Lora Gulley

Medicaid is a program vital to the health of hundreds of thousands of Missourians. The issues are talked about at a high level, but the impact is felt everyday by those receiving Medicaid – or those who are not receiving Medicaid, but should be. Far too often decisions are made without the voices of those impacted, and there are several possibilities for this trend to continue. But if you are armed with information to take action, we can break that cycle.

We have seen a lot of news about Medicaid including budget issues and bills at the state level. Why should we care?

All of these bills, budget items and campaigns can impact what new research is telling us: that our kids are not getting the coverage needed to ensure they are growing up healthy. Whether it’s work requirements creating an additional barrier to receiving this care or expansion ensuring that entire families are covered, it’s important our communities understand what is going on, how it impacts us, and what we can do about it.

How do we sift through all the information and news about Medicaid to best understand it?

Rather than thinking about each piece separately, think about them by impact: barriers to care, the budget, and how the program operates. They form the Medicaid services families experience in everyday life and can help us understand how and where to take action to advocate for an effective insurance plan.

We have heard a lot about barriers, especially lately with the drop of hundreds of thousands of kids off the Medicaid rolls. What kinds of barriers are decision makers working with?

It is the Medicaid program’s responsibility to ensure accessing and maintaining insurance is as simple as possible for eligible individuals. We are seeing attempts to do the exact opposite, creating new barriers that individuals and families must overcome to get health insurance. Mainly, this is through work requirements the state Legislature is working to put on the ballot this year. These would require all Medicaid recipients to report 80 hours of work per month or that they are exempt from said work based on the law. This rule creates a barrier to care.

On the contrary, we see Medicaid expansion proposed for the ballot as well, which would provide coverage for an additional 200,000 Missourians.

What else impacts the program’s operation?

Work requirements would be more paperwork and another way for individuals to lose coverage if they are unable to accurately report work or exemption. Expansion would change the threshold for who is eligible for coverage, including hundreds of thousands more individuals who are likely uninsured and paying for healthcare out of pocket. We also have a budget line item in 2020 and proposed again for 2021 for $34 million of the state budget to go to “Medicaid Transformation,” which could either positively impact families by streamlining the program or negatively impact families by making changes without participation from impacted communities.

How do decisions about the Medicaid budget impact Medicaid recipients?

The way the money works for Medicaid can change how the entire program is run, which changes the services Medicaid recipients have access to. Right now, there is a bill in the state Legislature that would change the way the federal government funds its part of this state program. Currently, the federal government gives a percentage of the cost to run the program. This bill would change that, so the federal government pays a set rate, regardless of the costs, in exchange for more state control over how the program is run. This means that if the costs for running the program go up, the state must either find a way to pay for them or cut services.

Transformation and expansion play a role as well. Transformation has an opportunity to streamline the program to save money, but that doesn’t necessarily mean that those changes will have a positive impact on Medicaid recipients. Medicaid expansion has proven to save states money on Medicaid by gaining additional federal dollars, freeing up more money in the budget.  

How does all this this directly impact the black community?

The racial disparities in healthcare are stark; black babies are three times more likely to die than white babies in the St. Louis region, regardless of income and education levels. Research tells us that changes to Medicaid coverage will play a critical role in addressing these racial inequities. For many black families, Medicaid not only plays an essential role in access to care, it also translates into financial flexibility, allowing for limited dollars to be spent on meeting other basic needs, such as housing, food or medicine.

When we see so much happening around Medicaid from operational barriers to budget changes that impact every aspect of the program, we must understand how they impact us and make our voices heard.

How do we take action?

We can vote, we can educate, and we can run for office. We must ensure our friends and neighbors are registered to vote, and then we must ensure they understand the issues to inform their vote. When we don’t see someone on the ballot that is representing us and our community, we should find someone who does and we support them in a run for office. That person may be you. We need to talk about how to change our path forward, away from upholding systemic racism and towards building equitable systems.

Lora Gulley is director of Mobilization and Advocacy for Generate Health.

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