Missouri’s rural areas are lagging behind their urban counterparts when it comes to health coverage – and the state’s decision to decline the federal expansion of Medicaid is a significant factor, according to a study published this month.
Passed more than a decade ago, the Affordable Care Act (ACA) allows for generous reimbursement from the federal government for states that allow all citizens living under the federal poverty level to qualify for Medicaid, a joint state-federal program providing health coverage for poor and disabled people. Originally, the law required states to expand Medicaid, but a 2012 U.S. Supreme Court decision made this optional. Missouri’s Medicaid program generally covers some parents, people living with disabilities, pregnant women and children with low income. Working adults living below the poverty level do not qualify – about 34 other states do cover these adults, according to the Kaiser Family Foundation.
The Georgetown University Health Policy Institute Center for Children and Families found that, in states where Medicaid has been expanded, rural areas see a sharp increase in health coverage. Lower incomes in small towns and other rural areas are a factor in that increase. But in states where Medicaid has not expanded, coverage rates in rural areas remain low.
While health coverage for children and families remains a critical issue, access to healthcare – including whether providers are compensated at a fair rate and whether providers accept patients with Medicaid – is also an area in need of study discourse. Missouri’s last comprehensive review of providers accepting Medicaid was released about ten years ago.