In the lobby of the Samuel U. Rodgers Health Center Downtown Campus, a clinic in northeast Kansas City, Missouri, Jim Torres offers what should be an easy sell.
For patients passing through to doctor appointments, Torres wants to sign them up for Medicaid — no strings attached. But he got off to a rough start.
“The first day, it looked like no one knew they were eligible,” Torres said. “No one knew to ask for it. And to be quite honest, we were unsure as to go about helping them apply.”
After years of Republican opposition, Missouri voters last year approved a ballot measure to greatly expand who is eligible for health care coverage under Medicaid. But it still took a lawsuit and a court order before Missouri's state government agreed to enact and fund that expansion.
Now, advocates say the state is doing little to help get eligible residents signed up.
"A little slower on this"
Following an August 10 order from a Cole County Circuit Court judge, Medicaid coverage has been available to anyone in the state who makes up to 138% of the federal poverty level. For an individual, that’s about $18,000 per year.
Studies have estimated that means about 275,000 Missouri residents could be newly eligible for health care coverage.
However, the Missouri Department of Social Services said it would be unable to process applications until October. As of mid-November, though, only about 16,000 people have actually been enrolled.
That’s not a big surprise to Timothy McBride, a health economist as Washington University’s Brown School and one of the leading experts on Missouri Medicaid.
“When I go around, and a lot of people know I know about expansion, people say ‘Has that started yet?’” McBride said.
McBride says that processing these applications adds a lot more work for the Department of Social Services, which was already understaffed. So far, though, the turnaround for enrollees has been about a week, which McBride says is a fairly quick pace.
“We’re always a little different from any other state,” McBride said. “We may just be a little slower on this.”
"Not making a proactive effort"
When it comes to actually getting people signed up, some health care advocates say that Missouri is dragging its feet — even by the standards of other Republican-led states.
Studies produced by McBride and others have estimated that expansion would not only reduce Missouri's rate of uninsured residents, it would also provide a huge boost to the economy. Medicaid expansion could save the state roughly $1 billion, due to increased federal spending, and by eliminating the need for state health spending related to behavioral health and criminal justice.
Despite those benefits, most GOP state leaders, including Gov. Mike Parson — a vocal opponent of Medicaid expansion — haven’t done much to promote the program now that it's law.
Missouri's lack of outreach stands in contrast to states like Louisiana, where state workers actively looked for people to enroll among food stamp recipients.
In Missouri, this search has largely fallen to health care nonprofits, but Missouri Foundation for Health vice president Sheldon Weisgrau says the state would be in a much better position to do that work.
“There are people who are known to the state,” Weisgrau says. “The state has information about their income, but the state is not making a proactive effort to reach out to them and enroll them. And they’re leaving that to the outside partners to get the word out.”
It's still early yet, and eventually more people will get enrolled in Medicaid, regardless of outreach. A spokesperson for the Missouri Hospital Association said that hospitals will be able to sign up uninsured patients who show up for emergency care.
And sign-ups will also probably increase after the federal COVID-19 public health emergency ends. When that happens in January, Missouri will be allowed to remove people from its Medicaid rolls who are no longer eligible, and it’s likely that many of them will sign up under expansion.
But Weisgrau says this process would happen much faster if the state took an active role. That’s what happened in Oklahoma, which also expanded its Medicaid this summer.
Oklahoma then worked to find people currently enrolled in state health care programs that could switch to the expanded Medicaid rolls. Thanks to those efforts, more than 200,000 people have been enrolled in their Medicaid program, and the state is now drawing down more federal money as a result.
“It’s really in the state’s best interest to get those people moved into the new group as fast as possible,” Weisgrau says.
Filling the gap
Last week, Missouri officials said they would search for current Medicaid enrollees who can be switched to the new expanded category, but McBride says this effort appears to have only just gotten started.
The Missouri Department of Social Services didn’t respond to questions from KCUR about its outreach efforts. In response to queries, spokeswoman Heather Dolce sent links to enrollment data and to the department’s application webpage.
For now, spreading the word about Medicaid expansion has fallen to nonprofit workers like Jim Torres.
Based on what he’s seen so far, Torres says he expects little help from the state in making his pitch to potential recipients.
“They may very well be eligible for full Medicaid — we’re talking doctors’ visits covered, prescriptions, hospitalizations, behavioral health and dental,” Torres said. “This is really good coverage at virtually no cost.”
