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Opinion: Medicaid expansion: A financial win for Missouri, now let’s get to work


Today on Oct. 1, 2021 — after a decade of work, a year of campaigning, a decisive vote in August of 2020, shenanigans by the opposition in the Missouri Legislature during the 2021 session, a Supreme Court decision, and three more months to iron out the details — Missouri has officially and finally expanded Medicaid coverage.

This is a victory for those who have pushed for Medicaid expansion in Missouri for several years. We owe a debt to everyone who knocked doors and talked to voters, gathered evidence and ran the numbers, spoke publicly and passionately about their experiences without insurance, lobbied legislators, wrote laws intent on finally bringing Medicaid expansion to our state, and went to court to fight for what was right. To all of you, this day is the result of your hard work and your perseverance.

Rep. Peter Merideth

This is a victory for direct democracy. When Missourians finally had the opportunity to decide for themselves whether or not they wanted to expand Medicaid coverage, they chose the compassionate option. When Republicans in Jefferson City connived and schemed and tried every political trick, legislative loophole, and legal maneuver to subvert the will of voters, the highest court in our state unanimously defended and upheld the vote of the people.

But most importantly, this is a victory for the nearly 300,000 people of this state who now qualify for health insurance after being denied access to life-affirming care for far too long. And it is a victory for our health care economy — especially our struggling rural hospitals, who will finally be reimbursed for caring for so many uninsured patients, and not be forced to eat those costs or shift them onto other patients.

Expanding Medicaid coverage is easily the most important and impactful policy change I have seen go into law since I first came to Jefferson City as a legislator almost five years ago. But the work isn’t over.

As legislators, we have a responsibility to fully fund Medicaid in the coming years. While other states have proven the federal government will cover the entire cost of expansion and actually save money in our state’s budget, our legislature still has to approve authority for the state to spend all those federal dollars, and thus far the Republicans in charge have refused to do so.  If we don’t act quickly in January, the entirety of the Medicaid program will be in jeopardy.

But just as importantly, the governor and legislature must begin the work of planning how best to spend the enormous influx of federal dollars we will receive for expansion in ways that will strengthen our program for the long term. In recent weeks, we have confirmed with our nonpartisan budget staff new estimates of the nearly $1.1 billion our state will receive simply for expanding thanks to Biden’s American Rescue Plan. That’s a billion dollars on top of the reimbursements for expansion itself — a billion dollars we can spend however we want. 

Right now, the most urgent need facing our health care system is underpaid direct care providers: those folks in difficult jobs caring for our most vulnerable neighbors with significant mental health or physical health challenges. Many of these providers — because of low state reimbursements and many years without a proper raise — are paid as little as minimum wage or even less, and providers are understandably struggling to keep enough good staff to handle the load.  We should invest in these Missourians using our current budget windfall to fund real raises that recognize the tough and important work they do. If we don’t, we will soon be facing a crisis of being unable to provide the care Missourians need. Investments we make with the ARP money now can get us through this crisis while we start to see budget savings and new revenue from expansion that can keep higher wages going in the long term.

In a couple of weeks, we will receive budget requests from state departments. I hope we will see real plans from the governor to spend these new federal dollars and provide these overdue raises, and I hope the Republican-controlled legislature will get to work on appropriating them.

We can and should celebrate today. But let’s get ready to go back to work tomorrow to give Medicaid the spending authority it needs, put these new billions of dollars from expansion to work in the best way we can to strengthen our system in the future, and ensure our direct care providers are paid the wages they deserve.

If you believe you’re eligible, I urge you to apply for coverage at the DHSS website here.