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Opinion: Missouri should stop subsidizing the medical care of out-of-state patients


Now that our state has adopted Medicaid expansion, the General Assembly must go about the important work of reforming the program to keep it affordable. Without reforms to the system, Medicaid will eat away at our state’s budget. According to the report on Medicaid commissioned by the Missouri Department of Social Services, Medicaid could be expected to take up 30 percent of our state’s general revenues by 2023 if reforms are not implemented. And costs continue to spiral out of control.

I was opposed to expanding Medicaid for this very reason. Expanding Medicaid means expanding costs and jeopardizing our state’s budget. I understand the need to subsidize health care for those in need; growing up, my sisters and I depended on Medicaid for our health care. However, now that more citizens are eligible for Medicaid coverage, it is clear reforms are needed to preserve the system and deliver the health coverage that the Missouri voters approved.

Streamlining the costs of Medicaid to benefit Missourians first will also benefit our providers. The cost savings we see in the Medicaid program should be used to increase reimbursements to folks like doctors and hospitals that are meeting the state’s medical needs. Our physicians have gone underpaid for years when it comes to our Medicaid program. Just imagine how much increased preventative care from our physicians could benefit the state’s costs overall by curbing emergency room visits. Common sense solutions like this will have long-term benefits for our state budget and our people. 

Thankfully, the aforementioned report found a cost-saving reform that just makes a lot of sense: stopping the state’s practice of subsidizing medical care for non-Missourians. As the report indicated:

Providing add-on payments to hospitals for non-Missouri residents served is a unique feature of the Missouri Medicaid program. Throughout the U.S., hospitals serving out-of-state Medicaid patients will be paid by the patient’s home state according to that state’s Medicaid regulations. In Missouri, the state provides additional add-on payments (estimated at approximately $177 million in SFY2019) to its hospitals for services provided to persons eligible for Medicaid from Kansas, Illinois or elsewhere.”

Yes, you read that right. Missouri is the ONLY state that pays “add-on payments” for out-of-state patients. So if someone from Illinois comes to a hospital in Cape Girardeau, the state is subsidizing that procedure. This is a practice that needs to end. For no good reason, our state is paying for the health services of non-Missourians that come to our state for treatment. Let me say that another way: We — the taxpayers of Missouri — are paying for the health care of non-Missourians when many of us can’t afford our own coverage! Other states do not return the courtesy; this is just us folks. Just us. This does not make any sense; our state health care system is supposed to help our residents, not the residents of other states.

This reform is just common sense, and I think it’s something we can all get behind. With money as tight as it is, we cannot be in the practice of providing additional services to non-residents, especially when those non-residents are already covered by their own state’s Medicaid system. I believe that keeping Missouri Medicaid dollars for Missourians will help keep costs low and make good on our mandate to implement Medicaid expansion, per the will of the people.