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As Congress moves toward potential Medicaid cuts, expansion grows more unlikely in Mississippi
Hundreds of thousands of poor, disabled or pregnant Mississippians could lose health care coverage if Congress slashes funding for Medicaid.
Although President Donald Trump has vowed Medicaid won’t be “touched,” the U.S. House of Representatives passed a budget resolution Tuesday that instructs the committee that oversees Medicaid and Medicare to cut $880 billion over 10 years. The cuts will help pay for Trump’s agenda on tax cuts and border reform.
The talk of such dramatic changes to the federal-state program has Mississippi lawmakers concerned – and hesitant to push expansion this year.
Proposals for Medicaid budget cuts nationwide include lowering the rate at which states are reimbursed for Medicaid services, capping the amount of money states can get per enrollee, and imposing block grants – meaning states would receive a fixed dollar amount for the program, regardless of need.
Mississippi, the poorest state in the nation, could suffer the most under some of these proposals, according to health policy experts.
Despite the state having some of the strictest eligibility requirements in the nation, pervasive poverty and poor social health determinants mean that more than 650,000 Mississippians – about half of whom are children – rely on the program for basic health care. More than half of births in Mississippi are funded by Medicaid.
“Mississippi has a relatively small population, with the lowest per capita annual income in the country, rates of chronic conditions that are consistently higher than the national average, and with around 60% of Mississippians living with multiple chronic conditions,” explained John Dillon Harris, a health care systems and policy consultant at the Center for Mississippi Health Policy. “… The result is a large Medicaid population that is very expensive to treat.”
Democratic lawmakers are also sounding the alarm about deep cuts to Medicaid. Rep. Omeria Scott, D-Laurel, said it’s something Mississippians “ought to really be afraid of.”
“If they are talking about cutting $880 billion out of the budget, Mississippi is going to be on its knees,” she said at the Democrats’ legislative press conference Tuesday.
However, since Mississippi is one of only 10 states not to expand Medicaid and draw down billions in additional federal funds, some proposed cuts wouldn’t directly affect the state’s current budget – though they would affect future enrollment.
“Mississippi isn’t drawing down as much, so that’s not going to be a direct cut to your current budget, but it’s an opportunity cost,” said Joan Alker, Medicaid expert and executive director of Georgetown University’s Center for Children and Families.
Threats to slash Medicaid spending have already scared away Mississippi lawmakers from attempting expansion this year – though they have passed “dummy bills,” void of details, to keep the issue alive “should something transpire,” House Speaker Jason White said.
After a decade of squelching any debate on the issue, Mississippi House GOP leaders in 2024 pushed for legislation that would expand Medicaid to 200,000 low-income adults, as 40 other states have done. While the bills died after a saga of partisan politics, advocates were hopeful that the historic session created enough momentum to get the policy through the finish line in 2025.
Now, lawmakers fear they may have bigger problems on their hands.
“Unfortunately, we’re hearing more about what may be cuts or block grants to the Medicaid program in general that we will have to deal with as a state because there’s no denying we have a large Medicaid population – so I don’t know the chances,” White said when asked about the likelihood Medicaid expansion would be brought up this year.
Others are more certain the issue is dead this year.
“In a most practical sense, I’d say we probably won’t be doing anything this year,” Senate Medicaid Chairman Kevin Blackwell told Mississippi Today, though he added that if anything changes, lawmakers could suspend the legislative rules and bring a bill back to life late in the session.
Click the dropdown to learn more about the specific proposals that would reduce Medicaid funding:
Reducing the federal match rate
The federal government could reduce the federal matching rate, or FMAP, which determines the percentage of Medicaid costs the federal government pays to each state. How much this would affect Mississippi would depend on the language of the proposed cut.
Mississippi currently has the highest FMAP in the country at 76.9% – meaning the federal government pays for nearly 80% of Mississippians’ Medicaid coverage, while the state makes up the rest – because of the state’s high poverty rate.
One of the proposals would take away the FMAP floor. As it stands, all states receive at least a 50% FMAP, even if they “should” be receiving less, according to the per capita income formula. If that floor was removed, richer states would be affected, as their FMAP would drop below 50%. Mississippi would likely not suffer from this proposal.
Another proposal would remove the increased federal match rate of 90% that the federal government offered to newly-expanded states in the last few years. Without the increased match rate, expansion would not hold the financial favor that has made it politically palatable to Republicans in the state.
Capping benefits per enrollee
The feds could also impose what’s called a “per capita cap,” limiting the amount a state could spend on Medicaid per person. If the caps were implemented, Medicaid would only receive a certain amount of money from the federal government to cover the care of a beneficiary – regardless of his or her medical needs. States would be locked into a fixed amount based on what they have historically spent.
The fact that Mississippi has one of the lowest per person Medicaid spending would count against the state – locking it into a lower fixed budget.
Alker, the Medicaid expert from Georgetown University, says pushing expansion legislation through this year could make Mississippi more likely to receive a higher per capita budget – though it’s no guarantee.
“I’ve seen proposals that look at taking away the American Rescue Plan Act incentives, which is extra funding for states that newly come to expansion … I have seen some chatter about how one proposal is to take away those incentives, but to not take them away from states that were counting on them,” explained Alker.
“In other words, sort of grandfathering in North Carolina and South Dakota (states that expanded Medicaid in the past two years). So, if anything, it might be smart for Mississippi to do the expansion this session and lock that in.”
Imposing a block grant
Imposing block grants would be similar to per capita caps, but arguably more punishing for states since funding wouldn’t change based on enrollment growth.
Block grants would limit states’ abilities to respond to emergencies, and would especially hurt rural areas, research says.
Limiting provider tax
Mississippi is currently almost maxed out on the tax it’s allowed to impose on hospitals, which helps the state pay for its share of Medicaid spending. One option being discussed in Congress is to lower the limit of or eliminate the tax, which would mean hospitals would be reimbursed at a lower rate and there would be less state money to fund the Medicaid program.
The proposal is less likely to garner support, explained Harris, the policy consultant at the Center for Mississippi Health Policy.
“It’ll be difficult to move this particular reform through Congress since such a large number of states, both red and blue, rely on this tax to pay for their programs,” he said.
But if it did go into effect, the impact would be profound.
“The state would have to get really creative in figuring out what to tax and how in order to maintain the current level of support hospitals receive through these supplemental payments,” Harris said.
Imposing work requirements
Work requirements have long been discussed as a means of making Medicaid expansion more palatable to conservatives who view the program as “welfare.” Now, Congress may decide to impose work requirements on the regular Medicaid population.
As it stands, Mississippi has one of the country’s strictest income requirements for Medicaid. Childless adults don’t qualify, and parents must make less than 28% of the federal poverty level, a mere $7,000 annually for a family of three, to qualify. More times than not, that means that working a full-time job counts against an individual.
If the state were to keep its strict income requirements while also imposing a work requirement, it would be difficult for Mississippians to qualify for the health care program.
The red tape that a work requirement would create would also likely deter eligible Mississippians from enrolling or staying on the program.
Lt. Gov. Delbert Hosemann said Mississippi lawmakers have “a leg up” since the state’s former Medicaid director recently landed a spot in Washington leading the federal Medicaid division under Trump. Hosemann has yet to say what, if anything, Snyder has told lawmakers so far, but said he expects to have “a direct commentary into the area of Medicaid” through Snyder.
Regardless of what action the federal government decides to take, cuts of this magnitude would affect millions of low-income people across the country, not just in Mississippi.
“States will be forced to deeply cut eligibility, benefits and reduce provider rates,” Alker said in a statement published online in response to the House budget resolution outlining Medicaid costs. “These cuts will especially harm rural communities who are more reliant on Medicaid, and where hospitals are already operating on tighter margins.”
Taylor Vance, Geoff Pender and Michael Goldberg contributed to this report.
Mississippi Today receives grant support from The Bower Foundation, as does the Center for Mississippi Health Policy. Donors do not in any way influence our newsroom’s editorial decisions. For more on that policy or to view a list of our donors, click here.
The post As Congress moves toward potential Medicaid cuts, expansion grows more unlikely in Mississippi appeared first on Mississippi Today.
America’s Digital Demand Threatens Black Communities with More Pollution
Ninety years ago, President Franklin D. Roosevelt and South Carolina Gov. Ibra Blackwood worked together to bring electricity to rural South Carolina. But to build the power plant that would make it happen, they destroyed the homes of 900 Black sharecropping families. With them, 6,000 graves — including those of formerly enslaved people — were removed or desecrated.
Today, as South Carolina races to power its digital future, history seems to be repeating itself, with Black communities once again paying the price for progress.
Last year, the parent companies of Facebook and Google pledged more than $4 billion for new data centers in South Carolina. Every email you send, question you ask ChatGPT, or Instagram post you share relies on these centers. However, on this new digital frontier, the health and safety of Black communities are at risk.
While state officials work to craft legislation to attract these new projects, residents and community advocates say this will ramp up environmental hazards, increase utility bills, and exacerbate health disparities. Meanwhile, experts say, the economic promise of AI remains a mirage for Black communities, widening wealth gaps and displacing workers.
“Most Black households, especially rural ones in the South, are not using AI or as much computing power, but they are having to pay for that demand in both money and dirty air,” said Shelby Green, a researcher at the Energy and Policy Institute.
South Carolina is joining other states, like Texas and Illinois, with proposals to reopen at least two power plants in rural Black communities to run these new projects. Rural communities have begun to attract tech companies for data centers due to their low population densities, ample open space, and relatively lower energy and land costs.
Energy experts argue that the growing electricity demands from data centers are prolonging America’s dependence on dirty energy sources. Nationwide, at least 17 fossil fuel generators scheduled for closure are now delayed or at risk of delay, and about 20 new fossil fuel projects are being planned to meet data centers’ soaring energy demands. By 2040, South Carolina projects the need for four new fossil fuel power plants.
At a protest last year, Audrey Henderson, a resident of one of the towns facing the prospect of a polluting power plant, said she fears the impacts on her and her neighbors’ properties.
“My forefathers worked hard to get that property; that we have land. I have children in New York to get land when I pass away. Grandchildren and so forth and so on,” she said. The fact “they could just come in here, give us a couple of dollars, and take our land and put pipelines into it. Then we also have well water, just stuff going into the wells is very disheartening, and I’m really concerned.”
Across the country, low-income Black communities face the harshest pollution exposure from these plants, while Black workers are disproportionately in roles most vulnerable to AI and automation. A McKinsey & Company analysis warns that if AI growth continues at its current pace, the wealth gap between Black and white households could widen by $43 billion annually within the next two decades because of disparities in who it serves.
Compounding these issues, data centers are expected to use 12% of the nation’s energy by 2028, a 550% increase from last year. An artificial intelligence search using ChatGPT, for example, uses anywhere from 10 to 30 times more energy than a regular internet search.
“The energy demand, data centers, and where the energy sector is going should not come at the expense of low income and Black communities,” said Xavier Boatwright, an activist who has worked on environmental issues in rural South Carolina for years.
In South Carolina, officials predict data centers will drive 70% of the state’s increased energy use, with subsidies already raising utility bills for consumers. Through his canvassing across the state, Boatwright said he now regularly sees rural mobile home communities where people are paying more for their utility bills than mortgages because of this increase.
“It’s kind of like if you go out and your employer is paying for your dinner, and you order the fanciest stuff on the menu,” explained Green, who researches how rising utility bills are pushing Southern Black communities into poverty. “You don’t really have to worry about how expensive it is because it’s not coming out of your pocket. That’s how these companies are operating; they’re not holding the risk associated with increasing electricity costs and these new power plants — you are.”
In majority-Black, poor rural Fairfield County, the state is proposing to reopen a stalled nuclear plant that has long been a symbol of broken promises and financial strain for residents. Advocates warn that restarting this decades-long gamble could further burden a population already facing systemic neglect. Billions of taxpayer dollars and rising energy costs are at stake, yet the benefits of the project seem unlikely to reach those facing the worst consequences.
In South Carolina, and across the country, statistically, Black people use the least amount of electricity, yet experience the highest energy burden—meaning a larger share of their income goes toward energy bills.
In the other case, a Black stronghold in Colleton County celebrated the monumental victory of closing a coal-fired power plant in their neighborhood, which was connected to poor health outcomes for residents. Now, the state proposes to convert that very site into a gas-fired power plant to meet the energy demands of data centers. Every year, the pollution from natural gas plants is responsible for approximately 4,500-12,000 early deaths in the U.S., studies show.
“If you mapped all of the existing power plants in South Carolina, they’d follow the old path of one of the foundational pillars of the American economy through South Carolina: plantations and enslaved labor,” Boatwright said. “We’ve seen the repeated pattern of these threats in our community.”
Who pays for this growth?
With this boom, tech companies like Google are making huge profits by securing special deals with utility companies.
Google’s head of data center energy, Amanda Peterson Corio, said Google’s energy supply contracts undergo “rigorous review” by utility regulators and are crafted “to ensure that Google covers the utility’s cost to serve us.”
Yet, last year, the company inked a deal in South Carolina to pay less than half the rate that households pay for electricity.
These low rates, combined with tax breaks and state-approved subsidies, are used to lure big tech companies. However, these deals force local families and households to cover the cost of building extra power plants, meaning everyday customers end up footing the bill.
A data center is a combination of massive warehouses packed with rows of servers and high-tech gear that stretch longer than football fields, all humming away to store and manage the digital data we use every day. They’re so massive, for example, that Google’s first South Carolina data center, which opened in Berkeley County in 2009, uses the equivalent electricity of roughly 300,000 homes and the amount of water of at least 9,000 homes. As of 2021, it was also powered by more fossil fuel based energy sources than any of Google’s two dozen other data centers nationwide.
This uneven situation leads to a growing gap between corporate savings and community expenses, with everyday people shouldering the extra burden. Black communities, in particular, tend to face higher utility costs and, as a result, are more likely to have their power shut off for missed payments. Along the East Coast, monthly utility bills are expected to increase as much as $40 to $50 mainly due to data centers.
South Carolina legislators — Democrats and Republicans — have implored the state’s regulators to rethink discounts and other subsidies, but the push has not made waves so far.
“Current residential ratepayers are going to pay a lot, lot more because of data centers that bring almost no employees,” Chip Campsen, a Republican South Carolina state senator, said at a legislative hearing last September. Tech companies must “participate in paying the capital costs for building the generating capacity for these massive users of energy.”
This issue ties into broader government policies aimed at boosting American technological growth and making the United States a leader in artificial intelligence. The Trump administration, for example, has signaled that it might bypass some environmental regulations to speed up projects like data centers and power plants. The new leader of the Environmental Protection Agency, Lee Zeldin, has said making “the United States the Artificial Intelligence capital of the world” will be one of his five guiding pillars, along with making it easier for tech and manufacturing companies to invest in the American economy.
Restarting the nuclear project
Near Jenkinsville, South Carolina, half-built nuclear reactors — remnants of the long-stalled V.C. Summer project — tower over a Black community where three out of four live in poverty. They stand as a stark reminder of a $9 billion investment that never produced power. Despite customers still footing the bill for this abandoned venture to the tune of multiple utility bill increases, the state-owned utility company Santee Cooper is now inviting proposals to complete one or both units. Supporters argue that reviving the project would add 2,200 megawatts to the grid — enough to power hundreds of thousands of homes — and help meet surging energy demands driven by tech giants. Recent inspections by the state’s Nuclear Advisory Council have deemed the site in excellent condition, bolstering growing legislative support.
Researchers say it would be the first and only nuclear project to restart after being halfway built. Critics caution that history warns against overly ambitious nuclear bets that can lead to decades of delays, spiraling costs, and additional burdens on customers. They contend that immediate, incremental investments in solar power and battery storage could offer a safer, more adaptable path forward rather than reinvesting in a risky long-term gamble. Currently, nuclear energy is about four times more expensive to produce than solar energy.
Last year, the state was granted over $130 million from the Biden administration for solar projects, but the funding is now in limbo under the Trump administration.
The Black-led South Carolina Energy Justice Coalition has spent years advocating for solar and wind energy in rural Black communities. “Every citizen is worthy of that type of energy by virtue of just being a human being,” Shayne Kinloch, the group’s director, said last year.
The gas issue
Along the banks of the Edisto River in the heart of South Carolina, a former coal-fired power plant — closed in 2013 — is poised for a dramatic transformation. Dominion Energy and Santee Cooper plan to convert the site into one of the nation’s largest gas-fired power stations, a move approved by the state’s Public Service Commission. Designed to produce up to four times the energy of the old plant, this project is a central part of efforts to retire remaining coal facilities by 2030 and transition toward a future of “reliable, affordable, and increasingly clean energy,” the companies said.
However, environmental advocates and legal experts warn that this expansion of gas infrastructure may echo a troubling legacy where vulnerable communities bear the brunt of environmental and economic risks. Shifting from coal to gas plants isn't environmentally or cost-effective, opponents say, because while gas produces slightly less pollution than coal, it still contributes significantly to greenhouse gas emissions. It also comes with high infrastructure and maintenance costs.
This month, the state's House of Representatives approved legislative changes that would weaken oversight of gas power plants. Joining Republicans, South Carolina’s Legislative Black Caucus Chairwoman Annie McDaniel, a Democrat representing the county home to the nuclear plant, voiced support for the legislation.
McDaniel did not respond to Capital B’s request for comment.
The changes, if passed by the state’s Senate, would allow the groups to bypass rigorous environmental reviews when proposing projects. Supporters claim these measures are necessary to meet rising energy demands from tech-driven growth. Critics argue this could sideline investments in renewable alternatives like solar and battery storage and raise the risk of rising costs, delays, and potential noncompliance with federal pollution standards.
“Instead of investing in more risky energy generation and infrastructure, they should be investing in energy solutions like solar and storage,” Boatwright said, “but utilities are choosing the most expensive and environmentally risky.”
The post America’s Digital Demand Threatens Black Communities with More Pollution appeared first on Capital B News.
“We’re in competition”: An East Texas school district faces hard choices as education options grow
The Lufkin school district says it must do a better job of promoting itself amid growing competition from charter schools and homeschooling.