Opinion -- As Medicaid Turns 60, Its Future Hangs in the Balance

By Sheldon Weisgrau

Missouri holds a central role in the history of health care in the United States. Sixty years ago, on July 30, 1965, President Lyndon B. Johnson traveled to Independence, Missouri, to stand side-by-side with native son Harry S. Truman and signed the Medicare and Medicaid Act into law. This historic legislation, which passed Congress with overwhelming bipartisan support, provided health insurance coverage to millions of Americans who were previously left out: seniors over the age of 65 (Medicare) and low-income individuals and families (Medicaid). Together, these programs serve as the foundation of our health care system. Today, Medicare and Medicaid provide health insurance coverage to 144 million people, or more than 4 in 10 Americans. Two-and-a-half million Missourians rely on these programs.

Cuts to Medicare have long been considered a political “third rail,” with politicians reluctant to tamper with a program that is viewed favorably by 82% of Americans, including large majorities of Democrats, Independents, and Republicans. Medicaid, despite nearly equal popularity, with 77% support, hasn’t proven as invulnerable. The recently passed federal budget bill will extend the tax cuts passed during the first Trump administration and add more than $3 trillion to the national debt. It also slashes $1 trillion from Medicaid over the next 10 years, the largest cut in health care funding in history. Nearly 12 million Americans, and more than 130,000 Missourians, will lose their health care coverage.

These cuts threaten the very foundations of Medicaid and the health care safety net. More than 1.25 million Missourians, about half of them children, rely on MO HealthNet (Missouri’s Medicaid program) for preventive care, doctor and hospital visits, laboratory and diagnostic services, and prescription drugs. MO HealthNet covers services across the life spectrum, paying for nearly 4 in 10 births and two-thirds of nursing home care in the state.

Those covered by Medicaid are more likely to receive preventive care, get timely treatment for cancer and other serious illnesses, and fill their prescriptions than those without insurance. Medicaid serves as the leading payer for mental and behavioral health and family planning services. The program reduces racial, ethnic, and rural health disparities; enhances health; and lowers mortality.

Medicaid provides other benefits as well. It improves high school and college graduation rates. Children who are covered by Medicaid earn more and require less health care as adults. By eliminating catastrophic out-of-pocket medical costs, Medicaid reduces debt (a significant problem in Missouri) and lowers poverty rates for families.

The program also reinvests tax dollars into the economy, creating jobs and economic growth in Missouri communities and supporting rural hospitals and other health care providers. (A special rural health fund included in the budget bill will offset only a fraction of the losses that will be suffered by rural health providers – currently more than 20 rural Missouri hospitals are at risk of closure).

For 60 years, Medicaid has delivered a valuable return on investment by providing a safety net for low-income Americans and an economic engine for neighborhoods and communities. As we celebrate its anniversary in the face of cuts that threaten to roll back so much of the security it provides, it is instructive to remember the words of President Johnson in 1965:

“Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old and to the poor… There is another tradition that we share today. It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.”

Medicaid is not “waste, fraud, and abuse.” It is not intended to separate the “deserving” from the “undeserving.” Medicaid is a vital lifeline for Missourians in their times of greatest adversity or misfortune. It has survived the political ups and downs of the past six decades largely intact. If we are unable to reverse course, the catastrophic reductions that we make today will lead to a sicker, less prosperous country tomorrow.

In the coming months, MFH will assess the future impacts of these dire cuts, inform the public and policymakers of their significance, and work with partners across the state and the nation to rebuild this critical program.

Mr. Weisgrau is the Vice President of Health Policy and Advocacy for the Missouri Foundation for Health.

Opinion -- Hawley Secures New Medicaid Funds, RECA in Reconciliation Bill

By Senator Hawley’s Office

U.S. Senator Josh Hawley (R-Mo.) secured the largest expansion ever to the Radiation Exposure Compensation Act (RECA) as well as new funding for Medicaid as part of the “One Big, Beautiful Bill” that passed the Senate today. Senator Hawley supported the legislation after negotiating the inclusion of these key Missouri priorities.

Senator Hawley’s RECA provision will deliver long-overdue compensation and health care for survivors of radiation-linked cancers in the St. Louis and St. Charles areas. The Senate-passed reconciliation bill will also deliver major relief for working people, such as no taxes on overtime, no taxes on tips, and a larger child tax credit for families. Following negotiations between Senate GOP Leadership and Senator Hawley, the legislation included a new $50 billion fund for rural hospitals. This means that Missouri is set to receive approximately $1 billion in new funding to support providers and Medicaid recipients over the next five years. Senator Hawley also secured the delay of any Medicaid reductions.

“RECA is generational legislation for Missouri and will finally deliver justice for survivors in the St. Louis region. And when this reconciliation bill is signed into law, Missouri will also see new health care funding and big tax cuts for working families. I call on the House to quickly pass this legislation and send it to President Trump’s desk,” said Senator Hawley. “But let me be clear, I will continue to do everything in my power to reverse future cuts to Medicaid. If Republicans want to be the party of the working class, we cannot cut health insurance for working people.”

For two years, Senator Hawley has fought to secure funding for survivors of nuclear contamination in Missouri and across the country, having twice passed a RECA reauthorization bill through the Senate in July 2023 and March 2024.

Editor — The measure passed with a 51-50 vote, with Vice-President J.D. Vance providing the tiebreaker vote. The bill must now go back to the US House, which can pass the bill as is and send it to President Donald Trump’s desk for his signature or revise it again. Passage was secured after Senators were up all night as there were massive efforts to lobby the lone holdout, Senator Lisa Murkowski (R-AK). Republicans Rand Paul, Thom Tillis, and Susan Collins voted no.

 

Opinion -- The “Big Beautiful Bill’s” Impact on Missouri Healthcare

By the Missouri Budget Project

A new fact sheet from Families USA details how the pending budget bill, set to be voted on by the Senate in the next week or so, will harm Missouri’s health system, including cutting off coverage for at least 210,000 Missourians, making it harder for people to get and maintain coverage, and taking away crucial patient protections for children. The bill also drives up costs for those buying insurance through the Marketplace, skyrocketing premiums and increasing out-of-pocket costs while taking away crucial premium tax credits.

“The cuts to Medicaid and the ACA will have devastating and dramatic impacts on health coverage, care, and costs for American families, and in many ways especially in Missouri. The cuts will not just mean that tens of thousands of Missouri residents lose coverage, but federal cuts will force state budgets into crisis, forcing states to drastically scale back services, leading to closures of rural hospitals and community clinics,” said Anthony Wright, executive director of Families USA. “Senator Hawley must side with patients and health providers and plans to oppose this bill that harms access and affordability of health care for so many Missouri working families.”

“The Senate budget bill as proposed is a direct threat to Missouri's families, communities, and long-term economic future. It fails the test of sound policy and abandons the values of fairness and opportunity that should define our state's priorities,” said Amy Blouin, President & CEO of the Missouri Budget Project. "We urge Senator Hawley to reject this harmful bill and instead champion a budget that reflects the real needs of Missourians — one that invests in our health care. Missouri deserves better.”

The proposed cuts are in opposition with the voters when 82% of adults nationwide — including 67% of Republicans want Congress to maintain or increase Medicaid spending.

The Medicaid program, MO HealthNet, covers 1,268,000 children and adults, including:

—1 in 5 Missouri residents.

—573,000 children — 42% of all children in Missouri.

—237,000 seniors and people with disabilities.

Marketplace coverage, available for individuals and families who do not qualify for MO HealthNet but also do not have employer sponsored coverage, serves:

—417,000 Missouri residents.

—28,000 small business owners in Missouri and over 47,000 self-employed Missouri residents.

—About 95% of enrollees in the state who received an advanced premium tax credit to help them pay their premium.

Families USA, the longtime health consumer advocate, is organizing with Missouri Budget Project and other groups in Missouri and across the nation to protect against cuts care cuts that would force Americans to face increased costs and the loss of health coverage. The Families USA website has a plethora of materials on how its partners are working to defend Medicaid, and has facts sheets on the overall importance of Medicaid to people, the economy and the health care system, how work reporting requirements would undermine access to Medicaid, and how cuts harm families and communities.

Families USA, a leading national voice for health care consumers, is dedicated to the achievement of high quality, affordable health care and improved health for all.

The Missouri Budget Project is a nonprofit public policy analysis organization that analyzes state budget, tax, and economic issues.

 

Opinion -- Federal Medicaid Cuts Imperil Rural Hospitals and Residents

Medicaid serves as a vital source of health insurance coverage for Americans living in rural areas, including children, parents, seniors, individuals with disabilities, and pregnant women. Congressional lawmakers are currently considering more than $800 billion in cuts to the Medicaid program, which would reduce Medicaid funding and terminate coverage for vulnerable Americans. The proposed changes would also result in a significant reduction in Medicaid reimbursement that could result in rural hospital closures.

The National Rural Health Association recently partnered with experts from Manatt Health to shed light on the potential impacts of those cuts on rural residents and the hospitals that care for them over the next decade. Report findings provide insight into the impact on rural America at a critical moment in the Congressional debate over the future of the reconciliation package.

The report shows the significant impact from coverage losses that rural communities will face given:

• Medicaid plays an outsized role in rural America, covering a larger share of children and adults in rural communities than in urban ones.
  
• Nearly half of all children and one in five adults in small towns and rural areas rely on Medicaid or CHIP for their health insurance.
  
• Medicaid covers nearly one-quarter of women of childbearing age and finances half of all births in these communities.

The press conference will discuss Manatt’s estimated loses rural hospitals will incur due to the One Big Beautiful Bill Act. Analysis shows deep cuts in Medicaid reimbursement for rural hospitals—including both federal and state funds—over the ten-year period outlined in the bill. Reductions in Medicaid funding of this magnitude would likely accelerate rural hospital closures and reduce access to care for rural residents, exacerbating economic hardship in communities where hospitals are major employers.

As a key insurer in rural communities, Medicaid provides a financial lifeline for rural health care providers — including hospitals, rural health clinics, community health centers, and nursing homes—that are already facing significant financial distress. These cuts may lead to more hospitals and other rural facility closures, and for those rural hospitals that remain open, lead to the elimination or curtailment of critical services, such as obstetrics.

“Medicaid is a substantial source of federal funds in rural communities across the country. The proposed changes to Medicaid will result in significant coverage losses, reduce access to care for rural patients, and threaten the viability of rural facilities,” said Alan Morgan, CEO of the National Rural Health Association. “It’s very clear that Medicaid cuts will result in rural hospital closures resulting in loss of access to care for those living in rural America.”

Opinion -- Proposed Medicaid Cuts Threaten Rural Healthcare

By Amy Blouin, President & CEO, Missouri Budget Project

June 13, 2025 — Medicaid means health insurance for rural Missourians. Rural hospitals and health clinics rely on Medicaid payments to keep their doors open.

But Congress is now rushing through a tax package that would eliminate Medicaid coverage for tens of thousands of rural Missourians and hurt their communities. Our U.S. senators need to stop this rush to avoid doing a lot of harm in rural areas.

Across Missouri, the consequences of Medicaid cuts go beyond individuals’ access to health care, and the harm to rural residents is multiplied.

When communities lose hospitals and health clinics, it means the loss of good-paying health care jobs. That hurts the local economy at a time when rural communities are already struggling.

This ripples into waves of poor community health, unemployment, population loss and a bleak future. It winds up driving people away from places they call home.

House-approved legislation in Washington, which awaits Senate consideration later this month, cuts Medicaid by $800 billion nationally. The proposal creates new mountains of red tape and harsh work requirements. It imposes obstacles so steep that eligible people, including working families, will lose coverage.

Here in Missouri, those cuts would take health care away from 170,000 Missourians, including children, older adults, patients with serious health conditions and disabilities, veterans, and low-paid workers. 

Missourians already struggle to get and keep Medicaid because our state enrollment and eligibility systems can’t keep up and are already very restrictive on participation. It takes much longer for our state to process applications, and Missourians routinely lose coverage for so-called “procedural reasons,” like accidentally leaving a space blank on a form, or a typo.

Folks trying to reach someone at the state’s call centers frequently face wait times of almost an hour - that is, if they don’t have to hang up the phone to go back to work, care for kids and seniors, or cook a meal.

New red tape would multiply these challenges, with Missourians having to file piles of paperwork every month to prove their activities or demonstrate why they are exempt. Rural Missourians would face even bigger obstacles to complying because of things like slow internet speeds, demanding work schedules, and having farther to travel.

For financially struggling rural hospitals, health clinics and nursing homes, cuts to Medicaid could force shutdowns, leaving everyone in those communities without access to senior or prenatal care, even basic care or emergency rooms. Already, rural Missourians are forced to travel long distances just to get the care they need. In a crisis, that delay can be deadly.

Even if Missourians can make it through Medicaid’s bureaucratic maze, their coverage would still be at risk when they most need it. For example, a cashier doesn’t get enough hours one pay period because business is slow. With the bill’s new work requirements, slow weeks would cost her health care coverage.

Or imagine a 56-year-old widow who stayed home with her children and helped watch her grandkids until they started kindergarten – she was able to get health coverage after Missouri approved Medicaid expansion. She looks for a job, but struggles to find work because of age discrimination. She would lose her health care under the legislation’s tough work requirements.

When Missourians like these can’t get health care, they and their families struggle. But we all pay the price.

When that cashier can’t pay for the medicine to control her high blood pressure and has a heart attack, or the grandmother doesn’t get an annual check-up that would have detected a cancer early, what would have been lower-priced prevention or treatment became an expensive health crisis. And when hospitals and clinics have to absorb more uncompensated care, those costs are passed on to us all through higher health care costs and insurance premiums.

Extra bureaucratic requirements don’t increase employment and don’t help struggling Missourians make ends meet. But they do eliminate health coverage and increase costs, make life harder for working families, and hurt rural communities.

Missouri’s U.S. senators will hopefully join a majority of their colleagues in stopping this impending train wreck of Medicaid slashing. Rural Missourians’ lives and indeed the survival of rural communities hang in the balance.

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The Missouri Budget Project is a nonprofit public policy analysis organization that analyzes state budget, tax, and economic issues.

Missouri to Implement Medicaid Expansion

In accordance with the Cole County Circuit Court's August 10 ruling, the Missouri Department of Social Services (DSS) will begin allowing individuals to apply for the MO HealthNet program under Article IV, Section 36(c) of the Missouri Constitution.

"My administration is always going to follow the law and yesterday's court order is no exception," Governor Mike Parson said. "The necessary funding to cover the health care costs of the expanded population remains the issue. We will continue to work with the General Assembly and DSS to chart a path forward to comply with the court order and keep the MO HealthNet program solvent." 

Missouri voters approved Medicaid expansion, the Supreme Court of Missouri held the expansion amendment to be constitutional, and the trial court has ordered the state not to prohibit enrollment. The expansion amendment also legally requires the state to maximize federal funding. DSS will continue to work towards fulfilling the state's legal obligations under the Constitution and court order. 

The state is currently working through administrative hurdles, including adequate appropriations, staffing capacity, and computer software changes in order to begin enrolling the expanded population. Governor Parson included funding in his FY 22-23 budget proposal to the General Assembly to cover both the health care costs of the expanded population and for 75 additional employees to administer the expanded program.

The proposed funds were not included in the final FY 21-22 budget. As a result, DSS is limited to administering the expanded MO HealthNet program without sufficient staffing or appropriations. 

Missourians who believe they are eligible for MO HealthNet benefits under the expanded Medicaid eligibility may go to MyDSS.MO.Gov to apply. DSS will begin making eligibility determinations once MO HealthNet's software is updated to reflect the court order. In order to comply with the court order and until the necessary funds can be appropriated, DSS will reassign existing employees from their current assignments and responsibilities in order to receive and evaluate MO HealthNet applications.

Due to current staffing capacity and funding restraints, the required system update is anticipated to take up to 60 days. Qualifying health care costs that are incurred by eligible Missourians between the time they apply and when DSS is able to verify their eligibility may be reimbursed at a later date. 

Medicaid Expansion Vote Moved to August 4th

On Tuesday, May 26th, Governor Mike Parson ordered the Missouri Medicaid Expansion Vote to be held on August 4th. Normally, such measures are placed on the November ballot. However, Parson says that if it were to pass, the state would need more time to prepare financially given the depleted revenue from the Coronavirus. The governor has the authority under state law to move ballot measures to the August election; if he does not do so, it will automatically appear in November.

The proposal would expand Medicaid eligibility to adults earning up to 138% of the poverty level. 36 states have expanded Medicaid, but Missouri has not.

Gov. Nixon signs legislation to expand Medicaid eligibility for aged, blind and disabled

During a visit to the non-profit organization Paraquad today, Gov. Jay Nixon signed House Bill 1565, which makes it easier for Missourians who are elderly, blind or disabled to qualify for Medicaid, including in-home and community-based services. The new law, passed with strong bipartisan support in the General Assembly, increases the asset limit to qualify for Medicaid coverage for the aged, blind and disabled for the first time in more than 40 years. The current asset limit is $1,000 for individuals and $2,000 for married couples living together.

“This will help thousands of Missourians live more independent lives,” Gov. Nixon said. “These are folks who just want a chance to be responsible and save for the future, but a law written more than 40 years ago wouldn’t let them. Today, we’re doing something about that.”

Aimee Wehmeier, President and CEO of Paraquad, said low asset limits in Missouri have historically compelled people with significant disabilities to make difficult decisions.

“Essentially, we had to choose between saving money and accessing necessary disability-related supports and services,” Wehmeier said. “In the past, being fiscally responsible and saving money meant losing Medicaid benefits, including health care, personal care services and reimbursements for durable medical equipment. Without these vital services, we would not be able to work or live independently. And without the ability to save money, we are not prepared for future health needs or personal emergencies.”

House Bill 1565 increases the asset limits to qualify for Medicaid coverage for the aged, blind and disabled.  Currently, an individual may have no more than $1,000 in assets, while married people living together may have no more than $2,000 in assets. Under this bill, beginning in FY 2018, this limit will increase annually by $1,000 for individuals and $2,000 for couples living together until the respective limits reach $5,000 and $10,000 by FY 2021. Additionally, there will be a cost-of-living adjustment (COLA) each year beginning in FY 2022. It is estimated that the law will result in an additional 10,000 Missourians becoming eligible for Medicaid coverage.

The new law continues a record of strengthening mental health and disability services over the past seven years.

In 2010, Gov. Nixon created the Partnership for Hope, which provides home- and community-based services to Missourians with developmental disabilities and their families. The Partnership for Hope, the first of its kind in the nation, is now helping more than 4,375 people with developmental disabilities in 103 counties and the City of St. Louis. 

Also in 2010, Gov. Nixon spearheaded the bipartisan effort to pass the law mandating the coverage of autism diagnosis and treatment. For the first time, insurance companies were required to cover one of the most highly effective types of therapy, Applied Behavioral Analysis, or ABA. While effective, the cost of ABA can exceed tens of thousands of dollars a year, making insurance coverage necessary for most families.  

In 2015, United Cerebral Palsy ranked Missouri third in the nation – and second most-improved since 2007 – for providing quality services that improve the lives of individuals with intellectual and developmental disabilities and their families. 

Last month, the Governor signed the Fiscal Year 2017 budget, which answers his call for historic investments in services for Missourians with developmental disabilities, mental illness and substance use disorders, increasing state and federal funding for the Department of Mental Health by more than $200 million. Included in this budget is $14 million to ensure that there continues to be no waiting list for in-home services for low-income Missourians with developmental disabilities. When Gov. Nixon took office, many Missourians had to wait months or even years for the services they needed to live independently. Today, that waiting list has been eliminated.

Medicaid Reform Essential To Maintaining Missouri’s Behavioral Health System

“A significant portion of the state’s behavioral health resources are located within the hospital community. However, these assets are strained because a large percentage of mental health patients are uninsured and unable to pay for their care.

In 2011, hospitals provided $1.1 billion in uncompensated care — a record amount. The number of uninsured people using emergency departments in the state for mental health and substance abuse grew by 116 percent during the past eight years, and charity care grew by 839 percent.

Medicaid reform not only presents the state’s hospitals with additional resources to stabilize the capacity needed to care for those with mental health and substance abuse problems, but it also provides the platform the state needs to begin building capacity within a system that has declined dramatically in recent years.

A strong mental health system is vital to every community in our state. Without it, individuals who need care go without, and law enforcement agencies are forced to deal with a population that could be better served by the medical community. With a properly functioning behavioral health system, costs are better managed as individuals seek care in less costly settings, and individuals receive the treatment they need so they can continue as productive members of their community.

Without Medicaid reform — and in light of the nearly $4 billion in cuts to hospitals envisioned in the Accountable Care Act and subsequent legislation — the current level of uncompensated care is unsustainable. This could result in fewer behavioral health resources in community hospitals throughout the state.

Medicaid reform is essential to maintaining Missouri’s behavioral health system.”

The Missouri Hospital Association is a not-for-profit association in Jefferson City that represents 154 Missouri hospitals. In addition to representation and advocacy on behalf of its membership, the association offers continuing education programs on current health care topics and seeks to educate the public about health care issues.

Committee rejects bill to expand Medicaid eligibility

By Meghan Boggess and Emily Donaldson

(MDN News) -- A Missouri House committee defeated a Democratic-backed measure to expand the state's Medicaid program Monday, Feb. 25, despite an overwhelming number of witnesses voicing their support at the hearing.

The bill, sponsored by Rep. Jacob Hummel, D-St. Louis, would have provided up to 300,000 more Missourians access to Medicaid. The committee defeated the measure in a 5-2 vote split along party lines.

Hummel said that if the state did not expand Medicaid, it would miss out on the federal funding allocated under the federal health care law.

"These are our dollars that we're sending to Washington that we need to bring back to the states," Hummel said.

Critics, however, argued giving more funding to the program would worsen the program's efficiency.

"Medicaid is a system that right now doesn't work...why are we going to take an additional 300,000 Missourians, and put them into a system that nobody believes works very efficiently to begin?" said Rep. Todd Richardson, R-Poplar Bluff.

But the Medicaid issue may not be dead in the House.

House Government Oversight Committee chairman Rep. Jay Barnes, R-Jefferson City, unveiled his own plan, which he called "market-based Medicaid."

The Associated Press reported that Barnes' legislation would expand the income eligibility for adults, possibly adding 180,000 people to the state's Medicaid rolls, but it would not cover all adults earning up to 138 percent of the federal poverty level, which is called for under the federal health care law.

The AP also reported that the bill cut eligibility for children by putting them on the same level as their parents, which would remove about 44,000 children from the rolls.

Missouri House Democrats push for Medicaid expansion in the state

by Josie Butler
(MDN News) -- Democratic lawmakers said they fear rural hospitals will be forced to close if new legislation expanding Medicaid in Missouri is not passed.

House Minority Floor Leader Jake Hummel, D-St. Louis City, filed legislation on Monday, February 18, that would expand Missouri's Medicaid system. Hummel, along with the House Democratic Caucus,  presented his bill at a press conference. He said he believes Medicaid is the biggest issue in the state.

Pemiscot Memorial Hospital CEO Kerry Noble spoke at the press conference. Noble said his hospital will be at risk for closing if the expansion is not passed.

Pemiscot Missouri is located in the Southeast Missouri and 30 percent of the population lives below the federal poverty line. Noble said the hospital has a $50 million operating budget, but $9 million of that is spent on uncompensated care. If Medicaid is not expanded, Nobel said the hospital would lose around $1 million annually, which would put the hospital at a great risk of closing. 

"We will jeopardize our facilities, we will no longer be in existence if passage of this expansion does not occur," Noble said.

The Senate Appropriations staff estimates that by 2020 $250 million would be cut from federal funding for hospitals for uncompensated care.

Hummel said Medicaid expansion, which would expand eligibility to 138 percent of the federal poverty level to leverage $8.2 billion in federal investment in the state, would also create 24,000 jobs and bring $9.6 billion in additional investments in Missouri economic activity. He said expansion would provide 300,000 Missourians with access to health care.

Rep. Jay Barnes, R-Jefferson City, said he believes Medicaid expansion is not the way to go. He said expansion will receive little support from House Republicans. 

"I think there is interest in transforming Missouri's Medicaid system into what would be the most free-market based Medicaid system in the entire country," Barnes said. "I think there's no interest in simply expanding Medicaid envisioned under Obamacare."

Barnes has been working on a piece of legislation that he said would transform the state's Medicaid program to deliver better care. Barnes said "stay tuned" for more information on his legislation.

During the annual State of the State Address in January, Gov. Jay Nixon said Medicaid expansion is "the right thing to do." "Strengthening Medicaid will strengthen our economy," Nixon said in his address. However, Nixon said he would support including a provision that would roll back Medicaid expansion if Washington does not honor its financial commitment.

Rep. Jeanne Kirkton, D-Webster Groves, said this legislation is a golden opportunity to grow Missouri's economy by "accepting the federal dollars to extend health care to more hardworking, uninsured Missourians." She said bringing the federal tax dollars back to Missouri is expected to decrease the rate of uninsured in Missouri in different regions of the state anywhere from 26 to 31 percent. "More access to care, less medical debt and lower mortality is not only a public good, it's good for our economy," Kirkton said. She said failing to expand Medicaid will weaken Missouri hospitals and maybe force some hospitals to close, which will stifle Missouri's economic growth. "This is too important of an issue to sweep under the rug," Hummel said. "We're willing to work across the isle and get something done."

Community leaders plan to deliver letters calling for Medicaid expansion

An organization of religious leaders and community activists -- the Missouri Medicaid Coalition -- presented lawmakers with more than 1,500 letters from concerned citizens.

The letters were delivered to the office of Rep. Sue Allen, R-Town & Country, on Thursday, Jan. 31. Allen serves as the chairwoman of the House Appropriations Committee on Health, Mental Health and Social Services.

Members of the coalition are calling for state lawmakers to expand Missouri's Medicaid rolls to provide coverage for 260,000 Missourians without health insurance, especially single parents and childless adults.

Retired Jefferson City Rev. John Bennett said that Medicaid expansion is a moral obligation for Missouri legislators. Bennett said his main concern lies with Missouri's uninsured children.

"There is overwhelming moral evidence that Medicaid expansion is necessary for Missouri," Bennett said.

At his State of the State address on Monday, Jan. 28, Gov. Jay Nixon touted the expansion as the right thing to do for the state. The Democratic governor also included funds for expanding Medicaid in his recent budget proposals. The Department of Social Services is looking at one of the largest percentages of budget increases with this new proposal.

"Providing health care for an estimated 300,000 more Missourians -- men, women and children -- who currently have no health insurance is the smart thing to do, and it's the right thing to do," Nixon said in a statement.

Letter to the Editor -- Business as Usual with Jay Nixon

To the Editor:
Late last month Governor Jay Nixon announced he would support an expansion of Missouri’s Medicaid program under ObamaCare. “[Expanding Medicaid is] the smart thing to do, and it’s the right thing to do,” he said.
Although one could describe Gov. Nixon’s announcement in many ways, “smart” and “right” would not appear in the parade of appropriate adjectives. Gov. Nixon doesn’t appear to have any plan to pay for the expansion, and he will be on his way out of Jefferson City when the new Medicaid costs begin to hit in earnest in 2017.
It fits a pattern. For decades, American politicians have feasted on the dangerous public misconception that Federal spending through the states is essentially free money. It’s not. Missouri taxpayers are also Federal taxpayers, liable for the debts that the Federal government incurs in their names. There’s no level of government cost splitting that can change the fact that Missourians, their children, and their grandchildren will have to account for this spending.
The move isn’t “smart” or “right.” It is, however, “business as usual,” and Missourians can’t afford that.

Patrick Ishmael
Policy Analyst, The Show-Me Institute
St. Louis

Missouri running out of time to decide on expanding Medicaid

Linda Spence is a 63-year-old full-time student at University of Missouri-Kansas City. After losing her job as a Program Director on the campus of UMKC, she has no health insurance because she does not qualify for Medicaid.
After the US Supreme Court ruled it unconstitutional for the federal government to force states into expanding their Medicaid coverage, Missouri now has a choice of whether or not to expand Medicaid for people like Linda Spence.
The Federal government will pay 100 percent of the financial burden imposed by Medicaid expansion for the first three years, but starting after the initial grace period, Missouri would start to become responsible for some of the cost. Starting in 2017, Missouri would be responsible for five percent of the cost in 2017 and 10 percent starting in 2022, according to state officials and advocacy groups.
Spence said she takes advantage of a discount at Truman Hospital for people with lower incomes. She said not many people know about this discount, and people who want it must apply for it. Spence also said without this discount, she would have no way of obtaining any kind of regular health care. She also said that not having insurance can affect the quality of health care she is able to receive.
"If I were able to qualify for something like Medicaid, granted I would have to qualify for it, but at least I would know it was something a little bit more guaranteed. I might have access to other physicians other than going through Truman. Maybe I would be able to choose my own doctor, for example. Go to specialists of my choosing, instead of just specialist that are available," said Spence.
A major concern legislators have with expansion is that it could take away a lot of funding from other areas of the budget, namely education.
"When you're looking at increases of potentially 100 or 200 million dollars that you have to find because of expansion, there is only one place where there is a pot of money big enough to take that, and that is public education," said Senate Appropriations Chair Kurt Schaefer, R-Columbia.
Schaefer said that there is no way around public education funding taking a hit with the Medicaid expansion, and if the true cost, is too detrimental to education then he would not be in favor of expansion.
Sen. Rob Schaaf, R-St. Joseph, thinks Missouri would have to pull funds from a diverse group of areas to fund expansion.
"I know from my experience as a legislator, that anytime one program absorbs up a bunch of resources, they try to spread the pain around everywhere else. So it isn't just education, every other program would suffer," Schaaf said.
Schaaf said Missouri does not have an obligation to use tax dollars to give able-bodied adults health care.
"We already take care of kids, and we take care of the disabled, and we take care of the elderly. These people are able-bodied, and it would be wrong for us to give them free health care and put them on Medicaid, and expect other working adults to pay for them," Schaaf, a licensed physician,  said.
For a single parent with one child to receive Medicaid under the current coverage in Missouri, their annual income would need to be less than $2,809.00, according to the Missouri Foundation for Health. The new program, should it be implemented in Missouri, would allow anyone at 133 percent of the federal poverty line to receive Medicaid. That covers a higher percentage of the poverty line than is currently afforded to people

HHS agencies to provide ongoing support for communities impacted by Joplin disaster

U.S. Department of Health and Human Services personnel from the National Disaster Medical System (NDMS) began returning to their home states today after deploying to assist in mass fatality operations in the aftermath of a devastating tornado in Joplin, Mo. HHS will provide ongoing assistance with additional aspects of response and recovery.
NDMS, within the HHS Office of the Assistant Secretary for Preparedness and Response, provides medical, victim identification, and veterinary personnel, equipment and supplies to augment state and local resources in disaster response. Similar to military reservists, NDMS personnel come from private sector jobs around the country to respond as intermittent federal employees during disasters. In the tornado response, the state of Missouri requested NDMS support in victim identification.
This response represents the largest number of NDMS mass fatality personnel deployed to a domestic disaster since Hurricane Katrina in 2005. More than 100 personnel from NDMS Disaster Mortuary Operational Response Teams and Family Assistance Center Teams assisted the local coroner’s office in identifying victims of the tornado. This NDMS support for 24-hour efforts in Missouri helped the coroner’s office reunite all victims with their loved ones as quickly as possible in a dignified, respectful manner.
“We’re honored to help state and local authorities bring some sense of closure to the families who lost family members to this storm,” said Dr. Nicole Lurie, assistant secretary for preparedness and response. “Although the situation in Joplin is still difficult, we’ve witnessed a tremendous amount of pride and resilience in the community. HHS will continue to work closely with state and local officials on the ongoing need for social services as the community recover.”
State, federal, and nonprofit partners are collaborating to meet the child care needs of Joplin families. The HHS Administration for Children and Families, in partnership with the Missouri Department of Social Services, convened a task force to address emergency child care needs as well as the recovery of the community's child care capacity. The tornado destroyed 19 child care centers with combined capacity to serve approximately 600 children.
The HHS Substance Abuse and Mental Health Services Administration (SAMHSA) is working with the state to bring the National Crisis Counseling Program to the impacted counties. The program supports short-term interventions to help disaster survivors in their recovery process. Immediately after the tornado, SAMHSA provided stress and grief materials to state and local agencies for use in counseling programs, primary care sites and other areas from which survivors are likely to seek help. With 20 of the area’s 25 mental health facilities destroyed, SAMHSA is also providing technical assistance to the state in restoring this behavioral health infrastructure.
To ensure that sufficient health care items and services are available to meet the needs of Medicare, Medicaid and Children’s Health Insurance Program beneficiaries in the affected area, the Centers for Medicare and Medicaid Services (CMS) is monitoring the status of health care facilities. CMS will waive or modify certain federal requirements as necessary and in accordance with the law for these facilities, such as allowing critical access hospitals to take more than the statutorily mandated limit of 25 patients and not count the expected longer lengths of stay for evacuated patients against the 96-hour average.
The Centers for Disease Control and Prevention is supporting the Joplin health department on restaurant inspections and on-going public health monitoring. CDC is also providing information on how to prevent illnesses and injuries as the community cleans up and clears debris from the tornado.
To ensure the safety of products regulated by the Food and Drug Administration, the FDA worked last week with state and local health departments to complete inspections of food processing facilities and pharmaceutical and medical device manufacturers that were located in the affected area.
For information on HHS support for response and recovery efforts in Missouri, visit www.phe.gov.

HHS Secretary Declares Public Health Emergency for Missouri

U.S Department of Health and Human Services Secretary Kathleen Sebelius has declared a public health emergency for Missouri in the aftermath of severe storms and tornadoes which struck the state Sunday night. The action will enable the Secretary to ensure that beneficiaries of the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP), continue to receive services during this emergency.

“Our hearts go out to the people of Joplin and the surrounding communities affected by last night’s tornadoes,” said Secretary Sebelius. “We are working closely with our state partners and community organizations to provide the support needed to respond to this disaster and in the ongoing flood recovery in the region.”

The public health emergency is declared under section 319 of the Public Health Service Act and is necessary so that HHS may waive or modify certain Medicare, Medicaid and CHIP requirements under section 1135 of the Social Security Act. The state can submit waiver requests through Centers for Medicare & Medicaid Services (CMS) Regional Office.

Under section 1135, HHS may permit affected health care facilities in Missouri to relax certain operating procedures temporarily so health care services can be delivered, such as allowing critical access hospitals to take more than the statutorily mandated limit of 25 patients and not count the expected longer lengths of stay for evacuated patients against the 96-hour average.

HHS agencies are working with state agencies and regional networks to respond to public health and medical needs of impacted communities. The HHS Assistant Secretary for Preparedness and Response is providing National Disaster Medical System assets to support the state and local health agencies in responding to the disaster.

A Disaster Mortuary Operational Response Assessment Team has deployed to Missouri to work with the state and local coroners and medical examiners in determining the full extent of federal mortuary resources that may be needed. A Disaster Mortuary Operational Response Team and a Family Assistance Center Team will provide assistance to coroners, medical examiners and families in identifying victims and returning remains to their loved ones. In addition, ASPR will provide a Disaster Portable Morgue Unit to support local mortuary operations.

An incident management team from the U.S. Food and Drug Administration (FDA) is working with state and local health departments to assist with inspections of FDA-regulated industries, such as food processing facilities and pharmaceutical and medical device manufacturers, impacted by the tornadoes to ensure the safety of FDA-regulated products.

An Incident Response Coordination Team will make sure federal public health and medical teams have what they need to assist the state at this critical time. This team is the “on the ground” command-and-control for federal public health and medical assets.

Information on steps to protect health immediately after a tornado or to prepare for disasters is available at http://www.phe.gov. Today’s Public Health Emergency declarations are available at http://www.hhs.gov/secretary/phe05232011.html.

Foundation Releases Annual Update on Missouri Medicaid

Missouri Foundation for Health (MFH) has released 2011 Missouri Medicaid Basics, an annual publication providing a straightforward, factual overview of the Missouri Medicaid program, now called MO HealthNet.

The publication is intended as a resource for the public, care providers and community leaders, and anyone seeking a clearer understanding of the MO HealthNet system.

Produced by MFH’s health policy staff, Missouri Medicaid Basics provides a clear framework for the state’s Medicaid program in three subject areas:

· MO HealthNet-eligible populations.

· Programs and services for MO HealthNet recipients.

· Funding sources for MO HealthNet (state, federal, and other).

The publication offers an explanation of MO HealthNet using a variety of easy-to-understand graphics and tables. New to the 2011 edition is a collection of graphics on
MO HealthNet enrollment growth by eligibility group and region.

There is updated information exploring the relationship between MO HealthNet enrollment and downturns in the state and national economies. This year’s version also highlights the impact of federal health reform on Medicaid.

2011 Missouri Medicaid Basics can be downloaded free of charge at http://www.mffh.org/mm/files/MedicaidBasics2011.pdf. Limited free print copies also are available; contact Chris Raborn at 314.345.5576 or craborn@mffh.org.

Established in 2000, MFH is the largest nongovernmental funder of community health activities in Missouri. MFH is in its eighth year of grantmaking, having issued more than
$410 million in grants and awards to date. It is dedicated to improving the health of unserved and underserved residents in 84 Missouri counties and the City of St. Louis.