A Story of Two Medicaid Extensions: Oklahoma Intervenes and Missouri Lags

Temporary worker James Dickerson applied for Medicaid because it will be cheaper than his current health plan. Home care assistant Sharon Coleman hopes to receive coverage that will cover the hospital stay. Incoming medical student Danielle Gaddis no longer worries that a trip to the doctor will leave her in debt.

All three are among the approximately 490,000 people who became eligible for Medicaid after Oklahoma and Missouri voters approved an expansion of the federal low-income public health insurance program in 2020. In both states, people who earn up to 138% of the federal poverty level – about $ 18,000 a year per person – can now get free insurance even if they don’t have a disability.

But the experiences of young people in these two states are rough. 215,000 people in Oklahoma and 275,000 in Missouri – has changed dramatically. Oklahoma has more than 210,000 registered man, while Missouri enlisted less tKhan 20,000

The difference lies in the approach of the two Republican-led states that have resisted expanding Medicaid for years.

Once Oklahoma voters approved the expansion, it was quickly passed: Legislature assigned $ 164 million will go to the state budget to finance it. Applications began in June this year, one month before the start of the program, and during the month 113,000 people were approved.

Over 100,000 Oklahomanians Signed Up for Medicaid Expansion Program

In August, Oklahoma Secretary of Health and Mental Health Kevin Corbett told state legislators about one of these participants: a 62-year-old woman who was able to make an appointment with a doctor and dentist for the first time in 20 years.

“Truly life changing,” Corbett said. “We are very happy with what we can do.”

Another states to have expanded Medicaid in recent years There is a sharp increase in enrollment in the first month. Louisiana’s combined Medicaid and Child Health Insurance program lists grew by more than 255,000; Virginia increased by nearly 184,000 people; Idaho added about 45,500 members, roughly half of the expected number of new applicants; and Montana added more than 23,000, 51% of the expected amount. On the other hand, Missouri included only about 7% of first-time eligible people on Medicaid.

“You can expand book-based Medicaid, but there are many ways you can create barriers to people staying out of the program,” said Sydney Watson, Director of the Center for the Study of Health Law, University of St. Louis.

The expansion was exhausting in Missouri. Legislature refused to finance a voter-endorsed program that prompted Republican Gov. Mike Parson to announce in May that the state would “withdraw” its expansion plan. Then, in August, the judge ordered state to start accepting applications, which he did. But Missouri couldn’t begin processing them until October 1.

Missouri Supreme Court Overturns Medicaid Expansion Decision

Marsiaril said the state is responsible for disseminating information about the program, and that Missouri has done little more than was required by law in an August court ruling. The criticism was echoes othersAccording to a law professor at the University of Missouri in Kansas City, this whiplash means many newly qualified Missourians are likely unaware that they may be eligible for Medicaid. Anne Marie Marsiaril

Heather Dolce, a spokesperson for the Missouri Department of Social Services that oversees Medicaid, said the department released information about the Medicaid expansion by updating its website, sending an email to family support participants and posting on social media. The department’s Facebook and Twitter accounts have several posts about the extension, including two tweets posted the day after publication KCUR article however, it was noted that the state’s efforts to disseminate information had been slow.

Meanwhile, Oklahoma’s efforts included information activities, TV interview, a plus video and social media campaign

In Missouri, with no reliable publicity from the government, most of the coverage was from clinics such as Affinia Healthcare in St. Louis. James Dickerson saw the Medicaid expansion flyer on the front door of Affinia Clinic when he went to the doctor for an ear infection.

The 59-year-old man, who works in various positions through a temporary agency, was eager to register. He had a good experience with Medicaid in 2014 when he was insured during spinal surgery due to a work injury.

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At Affinia, Dickerson met with Sunnit Johnson, a certified application consultant, who received all the information needed to submit his application within about five minutes. Most of these clinics have specialists who can help patients register for health insurance and other assistance programs.

Federal law requires Missouri to determine if an applicant qualifies for the program within 45 days. But Michelle Davis Reid, lead selection and selection coordinator for Northwest Health Services, based in St. Joseph, Missouri, said in November that some of the applications she submitted in August were still pending.

Dolce said there were 32,000 Medicaid applications in the state as of November 17. She did not directly answer the question about the number of employees processing applications, but said that overtime is used.

In Oklahoma, 144,000 of the 210,000 Medicaid expansion program participants were previously uninsured. The rest were enrolled when the state assessed whether people who applied for other benefit programs are eligible for Medicaid.

One Missouri program that may be a candidate for such recycling is The path to better health, a temporary insurance program that Sharon Coleman uses in St. Louis. The Gateway reaches approximately 16,000 residents of the City of St. Louis and St. Louis County, who earn up to 100% of the federal poverty level.

Angela Brown, CEO of the St. Louis Regional Health Commission, which operates Gateway, said she believed at least 90% of its members would be eligible for Medicaid when expanded, but bureaucratic hurdles made incentivizing patients to participate in the Medicaid program is straightforwardly simpler than the process required to transfer them to the new system. Gateway sent Coleman and other recipients a text message asking them to apply.

After receiving a warning, Coleman, 60, who provides home care for seniors, traveled to Affinia specifically to enroll in Medicaid. She has high blood pressure but is otherwise in good health – she said she hasn’t been to the hospital since her son was born 40 years ago. Coleman was relieved to learn that if she had to leave now, her bills would be covered by Medicaid. Gateway only covers primary care, specialty care, and emergency care.

“Now I can go to the emergency room and not worry about them sending me bills I can’t pay,” Coleman said after visiting Johnson, the enrollment officer.

In Oklahoma, 26-year-old Danielle Gaddis has been uninsured for two years. At the time, she did not want to see a doctor for fear of medical bills. So she was grateful for being on Medicaid in Oklahoma when she recently got sick. Like Dickerson and Coleman, Gaddis applied for Medicaid with the help of a specialist at the Mary Mahoney Memorial Health Center in Oklahoma City.

“Covid could be the end of the world for colds, so you’re worried,” said Gaddis, who will go to medical school in August after a year’s delay.

Gaddis said that as she begins her medical education, she constantly thinks about the uninsured experience.

“Nobody ever has to worry about,“ How long will I have to drive this before I go see what’s wrong? “- said Gaddis. “This is how it gets worse.”

Kaiser Health News is the national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente.

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