SUMRALL — Lamar County resident Kenneth Hornsby doesn’t mince words when discussing the challenges of accessing health care in his town.

“I myself live in Sumrall, so when I drive over here for my mom, it’d be nice if there was something closer,” Hornsby said. “At least I have transportation to get her to and from her doctors’ appointments.”

Hornsby’s story reflects a broader issue facing rural Mississippi residents: limited access to local health care and the burden of long-distance travel. As the push for Medicaid expansion continues, health care advocates like Ryan Kelly, executive director of the Mississippi Rural Health Association, stress the potential for transformative change.

Expanding Medicaid in Mississippi, they argue, could alleviate the financial strain on rural hospitals while improving access to care for underserved residents. The Mississippi House and Senate are set to revisit the issue during the 2025 legislative session, which begins Jan. 7.

“I think we were really close this year, the 2024 legislative session,” Kelly said. “I really believe we’ll get it across the finish line in 2025. The only argument this year was how do we do it?”

The financial stakes

Non-expansion states like Mississippi face unique challenges, including the loss of federal Disproportionate Share Hospital payments. These payments traditionally help hospitals cover the cost of care for uninsured or low-income patients.

The Kaiser Family Foundation reports that non-expansion states have an average uninsured rate of 14.1%, nearly double the 7.5% rate seen in expansion states. This gap places immense financial pressure on rural hospitals, which often serve large uninsured populations.

For instance, a rural hospital might have to absorb the cost of a $10,000 emergency surgery for an uninsured patient. Medicaid expansion would allow these hospitals to receive federal reimbursements for such care, stabilizing their finances and enabling investments in equipment, staffing and community health services.

Richard Roberson, CEO of the Mississippi Hospital Association, believes Medicaid expansion is essential for hospitals to continue serving their communities.

“Primarily, in an emergency department setting, because under federal law, hospitals are required to provide services regardless of a patient’s ability to pay,” Roberson said. “They would now be compensated for those services.”

If passed, Medicaid expansion would cover 90% of the costs for newly eligible patients, with Mississippi responsible for the remaining 10%, according to an independent analysis of Medicaid expansion in Mississippi.

Report projections estimate costs to the state to be $232 million to $260 million annually from 2024 to 2029. However, these estimates do not account for potential savings from reduced uncompensated care costs and increased federal funding.

Economic and workforce benefits

Medicaid expansion wouldn’t just benefit hospitals — it could bolster Mississippi’s economy. According to the Center on Budget and Policy Priorities (CBPP), a nonpartisan research and policy institute, expansion could create thousands of health care jobs as more revenue flows into the sector.

Roberson highlights that healthier residents lead to a more productive workforce, with fewer missed workdays due to untreated medical issues. Medicaid also enables enrollees to access preventative care, improving job performance and workforce participation rates statewide.

“A lot of new jobs would be created, particularly in health care, because there would be more revenue coming into health care,” Roberson said. “It creates opportunities for more health care jobs and a way to pay for those jobs that we don’t currently have.”

With over 25% of Mississippians currently receiving health benefits through Medicaid and the Children’s Health Insurance Program (CHIP), expanding eligibility could make a significant difference in addressing gaps in coverage.

Transportation challenges

For rural residents, even accessing health care can be an uphill battle due to transportation barriers. The American Hospital Association estimates that 3.6 million people annually are unable to obtain medical care because of transportation issues.

“We must have quality access to care, affordable access to care and quick access to care,” Kelly said.

He believes Medicaid expansion could improve ambulance and non-emergency medical transportation systems statewide, helping residents reach inpatient and outpatient care, dental services, mental health providers and pharmacies.

Federal regulations already mandate that Medicaid programs provide transportation assistance for beneficiaries, including children under the Early and Periodic Screening, Diagnostic and Treatment benefit. However, advocates argue more funding and infrastructure are needed to address Mississippi’s rural health care deserts.

Hollie Williamson, a Forrest County resident, understands the risks firsthand.

“I think it’s kind of sad that health care is spread out that far, that people have to travel so far to get health care,” Williamson said. “It puts people at a greater risk to have something severe happen to them and not be able to get the health care they need.”

On the other side

As Mississippi lawmakers prepare for the 2025 legislative session, the debate over Medicaid expansion is expected to be at the forefront. Residents like Hornsby and Williamson, alongside health care professionals, are hopeful for a resolution that brings care closer to home, pointing to the conference report key committee members agreed to in 2024. Despite that goal, opponents say expansion is not the answer.

Starla Brown, the state director of Americans for Prosperity-Mississippi, a community activist organization, points to the strain Medicaid creates for state and federal budgets. In an op-ed for the Magnolia Tribune, she said, “Medicaid was never designed to be a primary insurance provider for able-bodied consumers, but rather as a temporary solution for individuals and families who need it.”

She also warned, “Counting on the federal government to continue a 90% contribution to the program is dangerous as that contribution, as well as the federally permissible state provider-tax rate, could both decrease.”

“If costs spiral out of control, the federal government will not let states limit enrollment or reduce eligibility,” she wrote. “Mississippi legislators who want to see a balanced budget should heed caution of the potentially long-lasting effect Medicaid expansion could impose on taxpayers.”

RHCJC News requested additional interviews for this story. These lawmakers declined to comment or did not respond to our requests: Gov. Tate Reeves (R), Speaker of the House Rep. Jason White (R), Commissioner of Insurance Mike Chaney (R), Rep. Elliot Burch (R), Rep. Carolyn Crawford (R), Rep. Jeffery Guice (R), Rep. Stacey Hobgood-Wilkes (R), Rep. Timmy Ladner (R), and Rep. Jansen Owen (R).