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Missouri Focus

Medicaid Expansion

Medicaid expansion implementation continues to be a key focus moving into 2021. The State Plan Amendment (notice of Missouri’s intent to implement expanded eligibility standards) is due to CMS by March 1 and expanded coverage is set to begin on July 1.

The legislature is already posturing ideas for Medicaid reform because of their concern regarding the cost of Medicaid expansion. Senator-elect Jason Bean (southeast Missouri) proposed two options: moving portions of the Medicaid population to managed care and cutting back payments on out-of-state patients. Senator Cindy O’Laughlin (northeast Missouri) posed an option to cap reimbursements hospitals receive for Medicaid patients to decrease funding to urban hospitals.  Senator Lincoln Hough (Springfield, Missouri) is a proponent of a threefold Medicaid reform tactic that is more beneficial for health systems. His plan focuses on sustainability, fair and reasonable payments to providers, and ensuring care is delivered as efficiently as possible.

The statewide Medicaid expansion coalition – compromised of both grassroots groups and more established organizations – continues to move forward toward implementation. The coalition provides data and policy options to the administration and legislature. BJC and Washington University School of Medicine are participating in the Missouri Foundation for Health (MFH) Medicaid Expansion implementation workgroups. The representation in these advocacy groups allows our voice to be heard in the implementation process.

Medicaid Managed Care

Missouri will release their Medicaid Managed Care RFP around July 1, 2021. Awards will be made no later than January 2022 with an effective date of July 1, 2022. Through the RFP process, BJC can help ensure there are metrics meaningful to providers included in the final product. We plan to have a group of thought leaders from BJC work with the Missouri Office of Administration as they design the rebid. Social Determinants of Health is thought to be a large pillar in the rebid.

Social Equity Issues

COVID-19 exacerbated the health disparities across communities as Black and Brown people continue to die from COVID at a much higher rate than White, middle class people. We will utilize this unfortunate gateway to highlight BJC efforts, FROMULATING ideas, and programs relating to health disparities and Social Determinants of Health.

Early childhood and daycare are a large focus of BJC and Governor Parson. In October, the Department of Early and Secondary Education (DESE) announced the creation of an Office of Early Learning. It will be responsible for programs such as Parents as Teachers, First Steps early intervention, and early childhood special education. There is going to be a massive conversation on children age zero to five with a lot of funding to programs to benefit this age group. Access to daycare will also be a focus because COVID-19 has caused many to close – 2300 daycares are still open out of 3500 pre-COVID. On Dec. 30, Governor Parson announced $46 million in childcare funding to support Missouri childcare providers and working families. We will also be advocating for the creation of child development accounts for each qualified child in Missouri with seed money deposited to help raise educational engagement for children and their families.  Early childhood education touches every part of Missouri, not just urban areas, so we expect to see a lot of collaboration across the state.

Even amidst a pandemic, violence continues to surge. Violence prevention has become a statewide issue. We will be strategic and structured about our messaging regarding violence prevention in the capitol to avoid falling upon deaf ears. Our focus will be on access to de-escalation and prevention to address the root cause of the issues and not simply place penalties on the backend. There will not be any sweeping changes this legislative session; however, education and conversations will improve awareness and movement on the issue.

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Page updated 02/23/2021

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