Despite renewal, Missouri's limited Medicaid expansion still in jeopardy
Missouri's limited Medicaid expansion got a last-minute extension to continue running Friday through 2022, but the program may not continue that long due to looming CMS payment changes.
Missouri's limited Medicaid 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.
Gateway to Better Health covers uninsured individuals ages 19-64 who reside in the St. Louis metro 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 a set fund of up to $30 million annually for the Gateway to Better Health.
"This extension will allow the state to continue to promote the objectives of Medicaid by extending . . . coverage for primary care and specialty care benefits provided through a defined provider network," CMS Medicaid Director Brian Neale said in a letter sent Sept. 1 to Missouri's acting Medicaid director.
Despite the renewal, the Gateway to Better Health may still have to shut down soon, according to the Missouri Hospital Association.
In July, the CMS announced it was following through on an Affordable Care Act requirement to cut Medicaid disproportionate-share hospital payments by $43 billion from fiscal 2018 through 2025. According to a CMS rulemaking released last month, the cuts will start on Oct. 1. Gateway is primarily funded by Missouri's DSH allocation.
The CMS crafted the rule to reduce the level of cuts in states that have coverage expansion programs such as Gateway that are funded with DSH funds. However, the rule limits this protection to waivers that were approved as of July 31, 2009. Gateway was approved July 28, 2010.
"Because the Gateway waiver was approved after this date, the DSH funding that supports Gateway would be subject to statutory reductions as the proposed rule is currently drafted," Daniel Landon, senior vice president of governmental relations at the Missouri Hospital Association said in a letter to the CMS late last month.
To preserve Gateway, the CMS would have to alter the DSH rule to protect programs created with waivers after July 2009, Landon said.
The CMS is expected to release the final Medicaid DSH rule in the coming weeks ahead of the start of fiscal 2018, which begins Oct. 1.
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