JACKSON, Miss. (AP) — The first serious effort by Mississippi’s Republican-led Legislature to expand Medicaid appeared to be crumbling Thursday as leaders argued over whether to let voters decide the issue.

Under pressure during the final days of a four-month session, House and Senate negotiators released a proposal Monday to authorize Medicaid coverage for tens of thousands more low-income people, but it included a work requirement.

House Democrats balked before the plan could come up for a vote, saying it was Medicaid expansion in name only because the federal government has blocked several states from having such mandates.

Mississippi is one of the poorest states and has some of the worst health outcomes. Some business leaders, clergy members and health advocates are lobbying for Mississippi to join 40 other states in expanding Medicaid as allowed under the health overhaul law signed by then-President Barack Obama in 2010.

After more negotiations Wednesday, House Speaker Jason White said his chamber would file a new proposal Thursday. It would put two questions on the ballot this November: Should Mississippi expand Medicaid? If so, should the expansion include a work requirement?

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“For years, the response to Medicaid expansion was not just no, but entirely dismissed; with this ballot referendum, Mississippians will now have a seat at the table on how we improve healthcare outcomes in our state,” White said in a statement.

Republican Lt. Gov. Delbert Hosemann said Wednesday night that the proposal to put Medicaid expansion on the ballot “was not well received” by Senate leaders.

“We are disappointed in the outcome this year, but value the discussions which occurred this Session — the first time this Legislature has seriously considered healthcare reform in our state,” Hosemann said. “I remain committed to finding ways to increase access for working Mississippians who otherwise do not have the resources for a simple check-up or an extended hospital stay.”

Hosemann said Senate leaders are firm about having a work requirement “with necessary exceptions.”

Even if legislators agree on a plan, they face a likely veto from Republican Gov. Tate Reeves, who refers to Medicaid as welfare and says he does not want more people dependent on the insurance program that’s funded by federal and state governments.

The proposal filed Monday night would require new Mississippi Medicaid recipients to be employed at least 100 hours a month in a job that does not provide private health insurance. Otherwise, they must fit into other categories, such as being a fulltime student or the parent of a child younger than 6.

If the federal government rejects Mississippi’s work requirement, the state Division of Medicaid would be required to continue seeking approval each year — an acknowledgement that a different federal administration might provide a different decision.

Georgia is the only state with a Medicaid work requirement, and it is suing the federal government to keep the mandate in place. The work requirement was approved by then-President Donald Trump’s administration, but the Biden administration announced in December 2021 that it was revoking the approval. Georgia sued.

The House voted by a wide bipartisan margin in late February to expand Medicaid coverage to about 200,000 people who earn up to 138% of the federal poverty level, or $20,120 annually for one person. Mississippi has about 3 million residents, and its Medicaid program covered 374,823 people in March.

In late March, the Senate passed its own pared-down version that would extend eligibility to people earning up to 100% of the federal poverty level, just over $15,000 for one person. Senate Medicaid Committee Chairman Kevin Blackwell, a Republican from Southaven, said about 80,000 people would become eligible for coverage.

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