Its primaries were held on March 10, 2020, with runoffs taking place on June 23.

Voting for Alternative 65A supports approving the legislature's alternative medical marijuana amendment, which would restrict smoking marijuana to terminally ill patients; require pharmaceutical-grade marijuana products and treatment oversight by licensed physicians, nurses, and pharmacists; and leave tax rates, possession limits, and certain other details to be set by the legislature.

[7] Initiative 65 would legalize possession of up to 2.5 ounces (71 g) of medical marijuana for people with 22 kinds of pre-existing conditions.

Alternative 65A would legalize possession of an as-of-yet unspecified amount of medical marijuana for terminally ill patients with as-of-yet unspecified pre-existing conditions, would not necessarily delegate responsibility for administration to the state Department of Health, would not cap costs for medical marijuana ID cards, would not set a tax rate for the substance and would not set a deadline by which cards had to be issued.

A "yes" vote supports the following: removing the requirement that a candidate for governor or elected state office receive the most votes in a majority of the state's 122 House of Representatives districts (the electoral vote requirement), removing the role of the Mississippi House of Representatives in choosing a winner if no candidate receives majority approval, and providing that a candidate for governor or state office must receive a majority vote of the people to win and that a runoff election will be held between the two highest vote-getters if no candidate receives a majority vote.