By Surabhi Dangi-Garimella, Ph.D.

Hospital closures, service cuts, and lack of medical care in some of the poorest neighborhoods in the state—that is the status of hospitals and medical care in Mississippi, where 38 rural hospitals (54%) are expected to shutter their doors.

According to the Mississippi State Medical Association (MSMA), hospital closures across the state are jeopardizing resident access to medical care. This crisis was in the making for some time now and may have largely been driven by the healthcare coverage gap, which affects those who do not qualify for Medicaid but do not earn enough to afford private health insurance. Consequently, they remain uninsured. Hospitals cannot deny care to uninsured patients even if they cannot pay out of pocket and end up absorbing the cost, which is an unsustainable model for any business. 

COVID-19, staffing shortages, and inflation have further added fuel to the fire. 

The MSMA has recommended certain policy suggestions to slow the spread of this fire:

  • Raising the Medicaid income eligibility 
  • Offsetting hospital taxes
  • Introducing changes to the healthcare delivery and referral process in the state 
  • Providing access to private insurance for qualified recipients
  • Implementing an accountable care payment model, which emphasizes a preventive care approach

Is Medicaid Expansion Part of the Solution? 

MSMA believes absence of Medicaid expansion to a wider population in the state is one of the reasons for hospital closures. Mississippi is one of 11 states to have resisted expansion, and may not see any progress there as the state’s governor is a strong opponent of expansion. 

The median income limit to qualify for Medicaid in non-expansion states was $8,905 for a family of three in 2020 and childless adults in almost all the expansion states are ineligible for Medicaid. In expansion states, all adults with incomes up to 138% of the Federal Poverty Level ($17,609 for an individual in 2020) would qualify for Medicaid. Since the Affordable Care Act anticipated Medicaid coverage for everyone below the Federal Poverty Level, those under the poverty level who don’t qualify for Medicaid cannot receive financial assistance to enroll in other coverage. 

In 2019, 102,000 Mississippians were stuck in this coverage gap. Expansion in the state would allow more comprehensive healthcare benefits and also lower out-of-pocket costs for this population. Consequently, it’d reduce the burden of uncompensated care that hospitals in Mississippi are currently providing.

As a temporary measure, the Mississippi Hospital Association has recommended raising the Medicaid reimbursement rate cap, which would lower the cost of care of the state’s current Medicaid enrollees.


Surabhi Dangi-Garimella, Ph.D. is a biologist who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.