About 73% of Illinois’ Medicaid recipients remain on the rolls after the first redetermination cycle following the COVID-19 pandemic, while approximately 660,000 recipients have been disenrolled.Speaking at a news conference in Chicago, Gov. J.B. Pritzker celebrated that 2.6 million Illinoisans remained on the rolls despite redeterminations beginning anew, saying “this is what good government looks like.”“I am proud to announce that Illinois is among the leading states in the country with a retention rate of 73%, one of the highest in the entire nation,” he said. “We made every effort to automate renewals, give customers more time and information, and to build the capacity necessary to manage the caseload and work to avoid letting people slip through the cracks.”During the early stages of the COVID-19 pandemic, Congress enacted changes to Medicaid requiring states to keep patients continuously enrolled through the public health crisis, even if they might have become ineligible due to changes in their income or family circumstances.That continuous enrollment program expired in March 2023, forcing states to resume requiring Medicaid enrollees to reapply each year and determine if they were still eligible.Federal officials estimated at-the-time that 17.4% of all the people enrolled in Medicaid and the Children’s Health Insurance Program would be disenrolled through redeterminations. That would have translated to about 15 million people nationwide, and 700,000 in Illinois.The Department of Healthcare and Family Services said at the time it hoped to lessen the impact of the change and hold the number of people disenrolled to about 384,000.But on Monday, HFS reported more than 660,000 Illinoisanshad been disenrolled from state health insurance in the past year. About two-thirds of those people lost coverage because of procedural reasons, like submitting incomplete information or not completing forms in time. The remaining were disenrolled due to finding new coverage, moving states, or making too much money to be eligible for Medicaid.A report by the national health nonprofit KFF, formerly the Kaiser Family Foundation, noted procedural disenrollment can be “concerning because many people who are disenrolled for these paperwork reasons may still be eligible for Medicaid coverage.”Illinois had a high mark of nearly 4 million residents on Medicaid during fiscal year 2023, but redetermination effectively lowered the number of people on Illinois Medicaid down to pre-COVID levels.Elizabeth Whitehorn, director of HFS, said reliance on publicly funded insurance grew due to the onset of COVID-19.“At the beginning of the pandemic, the federal government implemented the continuous Medicaid coverage requirements directing states to stop the regular practice of annual redeterminations for Medicaid,” she said. “During the three years that the continuous coverage requirement was in place, our Medicaid enrollee population in Illinois grew by nearly one million people.”More than 300,000 Illinois Medicaid recipients are still in the midst of redetermination, a majority of whom have not submitted paperwork, according to HFS. Paperwork is pending for about 90,000 of those cases, according to the department noted.Pritzker said the state launched an advertising campaign to remind residents about redetermination and applying to renew Medicaid status in 15 languages and installed new renewal methods.“We added text messaging capabilities and telephone helpline improvements to make it as convenient as possible for Illinoisans,” he said. “We are seeking federal approval to make permanent many of the capacity and efficiency-boosting practices that we adopted.”Since last May, the Department of Human Services reported taking more than 75,000 medical redetermination phone calls, where IDHS workers can provide technical assistance and allow customers to submit information required for redetermination.Redeterminations of Medicaid customers will continue on an annual basis, HFS said. People who need immediate assistance with insurance coverage can visit getcovered.illinois.gov or abe.illinois.gov to apply for state benefits.Cole Longcor and Peter Hancock contributed to this report.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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There’s been a steady push by Republicans this legislative session to regulate voting laws in Missouri.It isn’t new, but it’s been gaining steam.The bills seek to regulate — or restrict — provisions around who can vote and how, the way votes are counted and other matters related to election security.Almost all aim to address concerns that either don’t exist or to prevent changes from ever happening.Republicans want to ensure that only U.S. citizens can vote, but the Missouri Constitution and voting requirements from the secretary of state’s office already outline that requirement.Republicans want to ban foreign governments from funding constitutional amendments, but the Missouri Constitution addresses foreign influence in elections as well.Republicans want to ramp up election security by creating a new division that would investigate claims of election fraud, but such a division already exists and has been active for more than 10 years.Republicans want to ban ranked-choice voting, but the voting practice is not established in state law. St. Louis practices a version of it for local elections.The Heritage Foundation, a conservative think tank that is often cited by Republicans, has ranked Missouri sixth nationally in its Election Integrity Scorecard.What is driving Republicans to pursue these voting measures?For one lawmaker, it’s about election integrity. For another, it’s about being proactive.Opponents say these efforts are driven by “anti-immigrant bigotry” and a desire for “consolidation of power.”

Brian Munoz

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St. Louis Public RadioMissouri State Sen. Denny Hoskins, R-Warrensberg, speaks in 2023 during an Education and Workforce Development Committee hearing in Jefferson City.

Justifying causesSen. Denny Hoskins, a Warrensburg Republican, has been vocal all session about amending the Missouri Constitution to clarify that only U.S. citizens can vote in Missouri. He takes issue with language in the state constitution that he believes isn’t clear enough on who can and cannot vote in the state.Article 8 Section 2 of the Missouri Constitution states that “All citizens of the United States … over the age of eighteen who are residents of this state … are entitled to vote.” Hoskins wants “All” changed to “Only” to tame the possibility of noncitizens voting in elections.But opponents say the constitution is unambiguous on the issue and point to what they believe is behind this rhetoric.“That just taps into this whole anti-immigrant bigotry fueled by (former President Donald) Trump and is kind of the norm in our American society today,” said Rep. David Tyson Smith, a Democrat from Columbia.“You keep pushing this envelope, like, ‘How far can I push this?’ and that leads to other things,” Smith added. “And that’s dangerous.”Hoskins might get his wish later this year if a proposal aiming to increase the threshold needed to approve constitutional amendments gets one more affirmative vote in the Senate.In addition to the threshold requirement, the proposal, sponsored by Sen. Mary Elizabeth Coleman, a Republican from Arnold, would ask voters whether the constitution should be changed to reflect that only U.S. citizens can vote on constitutional amendments and to ban constitutional amendments sponsored by foreign governments.The proposal has been a focus of Democrats who claim the intention of the two latter provisions is to mislead voters and act as a distraction.“It takes away from the conversation — and that’s the point of it,” said Senate Minority Leader John Rizzo, a Democrat from Independence.Rizzo, now in his 14th and final year in the legislature, said the push behind Coleman’s proposed changes to the threshold for approving constitutional amendments is driven in part by a desire for Republicans to consolidate power.“They have had the supermajority for so long now that the only thing left for them to take away is the ability for people to go around them,” he said. “It just drives them crazy that there is an ability for people to have a voice in government that doesn’t go through them.”Hoskins has an opposite point of view.“What we’ve seen is, since Missouri has become a more red Republican state, the minority and out-of-state special interests have come in and sponsored some ballot measures in order to try and get something passed,” Hoskins said.“So it seems like the liberal special interests are, since they can’t get stuff through the legislature because we have supermajorities of all Republicans … they’re coming in and trying to bypass the legislature and put something on the ballot,” he said.Out of all the proposals by Republicans this session aimed at regulating voting, Coleman’s has drawn the most opposition and scorn. But it isn’t the only one.

Brian Munoz

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St. Louis Public RadioBen Brown speaks to voters in 2022 during a campaign stop the day before Missouri’s primary election in Washington, Mo.

Preemptive or premature?Ranked-choice voting does not occur in Missouri. It’s a practice where voters rank their preferred candidates on one ballot so their votes can be redistributed among top vote getters until a winner is declared after receiving a majority of the vote. Yet Republicans want it banned, saying it’s too confusing.“I don’t see a good justification to insert a great deal of chaos into the ballot box,” said Rep. Alex Riley, a Springfield Republican.Riley said he fears ranked-choice voting would create unnecessary turmoil for voters who might not follow the necessary steps needed to fill in a ballot.The proposal to ban ranked-choice voting, sponsored by Sen. Ben Brown, a Republican Washington, is one vote away from being placed on the ballot and has received increased attention this session partly because, similar to Coleman’s bill, it would also ask voters whether the state constitution should be amended to allow only U.S. citizens to vote.But whereas Coleman’s proposal only addresses constitutional amendments when referring to the citizenship requirement, Brown’s proposal includes all voting in the state.Smith, who’s had a front-row seat to discussions regarding voting as a member of the House Elections and Elected Officials Committee, doesn’t see the point.“We don’t have an epidemic of voting problems in America with undocumented people voting,” he said. “That’s not an epidemic, that’s not a problem, that’s not a crisis.”Smith is correct as far as Missouri’s concerned.“I’m not aware of that sort of activity on any kind of a large scale,” said JoDonn Chaney, director of communications for the secretary of state’s office, referring to non-U.S. citizens voting in Missouri.Still, Republicans say they want to be proactive.“Putting some additional protections within the constitution itself … whether we have massive numbers of illegal immigrants voting in Missouri, I can’t point to that and say, ‘Yeah, we do.’ I can’t say that we don’t. I think that’d be really hard to tell,” Riley said.“But, to address that issue going forward … it makes sense to me to put some additional language, some additional safeguards in the state constitution itself,” he said.Republicans take a similar approach of placing protective measures around foreign governments’ ability to make contributions to election campaigns or ballot initiatives.Hoskins, a candidate for secretary of state, said he believes foreign interference in elections is occurring in Missouri. But when asked if he could provide an example, Hoskins said he couldn’t because of the complexity of the process.“I believe that foreign governments would not just give directly to one PAC that is promoting or trying to kill an initiative or something that’s on the ballot,” he said.“It’s probably funneled through a million different ways, four or five different LLCs or companies or PACs or non-for-profits before it actually got to the place where they bought the ads or radio, TV, social media, newspaper, whatever it is,” Hoskins said. “And that’s where it’s very tough to follow the money trail.”Elizabeth Ziegler, executive director of the Missouri Ethics Commission, which is charged with overseeing campaign finance reports, said the agency doesn’t have “any final enforcement actions toward contributions (to) campaign finance committees from foreign nationals.”Article 8 Section 23, paragraph (16) of the Missouri Constitution also provides protections against contributions made by foreign governments, whether they go toward a candidate committee, campaign committee or a ballot measure:“(16) No campaign committee, candidate committee, continuing committee, exploratory committee, political party committee, and political party shall knowingly accept contributions from:(a) Any natural person who is not a citizen of the United States;(b) A foreign government; or(c) Any foreign corporation that does not have the authority to transact business in this state pursuant to chapter 347, RSMo, as amended from time to time.”‘People versus politicians’Peverill Squire, a political science professor at the University of Missouri, said there are two underlying reasons he believes are behind Republicans’ motivation to push measures intended to make it harder to vote.“First, it is a way to appeal to GOP primary voters,” Squire said. “Republican incumbents want to make sure that they are not vulnerable to a challenge from their right. Second, there is a calculation that making voting harder will hurt Democratic voters more than Republican voters, though that may not prove to be the case.”This is an election year for state offices and many Republican incumbents who are termed-out in the legislature are running for various statewide offices. As a result, rhetoric on the Senate floor this session has been filled with talk that sounded more and more like campaign speeches.“Ultimately, this push, it’s more of the national narrative bleeding down into the state,” said Connor Luebbert, a lead advocate for the Missouri Voter Protection Coalition.Or it just may be a fight between people and their politicians.“In the baseball game of politics,” Rizzo said, “it’s people versus politicians and the politicians want their home runs to count for double.”This story originally appeared in the Columbia Missourian. It can be republished in print or online. 

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With little fanfare, a Missouri House committee advanced a tax Monday that funds roughly a third of the state’s Medicaid program.The House Budget Committee voted 27-0 to pass the Federal Reimbursement Allowance. It now moves to the full House.Sen. Lincoln Hough, R-Springfield, is the sponsor of the bill and presented it to the House committee.“I think you all are fairly aware of what this bill is and the necessity of about a third of our MO HealthNet budget being derived from these reimbursements from the feds,” Hough said.Rep. Ingrid Burnett, D-Kansas City, was the only representative to inquire about the bill in committee.“I’m very relieved that we’re bringing this up to the table now and getting it done,” Burnett said.The allowance is a tax on state health care providers like hospitals, ambulance districts and pharmacies. That tax is then reimbursed by the federal government on a greater scale.Right now, the tax is set to expire at the end of September if it is not reauthorized this session. The bill being considered would extend the tax until September 2029.The last time the Federal Reimbursement Allowance was up for reauthorization in 2021, it took a special session to pass it.This year, the tax’s passage again looked daunting due to a filibuster from a faction of Senate Republicans.Those senators held the floor for more than 40 hours a couple of weeks ago to advocate for the Senate to first pass an amendment that, if approved by voters, would make it harder to amend the constitution.However, the Federal Reimbursement Allowance was ultimately passed by the Senate without that demand being met.The road to pass the tax in the House appears smoother. The House Budget Committee both heard the bill and passed it Monday afternoon.The whole House could vote on it as early as Wednesday.House Majority Floor Leader Jon Patterson, R-Lee’s Summit, said that whenever the House is able to take up the bill and pass it on the floor, it will.“If you recall at the beginning of the year, that was one of the top priorities, making sure that our Medicaid program is funded,” Patterson said.Missouri lawmakers have until 6 p.m. Friday to pass any more legislation before adjourning.

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