outside the capitol building


MHA Today | July 23, 2021



MHA Today

MHA Today is provided as a service to members of the Missouri Hospital Association.

Past issues are available in the Media Library.


Yesterday, in a unanimous decision, the Missouri Supreme Court upheld Amendment 2, the initiative to expand Medicaid to hundreds of thousands of low-income Missourians. This was an important victory for an effort that has spanned nearly a decade.

Hospitals have been advocates from the beginning of the Medicaid expansion process. Those with elephantine memories will recall that the Affordable Care Act — by design — traded coverage for payment cuts. The U.S. Supreme Court invalidated the part of the law that required states to expand Medicaid eligibility, leaving states like Missouri exposed to payment reductions without the enhanced Medicaid-related coverage to offset the losses. As we move forward, Missouri will have an opportunity to establish a level playing field with many of its neighbors.

It’s fair to want to run a long-awaited victory lap. Given the blood, sweat, toil and tears invested in advocacy efforts since the middle of the last decade, we certainly have reason. However, our success on this issue always has been tied to the ability to look ahead. As each obstacle presented itself during this journey, we remained flexible enough to rise to the challenge. That frame of mind will be necessary during implementation.

The truth is, we’re not done.

In the coming weeks, the state will need to submit a federal Medicaid State Plan Amendment to authorize the expansion. That effort should be perfunctory, given the earlier SPA submitted, and later withdrawn, by the Department of Social Services. And, we’re confident that the Biden administration will approve it quickly.

Two challenges lay ahead. First, we’ll need to engage all stakeholders in enrollment efforts to cover as many lives as possible. Second, because the current budget may not have the capacity to cover the full Medicaid population with expansion included, a supplemental appropriation may be required later in the state fiscal year.

Together with the partners that helped get Medicaid expansion across the finish line, we can build a strong enrollment program. Throughout the advocacy process, our partnerships — within the provider community, and among business leaders, health advocacy foundations and others — generated the heft needed to convince Missourians that this was the right step. Many of those same groups must and will be part of the enrollment outreach effort.

Although the courts determined that expansion must occur, funding concerns remain. Missouri has the revenue to implement expansion. Not only is state government flush with federal pandemic relief funds, the General Assembly appropriated, and the governor approved, $500 million in a Medicaid Stabilization Fund to enable spending not allocated in the state budget. That amount is five times the projected annual state cost of expansion. Also, Congress authorized significant federal incentives last spring for states like Missouri that are late to the game in expanding Medicaid eligibility.

Thursday was a great day for Missourians. It also was a great day for hospitals and the state’s health care system.

Thank you for all of your efforts. There’s more work to do. However, the return on our investments will be improved lives and stronger communities.

Let me know what you are thinking.

Herb Kuhn, MHA President & CEO



Herb B. Kuhn
MHA President and CEO

In This Issue

U.S. House Committee Advances Legislation On Opioids, Maternal Health, Social Determinants
Missouri Medicaid Caseload Continues Its Relentless Growth
State Attorneys General Announce $26 Billion National Opioid Settlement
MLN Connects Provider eNews Available
Supreme Court Upholds Damage Caps
CMS Updates Care Compare Data
DMH Extends Hospital Application Deadline For Zero Suicide Academy

Health Law Insight
Quality and Population Health
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