Politics

As Medicaid rules return, Missourians could lose coverage

Published

2 years ago

February 13, 2023

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Nia Sumpter, a student, mother and patient advocate, calls herself a sickle cell warrior. People with the disease — which affects red blood cells — need to see doctors all the time. Before she enrolled in health insurance, her treatment racked up thousands of dollars in hospital bills.“With sickle cell disease, that meant I was now responsible for affording … transfusions and all of the other types of medicines,” said Sumpter, who lives in St. Louis County. “And so now I’m stuck on the hook for that. And my credit is literally like, shot.”Sickle cell disease can be tough on a patient’s body, and it’s a lot of work juggling doctors, insurance and paperwork. That’s particularly the case for people on Medicaid, like Sumpter.Sumpter enrolled in Missouri’s Medicaid program last year when the state expanded coverage to low-income adults. For someone like her with costly medical bills, Medicaid can be a lifesaver.She’s one of a record 1.4 million people now enrolled in Missouri’s Medicaid program — the government-funded health insurance for disabled and low-income people and families. Missouri was one of only two states that expanded its program, Mo HealthNet, during the pandemic. That made more than a 250,000 people eligible for Medicaid coverage statewide.The federal government barred states from kicking anyone out of the program during the coronavirus pandemic. But that provision ends this spring. State officials have said they expect hundreds of thousands of people to lose their coverage. And as the state starts to review patients, it’s possible those who need health coverage will lose their insurance.

Sarah Fentem

St. Louis Public RadioPatient advocate Nia Sumpter, shown with her son Zacheriah, on Feb. 1 was one of more than 250,000 people who became eligible for the Medicaid when Missouri expanded the program to low-income adults. This spring, Sumpter and other Medicaid recipients will need to submit annual re-enrollment forms for the first time since the start of the pandemic.

Lost in the mailIn Missouri, people enrolled in Medicaid have in the past had to prove their eligibility every year by providing the state with documentation of income, disability and other qualifying factors. Federal lawmakers in 2020 halted that requirement as part of a legal package that protects families from the financial effects of the pandemic.The state will soon begin reviewing Medicaid data, and starting in May recipients will once again need to prove eligibility each year to keep coverage. That could include filling out information online or sending forms to the state Social Services Department through the mail.St. Louis Regional Health Commission CEO Angela Fleming Brown and other health advocates are worried people will fall off the rolls even if they’re still eligible. Before the state expanded Medicaid, the commission administered a similar health coverage program for low-income people in the region.Fleming Brown said even for that smaller-scale program, it was difficult for administrators to contact people with forms or information about their coverage.“This is because many of the people that we find in the safety net population tend to change addresses and phone numbers frequently,” she said. “And so they’ll usually get lost or they do not receive immediate termination forms.”As a result, many don’t receive mailed or phone notices that their coverage is expiring. Some don’t know they may need to submit information to the state to keep it.That includes Nia Sumpter. When she learned that Medicaid enrollees need to re-up their coverage every year, she put her head on the table.“I didn’t realize I had to reenroll,” she said. “Is that a thing?”Sumpter said she hasn’t yet received any mail from the state about the need to renew coverage after the pandemic provisions end, but she has seen sporadic text messages from the state about applications. She thought they didn’t apply to her family’s situation.“I thought once I applied I was gonna be OK,” Sumpter said. “So I kind of disregarded the text messages about reenrolling or possibly enrolling.”Sumpter, who’s chair of the Regional Health Commission’s Patient Advisory Board, said that the constant paperwork and bureaucratic processes put people like her with chronic health conditions at risk of losing vital health coverage. She thinks people with disabilities should have continuous coverage.She considers herself lucky she’s had a doctor who pushes her insurer to cover her treatment and keeps her updated.“If you do not have a physician who cares about you, it can be very dangerous,” Sumpter said.

Tessa Weinberg

Missouri IndependentDemonstrators urge Gov. Mike Parson to fund voter-approved Medicaid expansion in July 2021 outside the Governor’s Mansion in Jefferson City.

‘Not the best track record’Missouri’s history of managing Medicaid patients worries Sheldon Weisgrau, vice president of health policy at the Missouri Foundation For Health. This year, many Missourians are on Medicaid for the first time because of the state’s expansion. They aren’t used to the annual renewal process, he said.“Missouri does not have the best track record in this area, which is why a lot of us are watching really carefully what the state is doing,” Weisgrau said.In 2018 and 2019, more than 100,000 Medicaid recipients — many of them children — dropped off the rolls when state officials reviewed the Medicaid program.After Missouri struggled to process Medicaid applications for people who became eligible after the state expanded access, federal officials directed the state to improve its efforts to sign people up.Pro-Medicaid advocates said Missouri could have better educated residents about the changes or helped newly eligible people sign up for coverage. As state enrollment lagged, local clinics, nonprofits and religious groups helped people enroll.Weisgrau said the program’s expansion to more low-income adults means state officials are now faced with an unprecedented task.“They’ve never had to do it at a point where the Medicaid program has this many people enrolled in it,” he said. “I mean, we are far above the highest number of Medicaid beneficiaries than we’ve ever been in Missouri.”It’s one thing for someone to lose eligibility who no longer meets the eligibility guidelines for Medicaid, but “it’s another thing to lose eligibility for administrative reasons,” Weisgrau said. “You fall through the cracks, somehow you didn’t get the letter from the state you opened it and didn’t understand it. You submitted a piece of documentation that wasn’t complete. And I think the real worry is that there’s going to be a lot of people that fall into that category.”

Tim Bommel

Missouri House of RepresentativesTodd Richardson, Missouri Department of Social Services director, told state lawmakers in a legislative hearing earlier this month he expects close to 200,000 people to lose Medicaid coverage over the next fiscal year.

Churning through the system Todd Richardson, Missouri Department of Social Services director, told state lawmakers in a legislative hearing earlier this month that he expects close to 200,000 people to lose Medicaid coverage over the next fiscal year.“I don’t think there’s any doubt that Missouri, like every other state in the country, expects to see enrollment come down once a full set of the redeterminations are done,” Richardson said, as reported in the Missouri Independent.Kim Evans, the director of the Social Services Department’s Family Support Division, said she’s certain Medicaid enrollment will drop during 2023. For one thing, some people have had continuous coverage even though they may be making too much money to qualify or have moved to a different insurance plan, she said.But “we’re trying to reduce what we call churn,” she said. “Churn is where [people] close because they failed to return some information to us. And then within the next 60 to 90 days, they come back in and have to reapply. We’re trying to reduce that and take the burden off the participants.”A recent study by the Kaiser Family Foundation found that two-thirds of those who lost Medicaid coverage had a period without health insurance. It also found more than 40% of people disenrolled eventually reenrolled in Medicaid within a year, indicating that they had lost coverage that they still needed.How to prepareHowever, the state has known this change was coming for a long time, and state officials say they’re in a much better position to handle renewals now than a few years ago.“We don’t want people to panic. We’re here to help,” Evans said.The department has made changes since 2019, she said. The agency has automated some of its systems to determine eligibility. For example, it can now use SNAP data and other information already on file to see someone’s income and determine if a person still qualifies.“Missouri has really expanded the resources, that we have the external resources to verify information,” Evans said. “And this will be the first time that we’ve automated that and used it.”The state will review eligibility gradually over more than a year, she said, going month by month. For example, if a person was enrolled in August 2022, the renewal will be in August 2023. People on Medicaid should be on the lookout for any forms coming in the mail around two months before their annual renewal date, she said.The best way to avoid losing coverage is for patients to update their contact information at mydss.gov/renew and to pay attention to texts and mail from social services, even if people usually regard them as spam, she said.

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Poll: Support for Missouri abortion rights amendment growing

Published

5 months ago

August 29, 2024

Natural Bridge

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A proposed constitutional amendment legalizing abortion in Missouri received support from more than half of respondents in a new poll from St. Louis University and YouGov.That’s a boost from a poll earlier this year, which could mean what’s known as Amendment 3 is in a solid position to pass in November.SLU/YouGov’s poll of 900 likely Missouri voters from Aug. 8-16 found that 52% of respondents would vote for Amendment 3, which would place constitutional protections for abortion up to fetal viability. Thirty-four percent would vote against the measure, while 14% aren’t sure.By comparison, the SLU/YouGov poll from February found that 44% of voters would back the abortion legalization amendment.St. Louis University political science professor Steven Rogers said 32% of Republicans and 53% of independents would vote for the amendment. That’s in addition to nearly 80% of Democratic respondents who would approve the measure. In the previous poll, 24% of Republicans supported the amendment.Rogers noted that neither Amendment 3 nor a separate ballot item raising the state’s minimum wage is helping Democratic candidates. GOP contenders for U.S. Senate, governor, lieutenant governor, treasurer and secretary of state all hold comfortable leads.“We are seeing this kind of crossover voting, a little bit, where there are voters who are basically saying, ‘I am going to the polls and I’m going to support a Republican candidate, but I’m also going to go to the polls and then I’m also going to try to expand abortion access and then raise the minimum wage,’” Rogers said.Republican gubernatorial nominee Mike Kehoe has a 51%-41% lead over Democrat Crystal Quade. And U.S. Sen. Josh Hawley is leading Democrat Lucas Kunce by 53% to 42%. Some GOP candidates for attorney general, secretary of state and treasurer have even larger leads over their Democratic rivals.

Brian Munoz

St. Louis Public RadioHundreds of demonstrators pack into a parking lot at Planned Parenthood of St. Louis and Southwest Missouri on June 24, 2022, during a demonstration following the Supreme Court’s reversal of a case that guaranteed the constitutional right to an abortion.

One of the biggest challenges for foes of Amendment 3 could be financial.Typically, Missouri ballot initiatives with well-funded and well-organized campaigns have a better chance of passing — especially if the opposition is underfunded and disorganized. Since the end of July, the campaign committee formed to pass Amendment 3 received more than $3 million in donations of $5,000 or more.That money could be used for television advertisements to improve the proposal’s standing further, Rogers said, as well as point out that Missouri’s current abortion ban doesn’t allow the procedure in the case of rape or incest.“Meanwhile, the anti side won’t have those resources to kind of try to make that counter argument as strongly, and they don’t have public opinion as strongly on their side,” Rogers said.There is precedent of a well-funded initiative almost failing due to opposition from socially conservative voters.In 2006, a measure providing constitutional protections for embryonic stem cell research nearly failed — even though a campaign committee aimed at passing it had a commanding financial advantage.Former state Sen. Bob Onder was part of the opposition campaign to that measure. He said earlier this month it is possible to create a similar dynamic in 2024 against Amendment 3, if social conservatives who oppose abortion rights can band together.“This is not about reproductive rights or care for miscarriages or IVF or anything else,” said Onder, the GOP nominee for Missouri’s 3rd Congressional District seat. “Missourians will learn that out-of-state special interests and dark money from out of state is lying to them and they will reject this amendment.”Quade said earlier this month that Missourians of all political ideologies are ready to roll back the state’s abortion ban.“Regardless of political party, we hear from folks who are tired of politicians being in their doctor’s offices,” Quade said. “They want politicians to mind their own business. So this is going to excite folks all across the political spectrum.”

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Democrat Mark Osmack makes his case for Missouri treasurer

Published

5 months ago

August 29, 2024

Natural Bridge

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Mark Osmack has been out of the electoral fray for awhile, but he never completely abandoned his passion for Missouri politics.Osmack, a Valley Park native and U.S. Army veteran, previously ran for Missouri’s 2nd Congressional District seat and for state Senate. Now he’s the Democratic nominee for state treasurer after receiving a phone call from Missouri Democratic Party Chairman Russ Carnahan asking him to run.“There’s a lot of decision making and processing and evaluation that goes into it, which is something I am very passionate and interested in,” Osmack said this week on an episode of Politically Speaking.Osmack is squaring off against state Treasurer Vivek Malek, who was able to easily win a crowded GOP primary against several veteran lawmakers including House Budget Chairman Cody Smith and state Sen. Andrew Koenig.While Malek was able to attract big donations to his political action committee and pour his own money into the campaign, Osmack isn’t worried that he won’t be able to compete in November. Since Malek was appointed to his post, Osmack contends he hasn’t proven that he’s a formidable opponent in a general election.“His actions and his decision making so far in his roughly two year tenure in that office have been questionable,” Osmack said.Among other things, Osmack was critical of Malek for placing unclaimed property notices on video gaming machines which are usually found in gas stations or convenience stores. The legality of the machines has been questioned for some time.As Malek explained on his own episode of Politically Speaking, he wanted to make sure the unclaimed property program was as widely advertised as possible. But he acknowledged it was a mistake to put the decals close to the machines and ultimately decided to remove them.Osmack said: “This doesn’t even pass the common sense sniff test of, ‘Hey, should I put state stickers claiming you might have a billion dollars on a gambling machine that is not registered with the state of Missouri?’ If we’re gonna give kudos for him acknowledging the wrong thing, it never should have been done in the first place.”Osmack’s platform includes supporting programs providing school meals using Missouri agriculture products and making child care more accessible for the working class.He said the fact that Missouri has such a large surplus shows that it’s possible to create programs to make child care within reach for parents.“It is quite audacious for [Republicans] to brag about $8 billion, with a B, dollars in state surplus, while we offer next to no social services to include pre-K, daycare, or child care,” Osmack said.Here’s are some other topics Osmack discussed on the show:How he would handle managing the state’s pension systems and approving low-income housing tax credits. The state treasurer’s office is on boards overseeing both of those programs.Malek’s decision to cut off investments from Chinese companies. Osmack said that Missouri needs to be cautious about abandoning China as a business partner, especially since they’re a major consumer of the state’s agriculture products. “There’s a way to make this work where we are not supporting communist nations to the detriment of the United States or our allies, while also maintaining strong economic ties that benefit Missouri farmers,” he said.What it was like to witness the skirmish at the Missouri State Fair between U.S. Sen. Josh Hawley and Democratic challenger Lucas Kunce.Whether Kunce can get the support of influential groups like the Democratic Senatorial Campaign Committee, which often channels money and staff to states with competitive Senate elections.

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As Illinois receives praise for its cannabis equity efforts, stakeholders work on system’s flaws

Published

5 months ago

August 29, 2024

Natural Bridge

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Medical marijuana patients can now purchase cannabis grown by small businesses as part of their allotment, Illinois’ top cannabis regulator said, but smaller, newly licensed cannabis growers are still seeking greater access to the state’s medical marijuana customers.Illinois legalized medicinal marijuana beginning in 2014, then legalized it for recreational use in 2020. While the 2020 law legalized cannabis use for any adult age 21 or older, it did not expand licensing for medical dispensaries.Patients can purchase marijuana as part of the medical cannabis program at dual-purpose dispensaries, which are licensed to serve both medical and recreational customers. But dual-purpose dispensaries are greatly outnumbered by dispensaries only licensed to sell recreationally, and there are no medical-only dispensaries in the state.As another part of the adult-use legalization law, lawmakers created a “craft grow” license category that was designed to give more opportunities to Illinoisans hoping to legally grow and sell marijuana. The smaller-scale grow operations were part of the 2020 law’s efforts to diversify the cannabis industry in Illinois.Prior to that, all cultivation centers in Illinois were large-scale operations dominated by large multi-state operators. The existing cultivators, mostly in operation since 2014, were allowed to grow recreational cannabis beginning in 2019.Until recently, dual-purpose dispensaries have been unsure as to whether craft-grown products, made by social equity licensees — those who have lived in a disproportionately impacted area or have been historically impacted by the war on drugs — can be sold medicinally as part of a patient’s medical allotment.Erin Johnson, the state’s cannabis regulation oversight officer, told Capitol News Illinois last month that her office has “been telling dispensaries, as they have been asking us” they can now sell craft-grown products to medical patients.“There was just a track and trace issue on our end, but never anything statutorily,” she said.

Dilpreet Raju

Capitol News IllinoisThe graphic shows how cannabis grown in Illinois gets from cultivation centers to customers.

No notice has been posted, but Johnson’s verbal guidance comes almost two years after the first craft grow business went online in Illinois.It allows roughly 150,000 medical patients, who dispensary owners say are the most consistent purchasers of marijuana, to buy products made by social equity businesses without paying recreational taxes. However — even as more dispensaries open — the number available to medical patients has not increased since 2018, something the Cannabis Regulation Oversight Office “desperately” wants to see changed. Johnson said Illinois is a limited license state, meaning “there are caps on everything” to help control the relatively new market.Berwyn Thompkins, who operates two cannabis businesses, said the rules limited options for patients and small businesses.“It’s about access,” Thompkins said. “Why wouldn’t we want all the patients — which the (adult-use) program was initially built around — why wouldn’t we want them to have access? They should have access to any dispensary.”Customers with a medical marijuana card pay a 1% tax on all marijuana products, whereas recreational customers pay retail taxes between roughly 20 and 40% on a given cannabis product, when accounting for local taxes.While Illinois has received praise for its equity-focused cannabis law, including through an independent study that showed more people of color own cannabis licenses than in any other state, some industry operators say they’ve experienced many unnecessary hurdles getting their businesses up and running.The state, in fact, announced last month that it had opened its 100th social equity dispensary.But Steve Olson, purchasing manager at a pair of dispensaries (including one dual-purpose dispensary) near Rockford, said small specialty license holders have been left in the lurch since the first craft grower opened in October 2022.“You would think that this would be something they’re (the government) trying to help out these social equity companies with, but they’re putting handcuffs on them in so many different spots,” he said. “One of them being this medical thing.”Olson said he contacted state agencies, including the Department of Financial and Professional Regulation, months ago about whether craft products can be sold to medical patients at their retail tax rate, but only heard one response: “They all say it was an oversight.”This potentially hurt social equity companies because they sell wholesale to dispensaries and may have been missing out on a consistent customer base through those medical dispensaries.Olson said the state’s attempts to provide licensees with a path to a successful business over the years, such as with corrective lotteries that granted more social equity licenses, have come up short.“It’s like they almost set up the social equity thing to fail so the big guys could come in and swoop up all these licenses,” Olson said. “I hate to feel like that but, if you look at it, it’s pretty black and white.”Olson said craft companies benefit from any type of retail sale.“If we sell it to medical patients or not, it’s a matter of, ‘Are we collecting the proper taxes?’ That’s all it is,” he said.State revenue from cannabis taxes, licensing costs and other fees goes into the Cannabis Regulation Fund, which is used to fund a host of programs, including cannabis offense expungement, the general revenue fund, and the R3 campaign aiming to uplift disinvested communities.For fiscal year 2024, nearly $256 million was paid out from Cannabis Regulation Fund for related initiatives, which includes almost $89 million transferred to the state’s general revenue fund and more than $20 million distributed to local governments, according to the Illinois Department of Revenue.Medical access still limitedThe state’s 55 medical dispensaries that predate the 2020 legalization law, mostly owned by publicly traded multistate operators that had been operating in Illinois since 2014 under the state’s medical marijuana program, were automatically granted a right to licenses to sell recreationally in January 2020. That gave them a dual-purpose license that no new entrants into the market can receive under current law.Since expanding their clientele in 2020, Illinois dispensaries have sold more than $6 billion worth of cannabis products through recreational transactions alone.Nearly two-thirds of dispensaries licensed to sell to medical patients are in the northeast counties of Cook, DuPage, Kane, Lake and Will. Dual-purpose dispensaries only represent about 20 percent of the state’s dispensaries.While the state began offering recreational dispensary licenses since the adult-use legalization law passed, it has not granted a new medical dispensary license since 2018. That has allowed the established players to continue to corner the market on the state’s nearly 150,000 medical marijuana patients.But social equity licensees and advocates say there are more ways to level the playing field, including expanding access to medical sales.Johnson, who became the state’s top cannabis regulator in late 2022, expressed hope for movement during the fall veto session on House Bill 2911, which would expand medical access to all Illinois dispensaries.“We would like every single dispensary in Illinois to be able to serve medical patients,” Johnson said. “It’s something that medical patients have been asking for, for years.”Johnson said the bill would benefit patients and small businesses.“It’s something we desperately want to happen as a state system, because we want to make sure that medical patients are able to easily access what they need,” she said. “We also think it’s good for our social equity dispensaries, as they’re opening, to be able to serve medical patients.”Rep. Bob Morgan, D-Deerfield, who was the first statewide project coordinator for Illinois’ medical cannabis program prior to joining the legislature, wrote in an email to Capitol News Illinois that the state needs to be doing more for its patients.“Illinois is failing the state’s 150,000 medical cannabis patients with debilitating conditions. Too many are still denied the patient protections they deserve, including access to their medicine,” Morgan wrote, adding he would continue to work with stakeholders on further legislation.Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association.

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