Legislative Spotlight: Medicaid Expansion Implementation

Legislative Spotlights March 8, 2021March 28, 2022

Over the past month, the St. Louis Regional Health Commission (RHC) has been celebrating some good news about public coverage options.

1. The Centers for Medicare & Medicaid Services (CMS) opened a special enrollment period, allowing millions the opportunity to get covered. Anyone who has been affected by COVID-19 can now gain health coverage from Feb 15 through May 15 through the Affordable Care Act Marketplace (Healthcare.Gov). The RHC advocated for this federal action back in April 2020, as one of our RHC COVID-response policy priorities.
2. The federal government is moving to prevent and undo Medicaid work requirements. This decision hinders the efforts of three bills in the MO legislature (HB332, SB224, HJR64) that aim to create work-reporting requirements. Read more about Medicaid work requirements at the Supreme Court and learn why Medicaid work requirements do not actually incentivize work.
3. The Missouri Department of Social Services (DSS) announced their plan to submit a state plan amendment in preparation for Medicaid expansion. The benefits package for the Adult Expansion Group is robust and meets the criteria passed in August’s ballot initiative for Medicaid expansion.
4. Medicaid expansion enticement is in the relief package (American Rescue Plan Act of 2021) that the US Senate passed on Saturday, March 6. The bill now needs approval of changes by the House and a signature by President Biden. If passed, the legislation would boost federal Medicaid matching funds by 5 percentage points for two years. This would bring ~$1.2 billion to Missouri’s general revenue. 

While we celebrate the steps to secure affordable health coverage in Missouri, we have to keep advocating for the timely, effective implementation of Medicaid expansion!

Recently, the House moved Medicaid expansion to a separate spending bill. Additionally, Representative Smith filed a House Joint Resolution 64 last week, which proposes a constitutional amendment that would make Medicaid expansion subject to appropriation (would require assignment of money) and instate work requirements. If passed, this bill would go to the people of Missouri for a ballot vote. At this time, advocates in Jefferson City have not recommended immediate action steps, but it’s our job as advocates to be ready to step in as needed.  

In response, we outline the reasons why RHC strongly supports the expansion of Medicaid:

1) Expansion aligns with the RHC’s mission to increase access to health care.

Almost 100,000 people are uninsured in the St. Louis region, meaning 1 in 10 do not have health insurance.¹ More than 500,000 individuals in Missouri are uninsured.¹ Medicaid expansion will improve access to health care by providing coverage to more than 230,000 Missourians, including people with chronic diseases, such as diabetes and asthma.²

2) Medicaid expansion aligns with the RHC’s mission to improve health outcomes and reduce health disparities.

Medicaid expansion will improve the health of Missourians, reduce overall mortality, and decrease health disparities among covered population.³ The nation would have had 15,600 fewer deaths if all states had expanded Medicaid from the start.⁴

Expansion will also reduce disparities in health outcomes. For example, expansion is associated with a significant reduction in disparities for rates of preterm birth (a predictor of infant mortality) for black infants compared with white infants.⁵ Medicaid expansion will provide an additional 36,000 African Americans with health care coverage.⁶

“As our nation battles structural racism, Medicaid expansion is one clear strategy to create a more equitable system of care.”

Angela Brown, Chief Executive Officer, St. Louis Regional Health Commission

3) Expansion will help keep community health centers and hospitals open. 

Missourians rely on community health centers (CHCs) for critical services, such as medical, dental, and behavioral health care, but these organizations are struggling to stay open with the current reimbursement rates. At St. Louis CHCs, 1 in 3 patients are uninsured, which puts financial strain on the organizations.⁴ Medicaid expansion will help these health centers continue to provide quality care to our community.

Since 2014, 15 hospitals in Missouri have closed, forcing people to drive longer distances to reach a hospital when experiencing a medical emergency.⁷ Medicaid expansion will protect access to health care across our state.

4) Medicaid expansion will save Missouri money and improve our economy.

Expansion will bring billions of our tax dollars home from Washington D.C. A study shows that expansion could save Missouri money.⁸ Other benefits could include increases in average household incomes, State Gross Domestic Product, and available jobs (especially in the health care setting). ^{9 10}

Missouri Budget Project shows that from expanding Medicaid, Missouri can expect additional savings and revenues that were not included in Governor Parson’s budget proposal for Fiscal Year 2022.¹¹ Missouri will receive $1.15 billion from the federal government over two years if it expands Medicaid.¹² This money comes from the American Rescue Plan’s temporary 5 percentage point increase of the FMAP (Federal Medical Assistance Percentage) for non-expansion populations. This additional funding for Missouri’s general revenue would more than cover Medicaid expansion and offset costs for other social services. This extra funding is on top of the Families First Coronavirus Response Act’s 6.2 percentage point FMAP increase, which is available through the duration of the COVID-19 public health emergency.

Check out additional tools to advocate for Medicaid expansion’s timely and effective implementation:

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• RHC’s blog post: Gateway to Better Health Data Demonstrates Need for Medicaid Expansion in Missouri
• Missouri Foundation for Health’s Medicaid expansion resource hub: Make Sense MO and the campaign’s Partner Hub 
• Healthcare for Missouri’s fact sheet: Medicaid Expansion Basics
• Center for Health Economics and Policy, Institute for Public Health at Washington University’ fiscal analysis: Analysis of the Fiscal Impact of Medicaid Expansion in Missouri
• Missouri Budget Project’s Report: Medicaid Expansion Saves State General Revenue in FY 2022
• Missouri Budget Project’s One-Pager: “Enhanced” Federal Medicaid Funding: An Explainer
• KFF’s report on work among Medicaid adults: Implications of Economic Downturn and Work Requirements
• KFF’s issue brief: New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending

Citations

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1. Access to Care 2019 Data Book
2. Kaiser Family Foundation – The coverage gap: uninsured poor adults in states that do not expand Medicaid  
3. Kaiser Family Foundation – The effects of Medicaid expansion under the ACA: updated findings from a literature review  
4. The National Bureau of Economic Research – Medicaid and mortality: new evidence from linked survey and administrative data
5. Kaiser Family Foundation – The effects of Medicaid expansion under the ACA: updated findings from a literature review  
6. Healthcare for Missouri
7. Missouri Health Association – Missouri Hospital Closures
8. Center for Health Economics and Policy, Institute for Public Health at Washington University – Analysis of the Fiscal Impact of Medicaid Expansion in Missouri
9. The Colorado Health Foundation  – Assessing the economic and budgetary impact of Medicaid expansion in Colorado
10. Policy Matters Ohio – Analysis: Ohio Medicaid expansion supports 54,000 jobs
11. Missouri Budget Project – Medicaid Expansion Saves State General Revenue in FY 2022
12. Kaiser Family Foundation – New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending