Joan Alker, executive director of Georgetown University’s Center for Children and Families, said the problem with work requirements largely is one of paperwork: Many Medicaid recipients who work struggle with the administrative burden of proving it, causing them to lose their coverage.

“Work requirements don’t work,” Alker told Stateline. “If you want to support people working, you are much better off helping them address their health problems that may be preventing them from working.”

Mississippi middle ground?

In Mississippi, Rep. Creekmore laments that his state’s failure to expand Medicaid means it is leaving billions of federal dollars on the table — money that would help support struggling rural hospitals by providing health insurance to about 123,000 people. Creekmore represents several rural counties with small hospitals.

For many conservatives, however, opposition to Medicaid expansion is fundamental, a function of their antipathy toward former President Barack Obama and welfare in general.

Gov. Reeves is one of them. He has pledged to veto any expansion bill, and last month he reiterated his opposition on X, formerly known as Twitter. “Our country is going broke, and he wants to add millions more to the welfare rolls,” Reeves wrote after President Joe Biden’s State of the Union speech. “We have to stand strong in Mississippi! NO Obamacare Medicaid expansion!”

In February, the Mississippi House approved bipartisan legislation that would fully expand Medicaid under the ACA, with a work requirement of 20 hours a week. However, the bill states that expansion would happen even if federal officials rejected the work rule. And Medicaid recipients would be allowed to meet the work rule by being full-time students or participating in workforce training.

Alker said the Mississippi House bill “builds in different pathways to get to the end result.”

“There’s lots of ways to think about the intersection of Medicaid and work,” she said. “So, they just built in flexibility to the bill, so that they can negotiate and get at the end of the day access to that extra federal funding and give people health care.”

Mississippi Democratic state Rep. Zakiya Summers, who co-authored the bill with Republican colleagues, said “the goal would be that we could get people better so that they actually can work.” Summers noted that even if the Biden administration rejected the work requirement, Mississippi could seek approval from a GOP administration later on.

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