Missouri's Medicaid income eligibility limits for adults are among the lowest in the nation, according to a report released this week from the Missouri Budget Project, a St. Louis-based nonprofit group that advocates for Medicaid expansion - a contrasting viewpoint to the majority of Republicans in the General Assembly.
The report shows Missouri parents are worse off than their children in terms of Medicaid coverage. Parents qualify for Medicaid at 19 percent of the Federal Poverty Level (FPL) - but their children are less limited with coverage at 300 percent of the FPL. More than 90,000 Missouri children are uninsured, despite having more eligibility than their parents who can still sign up their children if they don't qualify.
"Unfortunately, though Missouri has a very strong eligibility for children under the MO Healthnet program, not all families are aware of the program, and children go uninsured," said Amy Blouin, executive director of the Missouri Budget Project. "There has been a lot of research done nationally that indicates that if parents are covered with insurance, their children are also more likely to be covered, and that if parents lack insurance, their children are more likely to be uninsured as well. So a portion of Missouri's child uninsured rate is likely due to its low eligibility levels for parents."
At 100 percent FPL for a family of three, the total annual income is $20,090. Higher FPL percentages mean people can have greater annual incomes and can still apply for Medicaid. For example, a family of three covered at 135 percent have an annual income of $27,121 or less. The U.S. median percentage is 138 percent, with 26 states at the same figure.
Missouri's 19 percent FPL rate means a two-person family income limit for Medicaid enrollment is about $3,026 annually, or $252 per month, Blouin said. A three-person family's income limit is $3,817 annually, or $318 per month, and a four-person family's income limit is $4,607, or $383 per month. Blouin said the state's eligibility is technically slightly below the 19 percent FPL because it is tied to Temporary Assistance for Needy Families (TANF) income limits.
However, Missouri is like 22 other states that don't offer Medicaid to childless adults. Wisconsin provides Medicaid to childless adults at 100 percent, while 27 of the remaining states offer 138 percent FPL coverage. The District of Columbia surpasses all states with 221 percent FPL for parents and 215 percent for childless adults.
Households making between 100 to 400 percent of the FPL can take advantage of the Affordable Care Act through the federal marketplace. A large difference between the 19 percent FPL eligibility limit and the 100 percent marker for marketplace subsidies has created, the report shows, a "health insurance coverage gap," leaving 300,000 Missourians who don't have affordable employer-sponsored options without health insurance.
According to the Missouri Budget Project report, there are 50,000 uninsured Missourians with mental illness and 40,000 uninsured with developmental disabilities. The report also shows those who age out of the Medicaid program - at 19 - fall into the coverage gap.
The Affordable Care Act gives states the opportunity to increase Medicaid eligibility for low-income parents and other non-elderly adults to 138 percent FPL, also known as Medicaid expansion. The federal government funds 90 percent of the costs to expand a state's eligibility, but Republican lawmakers have historically been cautious of expansion due to concerns over affordability and the federal government's financial ability to support the program as it's in debt.
In his 2015 State of the State address, Democratic Gov. Jay Nixon said Medicaid expansion states have seen health care jobs triple compared to states that haven't opted for expansion. He also said Missouri taxpayers sent, at the time of his January speech, $2 billion to Washington, D.C., and that was spent in the states that expanded Medicaid.
Sen. Kurt Schaefer, R-Columbia, said that was a "false statement" Nixon made, telling reporters in January that, "Missouri is going to get a dollar amount back from the feds for Medicaid based on a formula of economic factors and the population that we have on Medicaid.
"And, regardless of what we send to Washington (and) whether Florida or Indiana or anyone else expands, we get our dollar amount based on the formula. So, it's not true to say that, somehow, we send money to other states and we don't get it back, because we're not going to add 400,000 people to welfare like the governor wants."
The News Tribune reported former Speaker of the House John Diehl, R-Town and Country, and Senate President Pro Tem Tom Dempsey, R-St. Charles, said Republicans were hesitant to expand Medicaid based on ACA provisions.
Heather Lockard, executive director of the Missouri Association for Community Action, which helped sponsor the report, said the findings show the importance of expanding Medicaid, adding it would prevent thousands of deaths annually.
"We know that access to quality health care alleviates chronic diseases, makes children more productive in school and allows families to focus on their overall well being," she said.
A Missouri Budget Project report published in January stated Missouri would save more than $81 million at first through Medicaid expansion and then increase the amount to more than $100 million annually in later years. The recently released report states Missouri allocates less than one-fourth the amount of funds than most other states on public health services.
News Tribune reporter Bob Watson contributed to this report.