1. Fact Sheet
Expanding Medicaid in Missouri
1. What is the issue?
• This policy brief addresses the issues surrounding Medicaid expansion in the state
of Missouri, and aims to help provide health care coverage to all Missourians.
• Approximately 147,000 poor, non-elderly adults are officially in the coverage gap in
Missouri, where they do not earn enough money to qualify for health insurance
marketplace subsidies, nor are they currently eligible for Medicaid coverage
(Garfield, Damico, Stephens, & Rouhani, 2014). Of these individuals, 63% do not
have dependent children, 67% are in a working family, and 55% are female
(Garfield et al., 2014).
• An additional 113,000 Missourians are also in need of Medicaid expansion
(Missouri Health Care for All [MHCFA], 2013). This includes children who are not
eligible for the Children’s Health Insurance Program (CHIP), custodial parents
making more than $3,500 yearly, and elderly, blind, or disabled individuals making
more than $10,000 yearly (Lipstein, 2015).
2. Why is this issue a problem?
• 260,000 individuals going without health insurance means that many will not see a
doctor unless a medical problem becomes an emergency. This means that mostly
minor but still contagious illnesses (influenza, strep throat, etc.) will not be treated
quickly and are more likely to spread, particularly since many low-income workers
are in service positions that involve a large amount of contact with the general
public (fast food workers, retail clerks, etc.). This also means that many medical
problems that could be prevented or treated at low cost are not dealt with until they
become unavoidable, at which point the cost may be catastrophic.
• Uninsured individuals who utilize emergency room services are often unable to
pay for the services received, so those uncompensated services are written off as
a loss.
• Uncompensated services raise family health insurance premium costs by
approximately $1,000 every year (MHCFA, 2013).

2. • If Medicaid was expanded, Missouri would save approximately $385 million from
2013-2022 (MHCFA, 2013).
• Revenue generated from providing health care through Medicaid would bring in
nearly $2 billion a year (MHCFA, 2013).
• Nearly 24,000 jobs, primarily in health care services and adjacent fields, would be
created in Missouri if Medicaid was expanded (MHCFA, 2013).
• Missouri taxpayers have already paid for the cost of expanding Medicaid through
2016, but that money is unused, and cannot legally be used for any other purpose
(Flint, 2014).
3. What are the current policies (acts, laws, regulations, rules, guidelines) that
address the issue?
• The Patient Protection and Affordable Care Act (ACA), signed into law by
President Obama on March 23, 2010, was a comprehensive health reform bill.
• On June 28, 2012, the Supreme Court ruled on the National Federation of
Independent Business v. Sebelius. This decision removed the provisions of the
ACA that required all states to expand Medicaid to anyone making below 138% of
the federal poverty line.
4. What do the current policies do?
• The ACA, among many other things, created the Health Care Marketplace, which
provided health insurance options to all citizens, as well as subsidies for
individuals making more than 100% of the federal poverty level (Kaiser, 2013).
• The ACA also provides funding for expanding Medicaid to every citizen earning
less than 138% of the federal poverty level, with all costs paid by the federal
government though 2016, with funding levels decreasing until federal funding
levels stabilize at 90% of the cost of Medicaid expansion in 2020 and subsequent
years (Kaiser, 2013).
5. What are the options available to improve the issue currently?

3. • State Sen. Ryan Silvey, R-Kansas City, has put SB 287 before the Missouri State
Senate Veterans’ Affairs and Health Committee. This bill would allow veterans,
their spouses, and their dependent children to be eligible for MOHealthNet
(Medicaid) benefits. This bill was introduced as a means of forcing a conversation
about Medicaid expansion in the state senate, not just to marginally increase the
population eligible for Medicaid in Missouri.
• To expand Medicaid in Missouri, a new bill would need to be proposed and passed
that would expand Medicaid eligibility to all Missourians making less than 138% of
the federal poverty levels.
• A different, less desirable solution would involve a bill that offered health insurance
subsidies for Marketplace plans (up to 100% of the premiums for a silver plan, plus
cost-sharing that varies by plan) to all individuals that would be eligible for
coverage under Medicaid expansion. This would basically replace public insurance
with private, for-profit plans, and would require the insured to pay co-pays for
services and medications. Although not an ideal solution, this plan might stand a
greater chance of passing the republican legislature than directly expanding
Medicaid. However, out-of-pocket spending costs would be far higher with a
Marketplace plan than with Medicaid ($1,948 versus $948, respectively), which
would be unrealistic for many individuals (Hill, 2015).
6. What types of information are needed to convince policy makers to make a
change?
• Testimonials from individuals who would benefit from Medicaid expansion, and
conversely, testimonials from individuals who are now permanently disabled
because they did not have health care coverage to treat medical concerns before
they became disabling, may persuade some legislators.
• Appealing to business-focused legislators will require data on the number of jobs
that will be created and the potential profits and revenue increases that will result
from the rise in “paying customers”.
• The risk of closure of rural hospitals due to reduced Disproportionate Share
Hospital (DSH) payments to the state for uninsured payments (reduced on the
belief that Medicaid would expand to cover such patients) should be emphasized
to appeal to legislators from rural districts whose populations, both insured and

4. uninsured, stand to lose access to medical care if their local hospitals close
(MHCFA, 2013).
• The continued exclusion of undocumented immigrants and legal immigrants who
have been in the country for less than five years (excluding certain circumstances,
such as refugees and human trafficking victims) should appeal to legislators who
are particularly concerned with immigration restrictions.
• Appeals and pressure from religious groups such as Metropolitan Congregation
United may sway religious legislators.
•
7. Who are the potential key stakeholders on this issue/policy change?
• Primary stakeholders include all individuals who would currently be eligible for
Medicaid if it were expanded.
• Members of the House Budget Committee, House Health Care Policy Committee,
and the Joint MOHealthNet Committee are the potential initial audiences for the
Medicaid expansion brief.
• Educating the general public of the possibility that they too may one day need
Medicaid is necessary, with a particular focus on reducing the exception bias many
opponents possess.
References

5. Flint, S. (2014, May 27). Who loses when a state declines the Medicaid expansion?
Health Social Work, 39(2). Retrieved from http://
hsw.oxfordjournals.org.ezproxy.umsl.edu/content/39/2/69.full
Garfield, R., Damico,. A., Stephens, J., & Rouhani, S. (2014, November 12). The
coverage gap: Uninsured poor adults in states that do no expand Medicaid - An
update. Retrieved from http://kff.org/health-reform/issue-brief/the-coverage-gap-
uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/
Hill, S. C. (2015). Medicaid Expansion In Opt-Out States Would Produce Consumer
Savings And Less Financial Burden Than Exchange Coverage. Health Affairs,
34(2), 340-349. doi:10.1377/hlthaff.2014.1058
Kaiser Family Foundation. (2013, April 25). Summary of the Affordable Care Act.
Retrieved from http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-
care-act/
Lipstein, S. H. (2015, January 14). Missouri legislators should consider Medicaid
expansion. St. Louis Post-Dispatch. Retrieved from http://www.stltoday.com/
news/opinion/missouri-legislators-should-consider-medicaid-expansion/
article_1d4afb33-e58c-5de6-9648-3a217fb42bb4.html
Missouri Health Care for All. (2013). Expand Medicaid in Missouri. Retrieved from http://
missourihealthcareforall.org/wp-content/uploads/2013/07/Medicaid-Expansion-
Fact-Sheet-2014.pdf