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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Missouri's Medicaid Enrollment Drop Stands Out, Nationally

Republicans in the Missouri Senate want to make sure the governor doesn't create a health care exchange without their consent.
KBIA/file photo
Republicans in the Missouri Senate want to make sure the governor doesn't create a health care exchange without their consent.

Georgetown University professor Tricia Brooks focuses her research on access to health insurance for children in low-income families with a particular focus on Medicaid and the children’s health insurance program, or CHIP. In this week's episode of Health and Wealth, Brooks talks about how Missouri's Medicaid enrollment drop compares to the rest of the country, and some of the factors behind it.


When did the current declines in enrollment start?

In 2017, we became concerned because the uninsured rate for children took a u-turn. It reversed course for the first time in a decade. And as we began to look more closely at that, we began to assess the fact that Medicaid enrollment for children was declining in a number of states, including Missouri. So we started following the enrollment trends very closely as data was released for 2018, knowing that if Medicaid and chip enrollment was declining, and knowing that 40 percent of children rely on Medicaid and chip, then we could expect the uninsured rate to begin to rise again.

When it comes to that uninsured rate, and the drop in Medicaid enrollment, how does Missouri compare to the rest of the country?

In terms of the enrollment decline for children in Medicaid and chip, Missouri is really leading the pack now. We’ve been following these trends for 16 months, all the way through 2018, through April of 2019 and Missouri has seen a decline of 12.1 percent of its child enrollment. That is the highest percentage in the country.

And not only does Missouri have the highest percentage in the country, but in that 16 month period it also is in the top 5 states in the number of kids that have lost coverage, and that’s really significant when you think about Missouri being a much smaller state than say a California, a Texas or a Florida.

The state has put forward the theory that enrollment declines are largely due to economic improvement – families aren’t using Medicaid because they’re making more money. Have you seen that?

I know that both at the federal level and in some states the economic argument was first and foremost the response to this particular issue. However, we certainly do not see an improvement of access to other insurance or wages- real wage growth in a way that would have put these families over income for Medicaid or chip.

And so let’s just talk specifically about Missouri for a moment in terms of whether these children should have lost coverage. More kids in Missouri are on Medicaid than CHIP. Medicaid has a lower income eligibility, at about 150 percent of the poverty level in Missouri.

If the family got an increase in income, those kids should’ve been eligible for CHIP but they haven’t been moving from Medicaid to Chip.

So I definitely don’t think that these families are fairing well enough economically that their children would be ineligible for Medicaid or chip or that they would’ve gotten private insurance. There definitely are not any trends at the federal level showing that access to affordable employer insurance has improved for low income families.

Sebastián Martínez Valdivia was a health reporter at KBIA and is documentary filmmaker who focuses on access to care in rural and immigrant communities. A native Spanish speaker and lifelong Missouri resident, Sebastián is interested in the often overlooked and under-covered world of immigrant life in the rural midwest. He has a bachelor's degree in broadcast journalism from the University of Missouri and a master's degree in documentary journalism at the same institution. Aside from public health, his other interests include conservation, climate change and ecology.