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This summer has been full of big moments. We celebrated our nation’s 250th birthday, and more recently, Medicaid and Medicare – two health care safety net pillars that have helped generations of Mississippians get the care they need, from babies to grandparents – turned 61. Summer is also peak time for back-to-school physicals and immunizations; services largely supported by the Medicaid and the Children’s Health Insurance Program.
But this summer also marked another anniversary, one that brings less celebration and more trepidation, the one-year anniversary of H.R. 1 — what President Donald Trump and Congressional leaders have called the “one big beautiful bill.”
Supporters and lawmakers pray at the start of a press conference advocating for Medicaid expansion and protection at the Mississippi Capitol in Jackson, Miss., on Tuesday, March 18, 2025. Credit: Eric Shelton/Mississippi TodayUnfortunately, for Mississippi families the effects will be anything but “beautiful.” Cuts to care to the tune of $1 trillion nationally mean stripping health care coverage away from people who need it and forcing our state leaders to make tough choices on which essential services to keep running.
The budget bill took a hatchet to funding for health care programs, shutting many Mississippians out, and forcing the state to figure out how to keep the lights on.
The most stringent requirements of H.R. 1 impact states that have expanded Medicaid, which Mississippi has not done. Our state budget will still feel significant impacts due to H.R. 1’s cuts, such as restrictions on how Mississippi can generate revenue to support its Medicaid program.
Unfortunately, our state’s Medicaid budget is facing other pressures, too.
In Mississippi, state financial support for Medicaid has been flat over the past 10 years. Despite rising health care costs and budget pressures within the state Division of Medicaid, the state has done little to preserve Medicaid. Mississippi has instead relied on short-term COVID-19 era federal funding to plug Medicaid budget gaps.
However, now that COVID funding has run out, Mississippi Medicaid faces a significant funding deficit — one that will only grow due to policies in H.R. 1. This fiscal reality is concerning, and some legislators are worried that without changes, “[we’re] going to be in the same boat” next year when it comes to balancing the Medicaid budget.
Without new solutions, the perpetual lack of state investment in Medicaid will jeopardize the health of nearly 700,000 children, pregnant women, older adults, disabled Mississippians and their families.
Amid these budget pressures, expanding Medicaid in Mississippi still remains a key opportunity. Mississippi is one of just 10 states that still refuses to expand Medicaid, a decision that leaves tens of thousands of working families without affordable health coverage and deepens the strain on our hospitals, communities and economy. And although H.R. 1 adds additional barriers for states that expanded Medicaid, the benefits far outweigh these challenges.
In fact, an analysis by the Care4Mississippi coalition and Families USA found that Medicaid expansion would unlock significant savings for our state. By not expanding in 2026, our state is leaving $73.8 million on the table in the form of lost state tax revenue and state health care spending that could otherwise be covered by the federal government. From a dollars-and-cents perspective, this funding would have made up for approximately one fifth of the department’s $390 million shortfall this year.
Plus, these expansion dollars could be counted on annually. When Mississippi expands Medicaid, the federal government will pay 90% of all costs. This federal matching arrangement is permanent, supporting Mississippi’s Medicaid budget now and into the future. Permanent funding provides security, allowing our state to maintain critical health programs and access to care.
Under Medicaid expansion, 67,000 more low-income Mississippians would have health coverage, dramatically reducing the costs of uncompensated care – health care that is provided but not paid for when people cannot afford their care. That cost currently falls on Mississippi taxpayers and hospitals.
The budget challenges that lawmakers and the Division of Medicaid are grappling with are very real. Mississippi Medicaid has already warned that budget cuts will force the agency to cut payments to providers. In addition, Mississippi must contend with H.R. 1’s substantial cuts to provider reimbursements, which dramatically limit Mississippi’s ability to boost payments to hospitals and nursing facilities. These are payments that incentivize providers to see Medicaid patients.
Taken together, the state’s ability to adequately pay Medicaid and safety-net providers is in jeopardy, and the resulting downstream effects on patients’ quality care, access to doctors and health care affordability could be dismal.
Medicaid expansion in Mississippi would not only provide a more immediate counterweight to these budget pressures but also help generate significant economic growth in the long run.
Despite slowed momentum to expand access to care, Mississippi needs to consider additional investments that would bolster its Medicaid budget and offset costs.
For example, directing opioid settlement funds to the Division of Medicaid to support treating opioid use disorder or raising tobacco taxes to generate over $100 million per year are both strategies that would support the Medicaid program.
In addition to Gov. Reeves’s recent request for waivers to ban the purchase of sugary drinks and unhealthy processed foods using SNAP benefits, we should consider a statewide tax on sugary drinks. Researchers have estimated a soda tax could bring over $100 million annually in revenue to the state. Taken together with Medicaid expansion, which is a key investment in the future of the state’s health care system, these options would help our state overcome Medicaid budget challenges.
Our state’s Medicaid program needs greater investment, not less, and there are common sense, tried-and-tested solutions that can help do that. When we reflect on milestone moments for our nation and our cornerstone public programs, our future — whether next year, the next 60 years, or the next 250 years — inevitably comes to mind. We need to set up strong and sustainable programs where everyone in Mississippi can be their healthiest and access the care they need, regardless of their income.
As we sail into next year, we must take more sustainable solutions like Medicaid expansion and taxes on considerably unhealthy goods seriously. In short, we can’t just fix the leak in the hull; we need to build a better boat.
Bio: Dr. John Gaudet is a native Mississippian who has practiced pediatrics in Hattiesburg for many years. Since retirement, he has been involved in medical education, helping to train the next generation of physicians.
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