Despite renewal, Missouri’s Medicaid expansion still at risk

Missouri’s limited Medicaid expansion received a last-minute extension to run through 2022.

The state’s expansion waiver, known as Gateway to Better Health, has been in place since 2010 and was on track to end Sept. 1 before the CMS extended the program through Dec. 31, 2022.

The program covers uninsured individuals ages 19-64 in the St. Louis metropolitan area with incomes at or below 100% of the federal poverty line. Childless adults living outside the St. Louis region are ineligible for Medicaid because the state did not expand the program under the Affordable Care Act.

Unlike an ACA Medicaid expansion, which extends coverage to adults at 138% of the federal poverty level at a match rate of 95% this year, Missouri receives set funding of up to $30 million annually for the Gateway program.

But the Missouri Hospital Association worries the expansion might shut down sooner than 2022.

In July, the CMS announced it was following through on an ACA requirement to cut Medicaid disproportionate-share hospital payments by $43 billion from fiscal 2018 through 2025. The cuts will start on Oct. 1, according to a CMS rule released last month. Gateway is primarily funded by Missouri’s DSH allocation.

To preserve Gateway, the CMS would have to alter the DSH rule to protect programs created with waivers after July 2009, Daniel Landon, senior vice president of governmental relations at the hospital association, wrote in a letter to the CMS late last month.

The CMS is expected to release the final Medicaid DSH rule in the coming weeks before the start of federal fiscal 2018, which begins Oct. 1.