Centers for Medicare and Medicaid Services | St. Louis Public Radio

Centers for Medicare and Medicaid Services

Lacy Seward, social services coordinator for the Monroe City Manor. Medicaid cuts proposed by Senate Republicans could hit hard in this small town, that helped vote them into office.
Durrie Bouscaren | St. Louis Public Radio.

MONROE CITY, MO. — The closest emergency room is 20 miles east on the highway. That’s why it isn’t unusual for people experiencing heart attacks, blood clots and strokes to show up at Dr. Rodney Yager’s clinic on Main Street in Monroe City.

Yager, who grew up in the area, can handle the fast pace of a small-town clinic. What worries him more is how federal health care policies being shaped in Washington, D.C., could affect his patients.

Van Tyler checks a list of names and addresses while delivering meals in Jennings for the Mid-East Area Agency on Aging in June, 2016.
File photo | Durrie Bouscaren | St. Louis Public Radio

States with rapidly aging populations, like Missouri, are seeing increased costs to Medicaid programs that cover low-income residents.

But the Republicans' health care proposal to replace the Affordable Care Act would create per-capita caps for federal Medicaid funding, potentially shifting increased costs to states. Advocacy groups for seniors warn that the proposal working its way through Congress may not adequately fund their care.

Keith Carter, 53, waits to pick up a prescription for diabetes at Affinia Healthcare in St. Louis. Though he falls in the income gap, he's able to get his preventive care covered through Gateway to Better Health.
Durrie Bouscaren | St. Louis Public Radio

At any given time, a half dozen people sit in the waiting room at Affinia Healthcare in south St. Louis. Two parents coo over a new baby, while a group of older patients chat along the back wall.

53-year-old Keith Carter sits alone. An embroidered polo shirt and badge show he’s just come from work.

“I seem fit. Inside, it’s just breaking down like sawdust. I just keep it in motion,” he said, as he waited to pick up a prescription to manage his diabetes.

Given the intricacies of individual insurance plans, co-pays and hospitals' calculations to determine how much to charge for care, it is no simple feat to figure out how much your health care costs. Shopping around for around for the best price in town? Even harder. But a new set of data released Wednesday by the Missouri Hospital Association might make that process a little bit easier.  

(via Flickr/ellie)

Open enrollment for Medicare starts this month, on Oct. 15, and closes Dec. 7.  It is the only time of the year that plan beneficiaries have the ability to change their Medicare health and drug plans.

Plan costs and coverage benefits seem to change almost as soon as they are enacted. Around 1700 people in the St. Louis area alone will be impacted by their Medicare Advantage plan not renewing their contract with Medicare, making open enrollment an important part of the year to pay attention to.

Gerald Roy with the U.S. Department of Health and Human Services speaks at a news conferenc announcing fraud charges while Stephen Wiggington, U.S. Attorney for the Southern District of Illinois looks on to the right on Thursday, June 18, 2015.
Camille Phillips | St. Louis Public Radio

Twelve people are facing federal charges in southern Illinois for allegedly defrauding a Medicaid program that provides home care for people with disabilities.

State and federal officials announced the charges Thursday in the U.S. Attorney’s office for the Southern District of Illinois as part of a coordinated national crackdown on health care fraud that brought charges against more than 240 people in 17 different federal districts.

Chief Medical Officer, Dr. Johnetta Craig, walks to a meeting at the Carondalet location of Family Care Health Centers in St. Louis.
Durrie Bouscaren | St. Louis Public Radio

Despite the efforts of healthcare advocates, hospitals and notable former legislators, the Missouri legislature did not pass Medicaid expansion this year, or even bring it to the debate floor. That means an estimated 147,000 Missourians will have another year without health coverage, and the community health clinics that care for the uninsured will continue trying to bridge the gap.   

Adrian Clark | Flickr

Medicare open enrollment, which runs through Dec. 7, gives beneficiaries an opportunity to review and change their health and prescription drug plans. On Wednesday, “St. Louis on the Air” host Don Marsh sat down with Julie Brookhart, public affairs specialist for the Kansas City regional office of the Centers for Medicare and Medicaid Services, to learn more about open enrollment.

Do I need to sign up for a new plan?

You don’t necessarily need to, Brookhart said, but open enrollment does provide an opportunity to compare plans.

This article first appeared in the St. Louis Beacon: WASHINGTON – A Chesterfield physician is deluged by faxes from companies claiming falsely that her patients had requested medical equipment. An elderly Missouri woman gets three or four calls a day from marketing firms trying to convince her to ask her doctor for equipment she doesn’t need or want.