Proposed Medicaid Work Requirement: Impact on Mississippi’s Low-Income Families

In This Report:

Key Findings

  • African-American mothers and families living in Mississippi’s small towns and rural communities would be hardest hit by the work requirement the state is seeking to impose on some Medicaid beneficiaries. These extremely poor parents would likely lose all health coverage, since few could afford private insurance.
  • The proposal creates a lose/lose situation: If these parents don’t find work, they would lose Medicaid coverage. If they do work the required 20 hours a week, they would make too much to qualify for Medicaid in Mississippi. As many as 5,000 people would be removed from Medicaid in the first year alone, according to an analysis of state estimates. The revised proposal does virtually nothing to address this problem.
  • Parents losing health coverage would be bad news for their children, as well. Mississippi has reduced its rate of uninsured children significantly in the past few years. But this proposal may reverse that progress. When parents are uninsured, children tend to go to the doctor less frequently and lose their own coverage. The family is at greater financial risk for medical debt.

(Updated August 3, 2018)


Mississippi has joined a handful of states seeking federal permission to require parents and caregivers who qualify for Medicaid to prove they are working at least 20 hours a week or participating in an approved work activity before receiving health coverage. Called the “Mississippi Workforce Training Initiative,” the application for a Section 1115 demonstration waiver pledges to bring more Medicaid beneficiaries into the workforce and move them onto other forms of health insurance. The proposal, however, ignores the fact that only the poorest and most vulnerable parents now receive Medicaid in Mississippi—and that few of them will be able to afford insurance even if they find jobs. A revised version of the proposal does little to address the underlying problems.1

In fact, the state’s own estimates suggest that about 5,000 of these Mississippi parents will lose their Medicaid coverage in the first year if the Centers for Medicare and Medicaid Services (CMS) approves the state’s request.2 The vast majority of these parents are likely to become uninsured.

Approval by the federal government is not certain. While CMS has given approval to four states—Arkansas, Kentucky, Indiana, and New Hampshire—to impose work rules, those states have all expanded Medicaid to adults making up to 138 percent of the federal poverty level. Mississippi, however, has not accepted the Medicaid expansion funding provided under the Affordable Care Act. The only Mississippi families affected by the proposed change would be those living at 27 percent of the poverty level or lower. That works out to $5,610 a year for a family of three or $468 a month—among the most restrictive eligibility limits in the nation

Full Report

Download the full report  or a Short Summary of Mississippi Revised Medicaid Waiver

More Information

Download a copy of the recording. 

The Georgetown Center on Children and Families is an independent, nonpartisan policy and research center founded in 2005 with a mission to expand and improve high-quality, affordable health coverage for America’s children and families. Mississippi Health Advocacy Program combines research, analysis and grass-roots organizing to improve health policies, practices and funding. Mississippi Center for Justice is a nonprofit, public interest law firm committed to advancing racial and economic justice.

  1. Mississippi’s revised waiver request can be accessed at
  2. These estimates are based on Georgetown CCF calculations of enrollment assumptions included in the state’s budget neutrality estimates
    accompanying the Section 1115 proposal. For simplicity’s sake we have divided the enrollment estimates (which are presented as monthly estimates) by 12 to get an annual estimate of those losing coverage. There may, in fact, be more people who lose coverage for less than 12 months or a smaller number who lose coverage for longer.