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On August 4, 2020 Make Your Choice on Medicaid Expansion in Missouri


On August 4, 2020, Missourians will vote to determine whether Missouri will become the 37th state to expand Medicaid under the Affordable Care Act (ACA).


The ACA called for Medicaid expansion in every state for individuals with income levels up to 138% of the Federal Poverty Level. However, it was ruled in 2012, that states could not be penalized for opting out of expansion; Missouri is one of 14 states that have not yet expanded coverage. Adults between the ages of 19 and 64 whose income is up to 138% FPL may be eligible for Medicaid, however those with less than 100% FPL do not qualify for health insurance or Medicaid. Accordingly, there are an estimated 113,000 uninsured Missourians who fall into the coverage gap (Figure 1) and are not eligible for Medicaid or marketplace insurance plans. (www.healthinsurance.org).



How does Medicaid expansion affect older adults in Missouri?:


Pros of expansion:


1. Missouri’s Medicaid program is the primary payer in long-term care. Expanding Medicaid would bring in federal funds paid for by Missourians through taxes back to Missouri that are currently allotted to other states. Many essential senior services are funded through this general revenue; Medicaid expansion may help protect these services including, nursing home care and home and community-based services that allow older adults to remain independent.


2.There are a large number of adults ages 50-64 who do not have access to affordable health coverage but are too young to qualify for Medicare. Medicaid Expansion would help bridge the gap for low-income older adults until they qualify for Medicare at 65. Additionally, individuals without access to health care enter Medicare much sicker; Medicaid helps to support these individuals by covering important services that Medicare covers to a lesser extent or not at all such as, transportation to the doctor, vision care, home health care, mental health services, and durable medical equipment.


Cons of expansion:


  1. There have been challenges in relation to addressing consumer confusion about Medicaid eligibility requirements after expansion, which most likely “…stems from inconsistent education, inadequate outreach, and limited availability of resources in multiple languages” (Missouri Foundation for Health). These challenges may contribute to Medicaid expansion aiding the population at differing scales rather than helping in a consistent manner. (Missouri Foundation for Health)


  1. Current research has focused on the first two years of expansion when the federal government financed 100% of the costs. However, beginning in 2020, states will be responsible for 10% of the expansion costs, creating a sense of uncertainty surrounding this transition (e.g., state policymakers may “…face fiscal constraints that make it challenging to finance the state share of expansion”) (Missouri Foundation for Health).

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OAA Reauthorization!

February 3, 2020

Last week, leaders on the Senate Health, Education, Labor and Pensions (HELP) and Aging Committees introduced a bipartisan, bicameral compromise bill to reauthorize the Older Americans Act for five years. The Supporting Older Americans Act of 2020, H.R. 4334, reflects a diligent effort from both House and Senate lawmakers to achieve an OAA reauthorization proposal that supports the needs of the nation’s growing number of older adults—and includes many of n4a’s top priorities.
As detailed in last week’s Legislative Update, the final compromise measure includes many of the same—or slightly modified—provisions that were in the House-passed bill and the bill that the Senate introduced in December. This is good news as many of legislative specifics were carefully drafted and included intensive input from n4a and other aging advocates.
n4a has endorsed the bill, and we are optimistic that the Senate and House will advance the compromise measure in the very near future. However, it is critical that lawmakers hear from local aging advocates to help get OAA reauthorization over the finish line! Contact your lawmakers to urge them to approve the Supporting Older Americans Act of 2020! 
Next Steps for OAA Reauthorization
The Supporting Older Americans Act of 2020, H.R. 4334, could circumvent additional committee action in the Senate to move straight to floor consideration. This is great news because it would significantly expedite the Senate approval process.
Following what we hope will be speedy Senate approval, the bill would then have to go back to the House for passage before heading to the President’s desk for signature. We don’t anticipate major hurdles to House approval, but we do know that action from grassroots advocates will be essential to ensuring that this bill gets to the President’s desk this winter!