Efforts continue to expand Medicaid in Kansas and Missouri

Advocates in each state taking similar tacks in hopes of coaxing reluctant Republican policymakers

0 | Health Reform, KanCare, Medicaid-CHIP

In the weeks ahead, Kansas -- led by Republican Gov. Sam Brownback (right) and a GOP-dominated Legislature -- is expected to reconsider expanding Medicaid eligibility as provided for under the Affordable Care Act. In Missouri, Gov. Jay Nixon, a Democrat, has been urging the Republican-controlled General Assembly to do the same.

In the weeks ahead, Kansas -- led by Republican Gov. Sam Brownback (right) and a GOP-dominated Legislature -- is expected to reconsider expanding Medicaid eligibility as provided for under the Affordable Care Act. In Missouri, Gov. Jay Nixon, a Democrat, has been urging the Republican-controlled General Assembly to do the same.

— The political dynamics are a bit different in Kansas than in Missouri, but in both states supporters of expanded Medicaid programs are taking the same tack in hopes of persuading reluctant Republican policymakers to eliminate the so-called "Medicaid gap" that is leaving more than 340,000 low-income Kansans and Missourians without health insurance.

The Affordable Care Act, as written, would have expanded Medicaid in every state, including Missouri and Kansas where the eligibility restrictions are relatively tight. But the U.S. Supreme Court in 2012 ruled that expansion was a decision for each state to make on its own.

Kansas and Missouri are among the 24 states that so far have chosen against broadening the program, despite entreaties from hospitals, doctors, consumer advocates and others.

Kansas, led by Republican Gov. Sam Brownback and a GOP-dominated Legislature, is expected to reconsider the issue in the weeks ahead.

In Missouri, Gov. Jay Nixon, a Democrat, has been urging the Republican-controlled General Assembly to do the same.

In this package of stories, KHI News Service looks at the latest developments in each state as their legislatures prepare to convene 2014 sessions.

Also included are profiles of families in each state that earn too much to qualify for Medicaid as it is currently configured, but too little for the subsidies intended to help people (earning between 100 percent and 400 percent of federal poverty guidelines) buy private health coverage through the new marketplaces created by the Affordable Care Act.

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Photo courtesy Kansas Hospital Association

Tom Bell, president and CEO of the Kansas Hospital Association.

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Kansas hospitals leading new push for Medicaid expansion

Many uninsured Kansans who Congress assumed would get coverage under the health reform law are instead falling in to what is being called the “Medicaid gap.”

They make too much money or don’t meet other criteria to qualify for the state’s Medicaid program – called KanCare – but don’t earn enough to be eligible for federal tax credits to offset the cost of private insurance. Those credits are available only to people with incomes between 100 percent and 400 percent of federal poverty guidelines. The federal poverty level is $11,490 a year for an individual and $19,530 for a family of three.

As many as an estimated 85,000 uninsured Kansans fall in the eligibility gap.

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Kathleen Christian and her grandson, Sebi.

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Profiles of the coverage gap: Kathleen Christian

Kathleen Christian is a remarkably healthy 63-year-old. She has no chronic conditions and rarely sees the doctor for anything other than preventive care.

Even so, she said she had been looking forward to getting health insurance under the Affordable Care Act, after having been without coverage since she was laid off in 2009.

But last month, Christian learned she would not be able to get coverage after all.

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KHI News Service file photo

Missouri Gov. Jay Nixon

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MO Medicaid expansion advocates hope summer work yields compromise

A year ago, Missouri had a Democrat governor who strongly supported expanding the state’s Medicaid program in line with the original intent of the Affordable Care Act but a Republican legislature that was foursquare against the idea.

Those political dynamics appear unchanged as the General Assembly prepares to convene Wednesday for this year’s session.

But Medicaid expansions advocates said they are hoping that the differing factions might find common ground and extend coverage to thousands of uninsured Missourians, especially after three legislative committees spent the summer and fall studying ways to improve the state-federal medical program for the poor.

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Jeanette Pettijohn

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Single mom in KCMO seeks benefit of preventive care

Jeanette Pettijohn is studying to be a special education teacher.

The 32-year-old Kansas City, Mo. woman attends classes at Metropolitan Community College-Penn Valley.

A divorced mother of four young children, she has a work-study job on campus that pays about $6,500 a year, which is still too much for her to qualify for Medicaid in Missouri, though the program covers her children.

She also is far below the earnings threshold ($27,570 for a family of five) that would qualify her for subsidized health insurance in the marketplace established by the federal health reform law.

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KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

Commentary
→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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