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 That effort should be perfunctory, given the earlier SPA submitted, and later withdrawn, by the Department of Social Services.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.
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
The U.S. House of Representatives’ Energy and Commerce Committee reviewed and approved 24 bills, including 16 related to health care. Responding to Centers for Disease Control and Prevention data indicating a 30% increase in opioid deaths in 2020, the committee unanimously approved five bills: H.R. 2379, supporting an opioid mitigation grant program for states; H.R. 654, enhancing opioid educational programs; H.R. 2364, supporting public health campaigns on synthetic opioids; H.R. 2051, requiring a response plan to methamphetamine as an emerging threat; and H.R. 2355, promoting more controlled substances data in state prescription drug monitoring programs. The committee also advanced bills on maternal health (H.R. 4387 and H.R. 951) and compiling and using data on social determinants of health (H.R. 4026 and H.R. 3894).
The Missouri Medicaid caseload grew by 9,000 in June to a record 1,089,000 participants. Since the beginning of the COVID-19 pandemic in February 2020, Missouri’s Medicaid caseload has grown nearly 243,000, or 28.7%. The number of children covered has increased by 150,000 during this time.
The record growth in the caseload is expected and will continue throughout calendar year 2021. To qualify for a 6.2% increase in federal matching funds under the Families First Coronavirus Response Act, states may not end a participant’s Medicaid coverage unless the participant moves to another state, dies or requests that their coverage end while the COVID-19 public health emergency is in effect. The Biden administration signaled its intention to continue the COVID-19 emergency declaration through the end of the calendar year, thus extending the conditions leading to the unprecedented growth in Medicaid coverage.
A group of state attorneys general announced on Wednesday, July 21, a $26 billion national settlement in response to claims that the three largest U.S. pharmaceutical companies and Johnson & Johnson helped fuel a deadly nationwide opioid epidemic. Under the settlement proposal, distributors McKesson, Cardinal Health, AmerisourceBergen and Johnson & Johnson would pay the combined $26 billion throughout the next 18 years.
The final amount companies may have to pay will depend on the extent to which states sign up for the settlement. Under the terms of the settlement, an unspecified number of states must sign the agreement for it to be binding. Missouri could receive $450 million from the settlement.
The Centers for Medicare & Medicaid Services issues updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.
COVID-19: EUA for Tocilizumab monoclonal antibody product
Wound debridement: comparative billing report in July
Thursday, the Missouri Supreme Court upheld statutory damage caps in medical malpractice actions. The case was the first challenge to reach the high court after the General Assembly abolished common law medical negligence claims and replaced them with a statutorily-created cause of action that included caps on noneconomic damages. The court found it “undisputed” that the legislature has authority to eliminate or alter common law causes of action. Because medical negligence claims now arise under the 2015 statute, damage caps do not violate the right to trial by jury guaranteed by article 1, § 22(a) of the Missouri Constitution.
MHA joined the Missouri Organization of Defense Attorneys in filing an amicus brief on behalf of the physician defendants.
The Missouri Department of Mental Health in partnership with the Missouri Behavioral Health Council is offering a complimentary Zero Suicide Academy. This two-day, virtual academy is scheduled for Tuesday, Aug. 31, and Wednesday, Sept. 1. Health care providers, including primary care, FQHC’s and hospitals, behavioral health providers and substance use providers are invited to apply. The application deadline has been extended to Friday, July 30.