Mississippi was not the only state where the Medicaid expansion work requirement was a hot topic during the 2024 legislative session.
South Dakota, a more conservative and Republican-dominated state than even Mississippi, debated the issue of work requirements during the 2024 legislative session and came to a much different conclusion.
In Mississippi, of course, efforts to expand Medicaid to provide health care coverage to the working poor, with the federal government paying most of the costs, were unsuccessful. While there were several nuanced reasons why the Mississippi Legislature did not expand Medicaid, perhaps the biggest reason is the insistence of Lt. Gov. Delbert Hosemann and the majority of the Senate, where he presides, that any expansion plan include a requirement that Medicaid enrollees had to be employed. .
However, it should be noted that it is not clear that the Medicaid expansion would have passed the Mississippi Senate even with a work requirement provision. But the Senate’s mandate for a work requirement doomed Medicaid expansion efforts in Mississippi. Since the federal government refused to approve work requirements for Medicaid expansion, many argued that there was no reason to approve a Mississippi proposal that would never go into effect because of strict work requirements.
The South Dakota legislature also debated a work requirement earlier this year and came to a much different conclusion than Mississippi lawmakers. It’s true that the issues in South Dakota were different than those in Mississippi, but the fact that the two legislatures came to a different conclusion on a work requirement could say a lot about how policymakers in the two states view the importance of a good health care system.
South Dakota lawmakers decided that Medicaid expansion was more important than having a work requirement. On the other hand, Mississippi lawmakers (at least Senate leaders) viewed having a work requirement as more important than providing health care coverage to the poor. They decided that having federal Medicaid expansion money flow — more than $1 billion a year — to financially troubled hospitals and other health care providers was too important to pass up.
South Dakota already had Medicaid expansion when the work requirement was debated there. It was placed on the ballot through a citizen-sponsored and voter-approved initiative. Last session, South Dakota lawmakers opted to put a proposal on the November 2024 ballot to allow voters to weigh in on a work requirement.
But here’s the catch: Even if voters approve the work requirement, that doesn’t mean it goes into effect.
The proposal would give state officials the option of imposing the work requirement. And, if state officials imposed the work requirement and federal officials rejected it, then Medicaid expansion would still be in effect in South Dakota.
Under the proposal offered by Hosemann and his leadership team, Medicaid in Mississippi would not have been expanded if the federal government had not passed a work requirement.
Many cite the work requirement as a logical fallacy or bogus issue. After all, Medicaid expansion provides health care coverage to people earning up to 138% of the federal poverty level, or about $20,000 a year for an individual or $43,000 a year for a family of four. It’s common sense that most people receiving health care through Medicaid expansion in the 40 states that have expanded Medicaid are working, otherwise they wouldn’t be making money.
The federal government has determined that it is a futile effort to try to enforce a Medicaid expansion work requirement. Studies have shown that Georgia officials, for example, spent more money enforcing a work requirement than providing health care coverage.
Most of the 10 states that have not expanded Medicaid are Republican-led Southern states. Many Republican-led states elsewhere in the country have expanded Medicaid.
And many of those states are much more Republican than Mississippi. The Mississippi Senate is made up of 36 Republicans and 16 Democrats, while the House is made up of 79 Republicans, 41 Democrats and two independents.
By contrast, the South Dakota Legislature is made up of 28 Republicans and just four Democrats with one vacancy, and the House is made up of 63 Republicans and just seven Democrats with one vacancy.
However, despite that overwhelming Republican majority, the South Dakota Legislature chose not to require people to work to receive health care coverage through Medicaid expansion.
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