The Case for Medicaid Expansion in Mississippi

Mississippi state legislators discussed a potential Medicaid eligibility expansion during the 2024 session, introducing bills in both the state Senate and House, though they were ultimately unable to come to final agreement. By expanding Medicaid, Mississippi would join the forty states and the District of Columbia that have increased their eligibility to cover individuals with incomes up to 138 percent of the federal poverty level, an eligibility category created by the Affordable Care Act (ACA).

Mississippi currently has some of the strictest Medicaid eligibility rules in the country. Adults who are not parents or caretakers and do not qualify for disability are not eligible for coverage, no matter how low their income. Parents and caretakers can only qualify if their income is below about $7,200 annually. Federal subsidies to help people afford ACA Marketplace health care plans are not available to those under 138 percent of the federal poverty level, leaving many low-income state residents without affordable health insurance options, a position often referred to as the coverage gap. The state’s uninsured rate, as of 2022, was about 11 percent, the fifth highest in the country.[i]

A new, interactive infographic by Avalere shows the number of individuals, by geographic areas, who would be eligible for Medicaid if Mississippi expanded eligibility to 138 percent of the federal poverty level. This analysis, with support from AARP Public Policy Institute, estimates that 125,000 uninsured individuals in Mississippi would be eligible for Medicaid in 2025 through expansion, about 7% of the population of 19–64 year-olds in the state. Of the 125,000 individuals who would be eligible, about 28,000 are between the ages 50 and 64, representing about 5% of the total 50–64 population in the state.

Many states implemented the Medicaid expansion eligibility category immediately after it was created, over ten years ago. Research on the impact of expansion has continued to show overwhelmingly positive results. Among the myriad of positive effects, states that expanded have seen a decrease in the number of uninsured residents, increases in use of preventative services--often referred to as “high value” services, and improvements in health outcomes. Research has found a number of indirect positive outcomes as well, on issues like food security and housing stability.^[ii]

Medicaid coverage supports individuals in maintaining their health, and in turn, staying healthy helps enrollees maintain employment. Analysis by KFF found that most working age, non-disabled adults who have Medicaid work full-time or part-time.[iii] Not surprisingly, being in better health was strongly related to being employed. However, lower-wage workers are less likely to have health insurance offered through their jobs.[iv]

States that have expanded Medicaid have also not had negative budget impacts. In fact, past Avalere analysis for the AARP Public Policy Institute found that Mississippi could potentially see $701 million in net savings if it expanded Medicaid.^[v] State savings would come from several sources, all ultimately stemming from increased federal funding. Under the ACA, the federal government would pay a significant portion of the cost of some services for this expansion population that are currently paid for by the state, and a 2021 federal law includes additional funding to states for two years after they expand Medicaid.

With the next state legislative session coming in just a few months, hopefully discussions about expanding Medicaid in Mississippi will restart. Enacting Medicaid expansion would be a win for the state in many ways, especially for newly covered residents.


[i] “Health Insurance Coverage of the Total Population,” KFF, State Health Facts, Health Insurance Coverage of the Total Population | KFF, and Devna Bose, “Mississippi has one of the country’s highest rates of people without health insurance,” Mississippi Today, October 2, 2023, Mississippi has one of highest rates of uninsured people - Mississippi Today.
[ii] “The Effects of Earlier Medicaid Expansions: A Literature Review,” The White House, Council of Economic Advisors, June 22, 2021, https://www.whitehouse.gov/cea/written-materials/2021/06/22/the-effects-of-earlier-medicaid-expansions-a-literature-review/.
[iii] Madeline Guth, Patrick Drake, Robin Rudowitz, and Maiss Mohamed, “Understanding the Intersection of Medicaid & Work: A Look at What the Data Say,” KFF, April 24, 2023, Understanding the Intersection of Medicaid & Work: A Look at What the Data Say | KFF.
[iv] “Lower-wage workers less likely than other workers to have medical care benefits in 2019,”
March 03, 2020, U.S. Department of Labor, Bureau of Labor Statistics, The Economics Daily, March 3, 2020, https://www.bls.gov/opub/ted/2020/lower-wage-workers-less-likely-than-other-workers-to-have-medical-care-benefits-in-2019.htm.
[v] Tobey Oliver and Sari Siegel, “Medicaid Expansion Population and Cost Estimates for Mississippi,” AARP Public Policy Institute (PPI), August 2023, https://www.aarp.org/content/dam/aarp/ppi/topics/health/coverage-access/2023-state-medicaid-expansion-fact-sheets/medicaid-expansion-population-cost-estimates-for-mississippi.doi.10.26419-2fppi.00178.005.pdf.