The budget passed by the Missouri House leaves out the $130 million needed to fund expansion. The remainder of the costs would be covered by the federal government.
Joan Alker, executive director of the Georgetown University Center for Children and Families, said she thinks the added incentives in the latest COVID relief package make this a perfect time for Missouri to fund expansion. Even when those incentives run out, she noted, the federal government pays 90 cents for every 10 cents the state pays in the long term. “And what states have found is that there really have not been long-term negative consequences for their budget,” she said.
Alker said that’s partly because of the federal match, money that stimulates jobs and the economy – and also because the state already is covering uninsured Missourians’ medical bills by paying for uncompensated care.
Just because people are uninsured doesn’t mean they don’t have serious medical needs, Alker said, adding that it means they’re less likely to get the less expensive, preventive care. “If they’re uninsured, they get sicker and they wind up in the emergency room,” she said, “and then they have medical debt, the hospital has medical debt, and the state ends up paying for some of that uncompensated care in various ways.”
Alker added that states that have expanded Medicaid have seen far fewer rural hospital closures. For many rural hospitals, their debt from uncompensated care gets too high to sustain over time. “Rural hospitals and rural providers, there’s already a big shortage,” she said, “so this can be a huge benefit to support those rural communities.”
Of the 12 states that have yet to expand Medicaid, Missouri and Oklahoma have the cues to do so from voters, who passed ballot initiatives last fall.