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It is uncanny how often that slogan seems to apply. Ahead of the Missouri General Assembly’s veto session yesterday, MHA shared a document with them that outlines the flow of federal dollars into Missouri to fund Medicaid expansion. It works like this: Gov. Parson’s budget estimate for fiscal year 2022 pegged the general revenue cost of expansion at $105 million. But, enacting the expansion would bring $1.1 billion in unexpected federal revenue to Missouri over two years because of a financial incentive in the American Rescue Plan Act of 2021 to encourage states to implement expansion. The incentive comes from a 5% increase in the Federal Medicaid Assistance Percentage, which is the federal government’s share of Medicaid costs. This 5% increase is authorized for two years after spending for expanded Medicaid begins.We all are familiar with the legend that Missouri is the “Show-Me” state. Although the slogan is not official, it is attributed to Missouri’s U.S. Congressman Willard Duncan Vandiver who served in the United States House of Representatives from 1897 to 1903. While a member of the U.S. House Committee on Naval Affairs, Vandiver attended an 1899 naval banquet in Philadelphia. In a speech there, he declared, “I come from a state that raises corn and cotton and cockleburs and Democrats, and frothy eloquence neither convinces nor satisfies me. I am from Missouri. You have got to show me.”

When this enhanced federal revenue is combined with the $1 billion the state set aside for the MO HealthNet Division for FY 2022, there is enough revenue to pay all state Medicaid expansion costs through May 2030 using MHA’s spending assumptions. And, this estimate doesn’t include substantial savings to the state’s current Medicaid budget that we are confident will emerge over time.

This isn’t the first time we’ve attempted to show those who doubt the math. In early 2020, MHA retained the health care consulting firm Health Management Associates to do a report on other conservative states’ experiences with Medicaid expansion. HMA did extensive research and interviews with current and former state officials in Ohio, Indiana and Arkansas to demonstrate that expansion was far from a drain on state budgets. That was before the success we had at the ballot box.

Now that all court challenges are exhausted and the state is moving to enroll the newly eligible, we have another opportunity to share what should be good news for state budget officials. The scenario we have outlined for lawmakers demonstrates an easy path for Missouri. And, that doesn’t include the economic impact the state will experience as a result of the increased revenue.

I think Congressman Vandiver would be pleased to know that Missouri still raises corn and cotton and cockleburs. Let us hope that our attempt to carry out his slogan calms fears in the State Capitol.

Let me know what you’re thinking.

Herb B. Kuhn
MHA President and CEO

In This Issue

HRSA Expands Areas Eligible For Federal Rural Health Grants
MLN Connects Provider eNews Available
Healwell Hosts Social Justice In Health Care Conference
TJC Announces Upcoming Webinar
HRSA Announces Funding Opportunity