Mississippi Medicaid Expansion Initiative (2022)

Mississippi Medicaid Expansion Initiative
Election date November 8, 2022
Topic Healthcare
Status Not on the ballot
Type State statute	Origin Citizens

The Mississippi Medicaid Expansion Initiative was not on the ballot in Mississippi as an indirect initiated constitutional amendment on November 8, 2022.

Proponents suspended the Yes on 76 campaign on May 19, 2021, citing the recent Mississippi Supreme Court ruling on Initiative 65 in which the court found that it is impossible for any initiative campaign to meet constitutional signature distribution requirements until a constitutional amendment is passed to change them. Click here to read more.

Measure design

The measure was designed to expand Medicaid in Mississippi to adults between 18 and 65 with incomes below 133% of the federal poverty level. Because the ACA includes a 5% income disregard, this measure effectively expanded Medicaid to those with incomes at or below 138% of the federal poverty level.

Text of measure

Ballot title

The ballot title would have been as follows:

“

Should Mississippi expand Medicaid eligibility to include adults ages 18-65 with incomes up to 138% of the federal poverty level?.

”

Ballot summary

The ballot summary would have been as follows:

“

Initiative Measure Number 76 seeks to amend the Mississippi Constitution to require Mississippi to provide medical assistance, under Mississippi’s Medicaid program, to individuals between the ages of 18 and 65 with income not exceeding 133% of the federal poverty level, plus 5% of the federal poverty level for the applicable family size, under the income methodology provided by applicable federal law, and who meet applicable non-financial eligibility conditions for Medicaid benefits under federal law.

”

Full text

The full text of the measure is available here.

Background

Medicaid expansion under the ACA

See also: Medicaid and Obamacare

The Affordable Care Act (ACA), also known as Obamacare, was signed into law on March 23, 2010. The ACA provided for the expansion of Medicaid to cover all individuals earning incomes up to 138 percent of the federal poverty level, which amounted to $17,236 for individuals in 2019. The law was designed to provide 100 percent of funding to cover the new recipients for the first three years and to cut off federal Medicaid funding to states that chose not to expand coverage. However, the United States Supreme Court ruled in National Federation of Independent Business v. Sebelius (2012) that the federal government could not withhold Medicaid funds from states that chose not to expand eligibility. According to the Kaiser Family Foundation, this ruling had the practical effect of making Medicaid expansion optional for states.

From 2014 to 2016, the federal government covered 100 percent of the costs of state expansion of Medicaid. In 2017, the total cost of expanded coverage that the federal government financed decreased to 95 percent. The ACA was designed to decrease the amount the federal government covers to 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020 and subsequent years.

The Affordable Care Act had not provided tax credits to adults with household incomes less than the federal poverty line because the law had aimed to cover these people under Medicaid. In states that did not expand Medicaid, many of these adults fell into a coverage gap in which they neither qualified for Medicaid nor for federal tax credits to purchase health insurance. As of 2018, around 2.5 million people fell into this coverage gap across the states that did not expand Medicaid.

Adoption of Medicaid expansion under the ACA

As of January 2022, a total of 38 states and Washington, D.C., had expanded or voted to expand Medicaid, while 12 states had not. The map below provides information on Medicaid expansions by state; for states that expanded, hover over the state to view the political affiliation of the governor at the time of expansion.

Path to the ballot

See also: Laws governing the initiative process in South Dakota

The state process

In Mississippi, the number of signatures required to qualify an initiated constitutional amendment for the ballot is equal to 12 percent of the total number of votes cast for governor in the last gubernatorial general election immediately preceding the signature deadline—not necessarily the gubernatorial election immediately preceding the targeted election date. Beginning with the day the sponsor receives the ballot title and summary, proponents have one year to circulate petitions and receive certification from the county circuit clerks. Petitions must be submitted to the secretary of state at least 90 days prior to the beginning of the regular session—which begins in the first week of January.

The requirements to get an initiated constitutional amendment certified for the 2022 ballot:

• Signatures: 106,190 valid signatures were required.
• Deadline: Petitions must be submitted to the secretary of state at least 90 days prior to the beginning of the regular session—which begins in the first week of January.

Petition sponsors must submit signatures to the appropriate county circuit clerks. There are no mandatory deadlines for this review and sponsors are recommended to coordinate with local clerks to ensure timely certification. Once the circuit clerks have certified the signatures, proponents must file the entire petition with the secretary of state. Sponsors must also pay a $500 fee upon filing.

Details about this initiative

• Dr. John Gaudet filed the initiative.
• Proponents suspended the Yes on 76 campaign on May 19, 2021, citing the recent Mississippi Supreme Court ruling on Initiative 65 in which the court found that it is impossible for any initiative campaign to meet constitutional signature distribution requirements until a constitutional amendment is passed to change them.

On May 14, 2021, the Mississippi Supreme Court overturned Initiative 65, the 2020 medical marijuana initiative. The ruling stated that the initiative petition did not comply with the signature distribution requirements in the Mississippi Constitution and that it is impossible for any petition to meet the requirements and has been impossible since congressional reapportionment in 2001.

The six justices wrote, "... Whether with intent, by oversight, or for some other reason, the drafters of [the constitutional signature distribution requirement] wrote a ballot initiative process that cannot work in a world where Mississippi has fewer than five representatives in Congress. To work in today’s reality, it will need amending—something that lies beyond the power of the Supreme Court."

The 1992 constitutional amendment that granted the power of citizen initiative in Mississippi required signatures to be collected evenly from all five congressional districts that existed at the time. It mandated no more than one-fifth of the required signatures could be collected from any single congressional district. During 2001 redistricting after the 2000 census, however, the number of congressional districts in the state was reduced to four.

Sponsors of some initiatives targeting the 2022 ballot in Mississippi filed a lawsuit challenging the Supreme Court's ruling.

Click here for more information on the lawsuit and the ruling.

See also

2022 measures

• 2022 ballot measures
• Healthcare on the ballot

Mississippi

• Mississippi ballot measures
• Mississippi ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• Mississippi Secretary of State: Initiatives
• Medicaid Expansion Initiative (#76)