Intersection of the Law and the Social Determinants of Health

Medicaid expansion advances in Missouri.

Among news relating to the social determinants of health (SDoH) this week are the latest events associated with Medicaid expansion in Missouri.

Many, including myself, thought that this issue was a moot point. Last month, a lower court ruled the expansion to be invalid. This was when the state’s governor and legislature refused to appropriate the necessary funding. Now, remember, Missouri voters approved Medicaid expansion in the state last August, with implementation set for this month. In a time when voters are fierce advocates for their rights, their voice matters.

The ongoing events make for quite the spectacle. Three residents of the state have sued, claiming Missouri is “required to implement expansion.” It seems that the state’s Medicaid program is bound by the original ballot initiative to enroll residents eligible for coverage under the expansion, while the circuit court is obligated to determine the appropriate relief for each of the plaintiffs. The question posed to Missouri’s Supreme Court justices was if the 2020 ballot item for expansion required lawmakers to appropriate money, which would have been a violation of state law. Despite claims of the state legislature, this was deemed not to be the case. As a result, 275,000 low-income individuals around the state will be eligible to join the existing Medicaid recipients in Missouri, although a new enrollment process must first be set up; the original federal paperwork to set up this process was withdrawn by the governor, so the state is almost back to square one.

Eligibility will be for adults between the ages of 19 and 65, if they make 133 percent or less of the federal poverty level: roughly $35,200 for a family of four. The new amendment also prohibits the state from enacting work requirements for Medicaid recipients; these have been found to be an epic failure across the states where they have been enacted. These actions come at a critical time, when COVID’s wrath is being felt heavily by Missourians. As of July 22:

• 3,238 cases have been reported, with a seven-day average of 2,244 cases;
• 1,548 persons are hospitalized, up 43 percent over the past two weeks; and
• 12 deaths have been logged.

Missouri, along with Florida and Texas, now account for 40 percent of new COVID cases in the U.S.

We’ve asked a variety of survey questions about Medicaid expansion in the past. However, the recent rise in COVID cases had our Monitor Mondays team wanting to check with our listeners. This week’s survey provided a good idea of the national trends, and can be viewed here.

Hang in there, all!

Programming Note: Listen to Ellen Fink-Samnick report on the SDoH every Monday on Monitor Mondays, 10 Eastern.