Missouri Medicaid expansion finally ready to begin
After more than a decade of efforts to bring the working poor into Missouri’s Medicaid program, the wait will end Friday when the health care program begins approving applicants.
That’s going to be huge for people like Amanda Reynolds. She’s a St. Louis resident who has dealt with cancer for years. And after being initially told she didn’t qualify, Reynolds connected with the American Cancer Society through a Facebook ad and sent in her application earlier this week.
Reynolds said once she’s approved for the program, she’ll be able to have consistency on who provides her medical procedures — and peace of mind that her care will be paid for.
“I’m majorly grateful that there’s hope and I still do have a way of getting medical,” Reynolds said. “It means the world to me. And I want to be able to share that with everybody, so they know that there is help out there.”
Last year, voters approved Medicaid expansion to include people who make up to around $17,800, and the Missouri Supreme Court upheld the measure earlier this summer. A Cole County judge ruled that people could start applying for Medicaid, but the Department of Social Services said it couldn’t give applicants an answer on whether they were approved until Oct. 1.
Department of Social Services spokeswoman Rebecca Woelfel said last week that the agency that oversees Medicaid “will work to verify information on any applications received prior to Oct. 1 as a preliminary step that will eventually expedite the processing of applications.”
She said last Friday that the number of people who have signed up so far is not available.
Woelfel also confirmed that the Department of Social Services submitted the state plan amendment to the federal Centers for Medicare and Medicaid Services last week. Those documents are critical for the state to take advantage of a higher federal match that comes with expanding the program.
The acceptance of Medicaid applicants for now closes one of the longest and most high-stakes policy disagreements in modern Missouri history.
Medicaid used to be much more available to the working poor in Missouri. But in 2005, the GOP-controlled legislature and then-Gov. Matt Blunt substantially restricted the program primarily to children and people with disabilities. A single parent with one child could only make around $3,000 a year to qualify.
While Missouri Democrats made Medicaid expansion a central focus of their policy agenda, they were unable to reverse those cuts — even after Jay Nixon captured the governorship in 2008. The passage of the Affordable Care Act did little to change the status quo, despite the federal government promising to initially pay for all of Medicaid expansion before ratcheting down to covering 90% of the cost.
The turning point came with the passage of a state constitutional amendment expanding Medicaid in 2020. Missouri’s hospitals, which have often dealt with the negative ramifications of not expanding Medicaid, played a big role in funding and supporting the initiative.
“You can get those individuals to access primary care when they need it to manage chronic conditions so that those conditions don't get so bad that they need emergency care for them,” said Dave Dillon of the Missouri Hospital Association in July.
But the Medicaid expansion measure was in doubt after lawmakers refused to allocate funding for expansion. That prompted several potential Medicaid participants to file a lawsuit. The Missouri Supreme Court unanimously ruled that the amendment was valid and that the state had to start letting people in the expansion population apply.
Missouri lawmakers, though, will likely still have some work to do on the Medicaid expansion issue next year — and in subsequent years.
In an interview with St. Louis Public Radio earlier this year, Gov. Mike Parson said the legislature will still have to pass a supplemental appropriation that would allow his administration to take advantage of the federal funds.
And while Missouri is slated to get additional coronavirus relief money from the federal American Rescue Plan that could help pay for the state portion of expansion, Parson added that lawmakers should be thinking ahead when that roughly $1 billion is spent.
“You’ve got to be thinking, ‘What is this going to look like five years from now, 10 years from now.’ And what is the cost going to be?” Parson said in July. “You’re not always going to have a surplus.”
During an episode of the “Politically Speaking” podcast, state Budget Director Dan Haug said money from the American Rescue Plan could defray the cost of Medicaid expansion now — but not necessarily in perpetuity.
“We don’t want to cliff in two or three years where all of a sudden you have $200 million that you need to find in the budget, because in most years that’s a very difficult thing to do,” Haug said.
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