejecting more than $2 billion annually from the federal government to the state in some of the years since 2014.
Efforts to expand Medicaid in Mississippi peaked in the 2024 legislative session thanks to the support at the time of Republican House Speaker Jason White. But those unsuccessful efforts evaporated with the passage of President Donald Trump’s so-called One Big Beautiful Bill, or HR 1, this past summer.
While the massive bill, which included cuts to health care and other safety net programs for the poor, did not end Medicaid expansion, it did stop momentum for the program.
Forty states and the District of Columbia have expanded Medicaid, but none since 2023. Trump’s One Big Beautiful Bill, staunchly supported by both Mississippi Republican U.S. Sens. Roger Wicker and Cindy Hyde-Smith, removed many of the financial incentives that were available for the handful of states, like Mississippi, that had not expanded Medicaid.
While multiple bills were filed during the ongoing 2026 Mississippi legislative session to expand Medicaid, they all died deaths with the Republican leadership of the Legislature not calling them up for consideration.
Even many of Missisisppi’s health care advocates have been for the most part silent on the issue.
But a recent study by the national nonprofit Families USA concludes that despite the harmful provisions of the One Big Beautiful Bill, “by not expanding Medicaid, Mississippi is leaving $73.8 million on the table in 2026 in the form of lost state tax revenue and state health care spending that could otherwise be covered by the federal government under Medicaid expansion. These losses grow every year.”
The Families USA study is based on an estimate of 67,000 Mississippians being covered by Medicaid expansion.
The study correctly points out that there are thousands of people currently covered by the state’s traditional Medicaid program, where the federal government pays 77.3% of the health care costs, who could be covered by Medicaid expansion, where the feds would pay 90%. The transfer of those recipients from traditional Medicaid to Medicaid expansion would result in $25 million in annual savings.
Other savings or additional revenue cited by Families USA that would be available if Medicaid were expanded includes $16.1 million in insurance premium taxes. The federal government pays an insurance premium tax to the state for each Medicaid recipient.
The more than $70 million cited by Families USA does not include the economic growth for Mississippi projected by other studies, such as by the state economist at the University Research Center. That study and others project an economic boom, including massive jobs growth, as a result of the money that would pour into the state from the federal government if Medicaid were expanded.
But, perhaps, for the sake of argument, all those studies are wrong and Medicaid expansion would not be the financial bonanza projected. Granted, money pouring into the state from Medicaid expansion would not be as much as it was before passage of the One Big Beautiful Bill.
Khaylah Scott, program manager for the Mississippi Health Advocacy Program, which has been advocating for Medicaid expansion since the program’s inception, said despite the One Big Beautiful Bill, expansion still makes sense, for the most important reason of all – to improve the state’s health care system and outcomes for Mississippians
“Clearly, the health provisions in H.R. 1 were written to deter non-expansion states from expanding Medicaid,” she said. “Given our Legislature’s shift in priority, I’d say H.R. 1 accomplished that. However, expansion … remains an option, and the 90% federal match is still on the table. … Even with H.R. 1 cuts, expansion brings a net financial gain to the state. “
Scott added, “We urge our state leaders to work with advocates and others to learn how we can achieve expansion while being fiscally responsible. We have many options to continue to fund and invest in Medicaid.”
In recent years, legislative leaders and Republican Gov. Tate Reeves have fought for and passed legislation to phase out the state income tax, or put more bluntly, to eliminate the tax that provides almost one-third of Mississippi’s general fund revenue.
And House leaders want to pass a tax credit scheme that will divert $20 million annually in revenue to private schools.
In short, legislative leaders find ways to pay for the items they believe are important – just not health care for poor, working Mississippians.
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