Now that the U.S. Supreme Court has ruled on the federal health law, we’ll be hearing a lot more about one of its key aspects: Medicaid.
In light of this, and in the first of an occasional series “breaking down” the region’s complex health system, below are six essential things to know about Medicaid in Kansas and Missouri.
The U.S. court ruling gave states the option whether or not to expand the income eligibility for the program. In Kansas, Governor Sam Brownback doesn’t want to implement any part of the health law, including an expansion. In Missouri, Governor Jay Nixon has said he’s still reviewing the matter to figure out what’s best for Missouri, and that state lawmakers - most of whom oppose an expansion - will be central in determining what happens. But an expansion isn’t the only issue: state and federal policy makers are still flushing out other Medicaid provisions within the federal law, and that aside, the Medicaid program on both sides of the state line has been subject to major changes, affecting the health care of hundreds of thousands of people.
Six things to know about Medicaid in Kansas and Missouri
1. It's a huge health insurance program.
Medicaid is the major public health insurance program for low income and disabled Americans. It formed in 1965, the same time congress created Medicare. According to the health research group, the Kaiser Family Foundation, the program now covers about 60 million low income parents, pregnant women, children, seniors and people with disabilities.
In Missouri, Medicaid covers about 900,000 people, or one in seven residents.
In Kansas, Medicaid covers about 300,000 people, or one in ten residents.
2. It varies by state. Sort of.
Medicaid is a state federal partnership program. States oversee the program, but must meet certain baseline eligibility and coverage requirements to receive federal funding. Ryan Barker, director of health policy at the Missouri Foundation for Health, explains:
“There are federal minimums for some of the eligibility categories, but states can go above those minimums if they choose to. So in certain categories, Missouri is higher than other states. In certain categories Missouri is lower or at the federal minimum. But there is some state flexibility built into the state Medicaid program.”
So certain services have to be covered, like emergency care and prenatal care. Then there are optional benefits states can include, such as dental care, prescription drugs, and home and community based services.
Eligibility for the program also varies for kids, parents, seniors and people with disabilities. In Missouri, parents must be at about 18 percent of the federal poverty level or lower to be eligible. For a single parent with two kids, for example, that’s an income of up to $3500/year. Barker says for kids, eligibility is much higher.
“Missouri is one of the top five most generous states when it comes to children’s eligibility. So between our Medicaid program and what is called our CHIP program (Children’s Health Insurance Program), that eligibility for kids goes up to 300 percent of the poverty level [Kids in that CHIP program, who fall within that upper income end, do have to pay a premium].”
In Kansas, eligibility for parents is a bit higher, but it’s lower for kids (about 233 percent of the federal poverty level).
3. It doesn't cover adults who don’t have kids (except for in Colorado and a few other states).
A main focus of the debates around a possible expansion of Medicaid has to do with adults, and specifically adults without kids. Currently, childless adults in most states, including Kansas and Missouri, are not eligible for Medicaid. Income alone doesn’t matter. Pregnant women, however, are eligible. Immigrants who are legally in the United States must wait five years before being eligible for Medicaid. Immigrants who are not in the U.S. legally are not eligible for the program.
4. It's a primary coverage option for long-term care services.
While parents and kids make up the majority of the population in the Mediciad program, seniors and people with disabilities account for the majority of the program’s costs. Scott Brunner, with the Kansas Health Institute, also points out that Medicaid is the main coverage option for long-term care services and nursing home stays. Medicare does not cover this and private coverage usually doesn't, either.
“Medicaid is the only public payer for those kinds of services. So as people age...they start out being cash payers for nursing facility care. As their resources dwindle, they spend themselves into poverty and become eligible for Medicaid. Then Medicaid starts paying for their long term care stays.”
Barker says in Missouri, Medicaid covers more than half of all nursing home care in the state.
5. It's not Medicare. But some people have both.
The Medicare program is meant for people over the age of 65 and for some individuals with disabilities. A person who has worked about 10 years full time in the U.S. is eligible for Medicare. Medicaid comes in, Brunner explains, as a sort of second insurance for low income people. Seniors with a little higher income can get Medicaid assistance paying for some Medicare premiums.
6. It costs states a lot. And funds a lot.
The Medicaid program costs about $6 billion in Missouri. The federal government subsidizes a large portion of that (and providers and hospitals also pay into it), but the program still comprises more than a sixth of the state’s general revenue budget. In Kansas, the program costs nearly $3 billion, with the state paying for about a third of that. At the same time, the program is a main funder of many safety net services. For example, Medicaid covered about half of all births in Missouri last year.
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