Two Medicaid Expansions in One: Oklahoma Jumps In and Missouri Lags

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HEALTH NEWS:

Temp worker James Dickerson applied to Medicaid because it would be less expensive than his current health insurance. Sharon Coleman, a home health aide, is excited to have coverage that covers a hospital stay. Danielle Gaddis, incoming medical student, no longer fears that a trip to see the doctor will result in her being in debt.

All three are among the roughly 490,000 people newly eligible for Medicaid after Oklahoma and Missouri voters in 2020 approved expanding the federal-state public health insurance program for people with low incomes. In both states, people who earn up to 138% of the federal poverty level — about $18,000 per year for an individual — can now get the free coverage even if they don’t have disabilities.

But the experience of the newly eligible in those two states — an estimated 215,000 people in Oklahoma and 275,000 in Missouri — has differed dramatically. Oklahoma has enrolled over 210,000 people, while Missouri has enrolled fewer than 20,000.

The difference is due to the approaches taken in the two states. Both are Republican-led and have resisted expanding Medicaid for many years.

Once Oklahoma voters approved the expansion, it was quickly embraced: The legislature appropriated $164 million in the state budget to fund it. Applications opened this June, one month before the program began, and within a month, 113,000 people had been approved.

In August, Oklahoma Secretary of Health and Mental Health Kevin Corbett told state lawmakers about one of those enrollees: a 62-year-old woman able to schedule appointments with a doctor and dentist for the first time in 20 years.

” Truly life-changing,” Corbett stated. “We are very proud of what we can do .”

Other states that have expanded Medicaid in recent years saw their enrollments rise by almost half. Idaho added about and Montana added over Louisiana’s combined Medicaid and Children’s Health Insurance Program rolls grew by over 255,000; Virginia’s increased by almost 184,000; Idaho added about 45,500 enrollees, roughly half of the anticipated number of newly eligible people; and Montana added over 23,000, 51% of its expected total. Missouri has only 7% of the newly eligible population in Medicaid.

“You can expand Medicaid on the books, but there are a lot of ways that you can throw up barriers to keep people from getting enrolled,” said Sidney Watson, director of the Center for Health Law Studies at Saint Louis University.

Missouri’s

Expansion process has been slow. The legislature refused to fund the voter-approved program, prompting Republican Gov. Mike Parson announced in May that the state would “withdraw its expansion plan.” Then, in August, a judge ordered the state to start accepting applications, which it did. However, Missouri was unable to begin processing the applications until October. 1.

That whiplash means many newly qualified Missourians are likely unaware they could be covered by Medicaid, according to University of Missouri-Kansas City law professor Ann Marie Marciarille.

Marciarille stated that the state is responsible for spreading the word about the program, and that Missouri has done very little beyond what was required by an August court order. The critique has been echoed by others.

Sunni Johnson, a certified application counselor at Affinia Healthcare in St. Louis, Missouri, files paper copies of the Medicaid applications she completed online. Clinics such as Affinia are responsible for much of the outreach efforts because there is not enough advertising from the state about Medicaid expansion. Johnson says she and her colleagues at the clinic complete about 20 Medicaid applications per day. (Bram Sable-Smith/KHN)

Heather Dolce, a spokesperson for the Missouri Department of Social Services, which oversees Medicaid, said the department had publicized the Medicaid expansion by updating its website, emailing participants in its family support programs and posting on social media. The department’s Facebook and Twitter accounts show a handful of posts about the expansion, including two tweets posted the day after the publication of a KCUR article that noted the state’s outreach efforts had been slow.

Oklahoma’s efforts, meanwhile, included outreach events, TV interviews, plus a video and social media campaign.

In Missouri without strong advertising, much of outreach has fallen on clinics like Affinia in St. Louis. James Dickerson noticed a flyer regarding the Medicaid expansion at the Affinia clinic’s front door when he visited a doctor to treat an ear infection.

The 59-year-old, who works various jobs through a temp agency, was eager to sign up. He had a good experience with Medicaid in 2014 when he was covered while getting spinal surgery for a workplace injury.

At Affinia Dickerson met Sunni Johnson (certified application counselor), who in just five minutes had all the information needed to submit his application. Many clinics offer assistance programs and help patients enroll in insurance.

By federal law, Missouri is required to determine whether an applicant is eligible for the program within 45 days. Michelle Davis Reed, who is the Northwest Health Services’ lead eligibility and enrollment coordinator, stated in November that she was still unable to process some of her August applications.

Dolce said the state had 32,000 Medicaid applications pending as of Nov. 17. Although she did not answer directly to a question regarding the number of applicants, she said that overtime was being used.

In Oklahoma, 144,000 of the 210,000 Medicaid expansion enrollees previously lacked insurance. When the state assessed whether applicants for other benefits programs were now eligible for Medicaid, the remainder were enrolled.

One Missouri program that could be a candidate for such reprocessing is Gateway to Better Health, a temporary insurance program that Sharon Coleman uses in St. Louis. Gateway covers about 16,000 residents of the city of St. Louis and St. Louis County who earn up to 100% of the federal poverty level.

James Dickerson (left) learned he could be eligible for Medicaid from a flyer on the door of Affinia Healthcare in St. Louis, where he sought care for an ear infection. In five minutes Dickerson provided Sunni Johnson, an application counselor with all necessary information to complete his Medicaid application online. (Bram Sable-Smith/KHN)

Angela Brown, CEO of the St. Louis Regional Health Commission, which administers Gateway, said she believes that at least 90% of its participants would qualify for Medicaid under expansion but that bureaucratic hurdles made encouraging patients to sign up for Medicaid directly simpler than the process necessary to move them into a new system. Gateway sent Coleman and other recipients a text message urging them to apply.

After getting the alert, Coleman, 60, who provides in-home care to older adults, went to Affinia specifically to enroll in Medicaid. She has high blood pressure, but her health is otherwise good — she said she hasn’t been to a hospital since her son was born 40 years ago. Coleman was relieved that Medicaid would cover her costs if she needed to leave immediately. Gateway does not cover urgent, specialty or primary care.

” I can now go to the emergency department and not have to worry about them sending me bills that I can’t afford,” Coleman stated after meeting with Johnson, an enrollment specialist.

In Oklahoma, 26-year-old Danielle Gaddis had been uninsured for two years. Fearing that she would be charged for medical expenses, she was reluctant to go to a doctor. When she became ill, she was grateful to have been enrolled in Oklahoma’s Medicaid program. Gaddis applied to Medicaid, just like Coleman and Dickerson, with the assistance of a specialist at Mary Mahoney Memorial Health Center, Oklahoma City.

“A cold can be fatal due to covid. So you should freak out,” Gaddis said. He will begin medical school in August, after waiting for a year.

Gaddis stated that she will keep the experience of being uninsured in mind as she begins her medical education.

“Nobody should have to worry about “How long will I have to ride this out before going to see what’s the problem?” Gaddis stated. “That’s how things get more difficult .”

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