Who is eligible
Parents with dependent children are eligible with household incomes up to 18% of FPL. Children are eligible for Medicaid or CHIP with household incomes up to 300% of FPL, and pregnant women are eligible with household incomes up to 196% of FPL.
- September 26, 2016
Missouri has not expanded Medicaid (MO HealthNet) under the ACA. Non-disabled adults without children are not eligible for Medicaid regardless of how low their income is, and parents with dependent children are only eligible with incomes that don’t exceed 18 percent of the poverty level. Only Texas has a lower Medicaid eligibility cap, at 15 percent.
If Missouri were to expand Medicaid, FamiliesUSA estimates that 452,000 people would be newly-eligible for coverage.
As the ACA was written, it called for Medicaid expansion in every state for residents with incomes up to 133 percent of poverty. But in 2012, the Supreme Court ruled that states could not be penalized for opting out of expansion, and Missouri is one of 19 states that has not yet taken steps to expand coverage.
Because subsidies are only available in the exchange for people whose household incomes are at least 100 percent of poverty (since Medicaid was supposed to be available for those below that level), there are 147,000 people in Missouri who are in the coverage gap and have no realistic access to health insurance. They aren’t eligible for Medicaid or for subsidies to offset the cost of private insurance.
Who is eligible?
In addition to the aged, blind, and disabled, the following populations are eligible for MO HealthNet Medicaid in Missouri:
- Adults without dependent children are not eligible at all (this is generally the case in states that have not expanded Medicaid) unless they’re disabled.
- Adults with dependent children are only eligible if their household income doesn’t exceed 18 percent of poverty level. This is about $3,562 a year for a family of three; only Texas has a more stringent guideline, at 15 percent.
- Infants under one are eligible for Medicaid if their household income is up to 196 percent of poverty.
- Children 1 – 18 are eligible if their household income is up to 150 percent of poverty.
- Children above the Medicaid income thresholds are eligible for CHIP if their household incomes are up to 300 percent of poverty. This is among the more generous limits in the country.
- Pregnant women are eligible for Medicaid if their household income does not exceed 196 percent of poverty.
How do I enroll?
- You can enroll through HealthCare.gov, either online or by phone at 1-800-318-2596.
- You enroll online directly through MO HealthNet.
- You can also complete and submit a paper application.
2014-2015 enrollment numbers
From October 2013 through April 2014, 45,513 HealthCare.gov applicants in Missouri enrolled in Medicaid or CHIP. They were already eligible for Medicaid under the existing guidelines, but had not enrolled prior to the opening of the ACA exchanges.
During the second open enrollment period (November 15, 2014 to February 15, 2015), 34,679 people enrolled in Medicaid/CHIP through the Missouri exchange.
Medicaid enrollment is year-round, but total enrollment in MO HealthNet decreased by 3.5 percent between September 2013 and August 2014. A spokesperson for the Missouri Department of Social Services said that enrollment had been trending downward for some time. But by May 2016, total enrollment in MO HealthNet had grown to 963,241 people – an increase of 14 percent since the fall of 2013. This increase in enrollment — despite the fact that the state hasn’t changed their eligibility guidelines — is known as the “woodworker effect,” as people already eligible for Medicaid came “out of the woodwork” due to the increased outreach and advertising that went along with the implementation of the ACA’s exchanges.
In 2013, 15.2 percent of Missouri’s population was uninsured. That number barely budged in the first half of 2014, falling just one tenth of a percentage point to 15.1 percent by mid-2014. But by the end of 2014, it had fallen to 13.4 percent, and by 2015, it had edged down a little more, to 11.6 percent. There is no doubt however, that Medicaid expansion would drive that number significantly lower.
Missing out on billions in federal funding
In states that expand Medicaid, the federal government pays the full cost of expansion through 2016. Starting in 2017, the state gradually starts to pay a share of the expansion cost, but never more than 10 percent. Because of the generous federal funding for Medicaid expansion, states that reject it are missing out on billions of federal dollars that would otherwise be available to provide healthcare in the state.
From 2013 through 2022, if Missouri continues to reject Medicaid expansion, the state will give up $17.8 billion in federal funding.
And because residents in states not expanding Medicaid still have to pay federal taxes, Missouri residents are paying for Medicaid expansion in other states. By 2022, people in Missouri will have paid $7.3 billion in federal taxes used to pay for Medicaid expansion in other states.
Hospitals in Missouri that treat uninsured patients will be especially hard-hit, as their federal disproportionate share hospital funding will start to be phased out over the next few years (it was supposed to be replaced by Medicaid funding) and unless the state accepts federal funding to expand Medicaid, the hospitals will still be treating significant numbers of uninsured patients. As a result of Missouri’s decision to opt out of Medicaid expansion, hospitals in the state are projected to lose $6.8 billion between 2013 and 2022.
Will Missouri expand coverage?
A University of Missouri School of Medicine study in 2012 concluded that “Medicaid expansion would be highly beneficial to the Missouri economy and its citizens.” And in June 2014, the Missouri Economic Research and Information Center announced that healthcare job growth in Missouri had slowed considerably since 2012, and was falling behind compared with states that had expanded Medicaid. Healthcare is the state’s largest employment sector.
Governor Jay Nixon has been a longtime proponent of Medicaid expansion, although the Republican supermajority in the state’s legislature blocked his efforts in 2012 and 2013.
But Senator Ryan Silvey, a Republican from Kansas City, is on board with Medicaid expansion, noting that “it’s going to be damaging to our hospitals if we don’t do something.” Silvey’s Democratic colleagues are also supportive of expansion. The legislature came close to approving a modified version of Medicaid expansion in the spring of 2014, and Silvey noted that some of the lawmakers who opposed it have since retired, meaning there might be a better chance for successful legislation in 2015.
In December 2014, Senator-elect Jill Schupp introduced SB 125, which called for expansion of Medicaid up to 138 percent of the poverty level. It was estimated that expansion of Medicaid would make coverage available to 300,000 uninsured Missouri residents (this is smaller than the Families USA number cited above, because people with incomes between 100 percent and 138 percent of the poverty level are currently eligible for subsidies in the exchange, and many of them have availed themselves of that opportunity; they are not uninsured but they would be newly-eligible for Medicaid – and the lower cost-sharing that it entails – if coverage were to be expanded).
Several other similar bills were introduced during the 2015 session aswell, including HB 153, HB 1351, and HB 474. But Republican leadership in the Missouri legislature vowed to block any attempts to expand Medicaid during the 2015 session, and none of the bills advanced to a full vote. Bob Onder, a new state senator from St. Charles, has made fighting Obamacare – including Medicaid expansion – his primary focus during the 2015 session. When the Supreme Court upheld the legality of subsidies in states like Missouri that use Healthcare.gov, Onder stated that the Court’s ruling was essentially liberal justices taking the opportunity to “rewrite” the ACA in order to “save” it. There was hope – nationwide – that the Court’s ruling on King v. Burwell to uphold subsidies would galvanize the Medicaid expansion movement, since it’s one more indication that the ACA is here to stay. But opposition to Medicaid expansion among Missouri’s legislative leadership is still strong.
Unfortunately, the legislature’s refusal to expand Medicaid means that hospitals are having to cut costs, and in June, Mercy Hospital announced 127 job cuts in Springfield.
2016 gubernatorial election
Governor Jay Nixon is term-limited, and cannot run in the 2016 election. The two candidates who won their primaries are Missouri Attorney General Chris Koster (a former Republican, running as a Democrat), and former US Navy SEAL Eric Greitens (a former Democrat, running as a Republican).
Koster supports Medicaid expansion, while Greitens opposes it. But even if Koster wins the election, Nixon’s fruitless efforts to push for Medicaid expansion in Missouri demonstrate the fact that without the legislature on board, the governor has little control over whether the state will expand Medicaid.