Even Medicaid is out of reach for some of Missouri’s poorest children, who are uninsured at a rate 2.5 times as high as their counterparts in Illinois. Being uninsured can limit a child’s access to health care or wreak havoc on a family’s finances in the case of an emergency.
New census numbers show that about 5 percent of Missouri children in families with incomes below 200 percent of poverty ($3,348 a month for a family of three) did not have health insurance in 2014. In Illinois, which has twice as many low-income families, only 2 percent of children in that demographic were uninsured.
Experts close to the issue disagree on the reasons for the disparity. Both Missouri and Illinois have offered Medicaid insurance to children in families that make less than 300 percent of the federal poverty level for some time, so Illinois' decision to expand Medicaid through the Affordable Care Act did not change the income qualifications for children in the program. Still, in Missouri, more parents are unable or choose not to enroll their children in Medicaid, even if they do qualify for the program.
Higher premiums for children’s Medicaid
Part of the difference may be the cost of enrollment. Like any insurance plan, state Medicaid programs for children can charge premiums and co-pays for office visits and prescription drugs. Those only kick in if a family makes at least 150 percent of the federal poverty level ($2,512 a month for a family of three) and become increasingly expensive as families get closer to the upper income limit of 300 percent.
Missouri’s program only charges a monthly premium, but the charges are higher than the ones in Illinois. A monthly premium for a Missouri family of three would be $23, $77 or $188, depending on where their income falls between 150 and 300 percent of the federal poverty level. The charges max out at 5 percent of a family’s income.
In Illinois, premiums range from $15 to $80, but there are copays for office visits, inpatient services and prescription drugs.
“The General Assembly establishes the percentage of income range of the FPL ( federal poverty level) for the premiums through appropriation. Within those perimeters, the (Missouri) Department of Social Services sets the premium at the lowest point within each income range,” said department spokesperson Rebecca Woefel in an email, when asked for comment.
The American Academy of Pediatrics breaks down the cost-sharing differences for Missouri and Illinois with fact sheets here and here.
Last year’s enrollment debacle for Missouri’s Medicaid
Though cost may be a factor for some, the real issue in 2014 was Missouri’s Medicaid enrollment system, said policy analyst Ryan Barker of the Missouri Foundation for Health. The program lost thousands of enrollees after installing a new computer system and laying off administrative staff.
“The Affordable Care Act said that all states had to update their IT system for Medicaid. … They had a very short time frame to implement that system, and it really had some issues in 2014,” Barker said.
Wait times spiked, and clerical staff were faced with a major backlog in applications to get into the program. In August 2014, 25,000 fewer children were on Missouri’s Medicaid rolls than in 2013, Barker said.
Enrollment frustrations were a major dynamic for patients last year, said Angela Clabon, the CEO of Myrtle Hilliard Davis, a network of community health centers in St. Louis.
“We still took care of our patients regardless of their ability to pay,” Clabon said. “We had to eat their cost.”
In some cases, Clabon said, those wait times meant that pregnant women were unable to get coverage before they gave birth.
Many of the issues with the system have been resolved, Barker said, and enrollment appears to be back to 2013 levels.
“We should see we’re around 3 percent (uninsured) next year, which will bring us more in line with what other states have seen,” Barker said.
Medicaid expansion for adults
Though the income qualifications for children’s Medicaid coverage has not changed in recent years, Illinois’ decision to expand Medicaid coverage for adults through the Affordable Care Act may have been a factor in getting their rate of uninsured children down to 2 percent.
“We think there’s a correlation between coverage for parents and the kids,” said health economist Tim McBride, who chairs the state’s Medicaid oversight committee. “When Illinois made it easy for parents to get coverage, they’re just going to sign up the whole family at the same time.”
The Missouri Department of Social Services declined to comment on the enrollment numbers, but pointed out that a six-month waiting period for children to sign up for Medicaid was eliminated by the legislature in 2014.
For more health and science news from St. Louis, follow Durrie on Twitter: @durrieB.
