Democrats want to expand the program to cover more low-income residents, which is an option under the federal health overhaul that President Barack Obama signed into law in 2010.
Republicans say that even with the federal government paying most of the tab for expansion, Mississippi can't afford to add an estimated 288,000 to 300,000 people to a program that already covers more than 640,000. Mississippi's population is just under 3 million.
The more fundamental question now is how lawmakers will keep the existing Medicaid program alive after the current state budget year ends June 30 — with or without expansion.
State programs come up for review and renewal every few years, and Medicaid, the federal-state health insurance program for the needy, is up this year.
At this point, there are no surviving bills that would keep Medicaid in business beyond June 30. Lawmakers are scheduled to remain in session through early April, and as long as they're at the Capitol, they have options to file new bills or to revive a Senate bill that was blocked Thursday in the House Rules Committee. Either option would take large majorities that would require bipartisan cooperation.
Another option would be for Republican Gov. Phil Bryant to call a special session, possibly during the regular session, to keep Medicaid alive.
During brief debate Friday, Republicans tried to revive House Bill 560, which failed Jan. 31. Democrats argued the bill should remain dead because it couldn't have been changed to allow Medicaid expansion. They want to consider Senate Bill 2207 because it could be amended for expansion, but House Republican leaders blocked the Senate bill Thursday.
"Think about all of God's children, think about local hospitals and health care professionals, think about the maimed," Rep. Steve Holland, D-Plantersville, told the House on Friday as he argued for expansion.
Reviving the House bill would've taken 68 votes. The vote was 60-52, largely along party lines.
House Speaker Philip Gunn, R-Clinton, told reporters later that there are not enough votes in the House to pass Medicaid expansion.
"As it stands right now, July 1 the program will cease to exist and the Democrats are the ones who have brought us to that point," Gunn said.
House Democratic Leader Bobby Moak of Bogue Chitto said expansion could support thousands of health care jobs in one of the poorest states in the nation. He said Republicans are blocking the chance for debate.
"It's too many Mississippi souls on the line," Moak said in an interview.
Republicans hold a majority in both the state House and the Senate.
Under the federal health law, states have the option of expanding Medicaid to cover people making up to 138 percent of the federal poverty level, or about $15,000. Mississippi's cutoff is now about $5,500.
The federal government would pay 100 percent of medical expenses for the newly qualified enrollees from 2014 to 2017, then the federal share would be reduced to 90 percent by 2020, with each state paying the balance.
Six Republican governors have proposed expanding Medicaid in their states to cover more low-income residents, citing the financial realities of their states' medical costs.
Associated Press writer Laura Tillman contributed to this report.