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In Missouri, cost of Medicaid expansion remains a mystery

In Missouri, cost of Medicaid expansion remains a mystery

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Doctors collect signatures to put Medicaid expansion on the ballot

Doctors Heidi Miller and Timothy Eberlein engage with St. Louis voter Chris Nelson about Medicaid expansion.  Medical professionals went door-to-door Thursday, encouraging voters to sign a petition to put the issue on the November ballot in Missouri. Photo by: Mary Butkus for Healthcare for Missouri

JEFFERSON CITY — When Republican Gov. Mike Parson announced he was moving a statewide vote on Medicaid expansion to the August primary, he said he wanted the vote to happen as fast as possible to help officials deal with potential cost increases.

The governor, who opposed the ballot initiative, denied his use of his executive power was an attempt to defeat the proposal by moving it to the lower turnout primary election.

“This was about policy, not politics,” Parson said at the time.

But now, more than two months after voters approved the expansion by a 53-47 margin, state budget writers appear to be no closer to determining how much the expansion will cost.

Departmental budget documents submitted by the Parson administration for the fiscal year beginning July 1, 2021, offer no guidance on how much officials believe it will cost to provide federally subsidized health insurance to an additional 230,000 Missourians.

There is just one hint in the fine print.

“It is anticipated that additional funding will be necessary to operate current MO HealthNet programs for Fiscal Year 2022,” the documents note.

A spokeswoman for the Department of Social Services said budget writers are still crunching the numbers.

“At nearly one-third of our entire state budget and the largest draw on general revenue, the Medicaid program is the largest and perhaps most complicated program in state government. Given the complexity and size of the program, the Department has not had adequate time to complete a sound estimate in the less than two months since the initiative was passed by voters,” said Rebecca Woelfel.

Officials, however, do expect estimates to be ready by January, when Parson or his Nov. 3 election opponent, Democratic Auditor Nicole Galloway, will lay out their budget proposal to lawmakers.

“We are continuing to work through the estimates and projections and believe we will have enough information to be considered for the governor’s recommendation,” Woelfel said.

A spokesman for Galloway, who supports expansion, said the lack of numbers is proof Parson hoped moving the date would kill the ballot initiative.

“This is the clearest evidence yet that the governor’s decision to move the vote on Medicaid expansion to August was a political maneuver to defeat it,” Eric Slusher said. “As we have said all along, Governor Parson cannot be trusted to implement Medicaid expansion.”

Supporters of expansion say it will allow the state to tap into more federal dollars to provide poor people with health insurance.

Galloway has said it can be done without raising taxes or raiding other funds.

“The experience of other states that have expanded Medicaid demonstrates this as well. Either the Governor’s own agency responsible for implementing it agrees with Galloway or Governor Parson has no intention of implementing it,” Slusher said.

Under the old rules, Medicaid in Missouri does not cover most adults without children because the income threshold is among the lowest in the nation.

The Affordable Care Act, signed into law by President Barack Obama in 2010, expanded Medicaid coverage to all adults under 65 who make less than 138% of the federal poverty line, though a 2012 U.S. Supreme Court ruling made expansion optional for the states.

Before the vote, Missouri was among 13 states — most in the Deep South — that have resisted Medicaid expansion, arguing that it would cost too much, especially if the federal government were to stop sharing the cost.

The federal government covers about 65% of Medicaid costs, while the rest comes from the state. But populations covered under Medicaid expansion would have 90% covered by federal funding.

Estimates about the cost have been fluid. A fiscal note filed by Galloway suggests the expansion will either save $1 billion or cost $200 million.

Republicans believe it will cost the state money, resulting in cuts to education and other state programs.

But there are a number of factors that could determine the ultimate cost, including the upcoming Nov. 3 election.

Parson or Galloway, for example, could decide to place all new enrollees into cheaper managed care plans.

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