Medicaid’s Checkup: Part 1

One of the few things healthcare providers almost unanimously agree on is the importance of annual checkups. Among other benefits, they offer providers a regular opportunity to gauge a patient’s health. The same idea should be applied to public policies, especially Missouri’s largest government-run program, Medicaid. After almost four years during which COVID-19 obscured the program’s performance, I think it’s long past time for a checkup.

First, here’s a quick recap of what’s happened with the program in recent years. In March of 2020, the COVID-19 global pandemic began, and the federal government declared a national state of emergency. Over the next several years, Medicaid’s enrollment boomed, and in response the federal government agreed to increase its share of funding for the program. But as is almost always the case, the additional federal money came with strings attached. Particularly, accepting the funds required Missouri’s Medicaid agency to stop checking whether program enrollees were eligible to receive services. This prohibition continued until the end of March 2023.

Additionally, during the pandemic period, Missouri voters approved a constitutional amendment that radically reshaped the state’s Medicaid program. The amendment expanded Medicaid by extending program eligibility to able-bodied Missourians making up to 138 percent of the federal poverty level. For a family of four, this figure represents yearly earnings of approximately $43,000. Unsurprisingly, this expansion has led to an enormous increase in program enrollment, and as with COVID relief funds, the federal government agreed to pay an increased share for those newly eligible to enroll.

Given these developments, it shouldn’t be surprising that Missouri’s Medicaid program looks much different today than it did four short years ago. Prior to the pandemic in 2019, Missouri’s Medicaid enrollment sat around 850,000, with about 520,000 of those enrolled being children. By 2023, total program enrollment had nearly doubled to 1.5 million, with approximately 740,000 of those being kids and 350,000 being adults who had enrolled as a result of the change in eligibility requirements. Today, according to the state’s most recent enrollment data, there are still nearly 1.3 million Missourians on the program, including 640,000 children and 340,000 “expansion” adults.

In terms of cost, the growth has been similarly shocking. In 2019, the program cost around $10.4 billion in total, with less than $2.2 billion coming from Missouri taxpayers via state income and sales taxes. In this year’s FY 2025 budget, Medicaid’s total cost has ballooned to an expected $18.2 billion, with $3.8 billion coming from state taxpayers. This represents a total increase of approximately 75%, and the growth of state taxpayer investment isn’t much lower at 74%.

In several upcoming blog posts, I’ll dive deeper into these numbers and explain why it’s important that our elected officials take action to rein in our Medicaid program sooner rather than later.