Neglecting a problem doesn’t make it go away, or cheaper to fix. Missouri is learning that lesson with regard to its IT systems right now.

As I’ve written before, many of Missouri’s government computer systems are critically out of date. COVID relief funds helped jumpstart long-needed modernization efforts, but the passage of the One Big Beautiful Bill last July means new federal requirements will soon depend on those upgrades.

Missouri’s Department of Social Services (DSS) has been tasked with integrating its Supplemental Nutrition Assistance Program (SNAP) and Medicaid eligibility systems while preparing for new community engagement requirements. This integration has been needed for years, but the new federal rules make it urgent. The goal is straightforward: simplify how benefits are administered while reducing costly errors. If Missouri cannot bring those error rates down, the state will be responsible for a larger share of program costs.

Some officials have warned that meeting the new requirements could force the department to shift resources away from other modernization work. There is no doubt funding plays a role. Modernizing large government IT systems can be expensive. But in this case, stronger systems are exactly what will make complying with new federal mandates possible.

There are reasons to worry about how this effort will go. This is not the first time DSS has faced a difficult administrative task, and the last major one did not go smoothly. When federal pandemic rules suspended Medicaid eligibility reviews, states had time to prepare for the return of normal operations. Missouri did not use that window to get ahead or fully modernize its systems. When eligibility reviews resumed and the state had to reassess hundreds of thousands of enrollees, Missouri struggled immensely.

More recently, Missouri’s experience with large IT modernization efforts across state government offers another warning. Lawmakers were told a few weeks ago that completing upgrades to the state’s financial management system will cost more than $250 million. This is a project that is already significantly behind schedule and over budget. It should be noted that Missouri’s difficulty with modernization is partly the result of how long these systems were allowed to fall behind. It‘s not surprising that the longer upgrades are delayed, the harder and more expensive they become.

The challenge Missouri faces now is that many of the policies it must implement depend on the very systems still awaiting modernization. Community engagement requirements require technology capable of tracking employment data. More frequent eligibility renewals require information that can move accurately between programs. Lower error rates require systems that can catch mistakes before they turn into federal penalties.

As lawmakers finalize Missouri’s budget in the weeks ahead, this issue should remain front of mind. Modernizing the systems that run the state’s safety net is not a project the state can afford to ignore any longer.

There’s no getting around the fact that Missouri will ultimately have to upgrade these systems. The only real question now is whether the state does it in time to avoid more costly mistakes and federal penalties.

The post Cost of Delaying Safety-Net Modernization appeared first on Show-Me Institute.

Unfortunately, that shocking finding is only one piece of the bad news included in the report. The same audit also revealed that thousands of people have remained enrolled on Missouri’s Medicaid program for up to ten years without the state checking whether they’re still eligible. Federal law requires annual eligibility reviews, but Missouri’s outdated IT systems somehow blocked the state’s Department of Social Services from checking the information of around 10,000 recipients for up to a decade. To be fair, some of these individuals might still qualify for benefits, but many probably do not. The point is that the state doesn’t know one way or the other.

The issues outlined in the audit are a perfect illustration of the many problems with Missouri’s Medicaid program that I’ve been writing about for years. This is an enormously expensive program that is riddled with waste and relies on outdated computer systems that are only making things worse.

Given Missouri’s budgetary uncertainty, it’s even more important that Medicaid benefits only go to people who are eligible for them. Eligibility reviews aren’t just bureaucratic hurdles with no purpose. Circumstances that make people eligible to receive welfare benefits change all the time. They find a job. They get married. They might even die. It’s essential that the state’s computer systems know this information as soon as possible to ensure that tax dollars aren’t being misspent.

Perhaps the worst part of the audit report is the recognition that these troubling findings aren’t new problems at all. Previous reports highlighted both the “death match” issue as well as the recipients who weren’t getting their eligibility checked. Some might remember that Medicaid eligibility redeterminations were a hot topic while they were paused during the COVID-19 pandemic, but it’s important to point out that these issues predate 2020, so we can’t just blame the pandemic.

This is another reason why some of the reforms I outlined from the One Big Beautiful Bill are so needed. Modernizing the state’s computer systems and improving eligibility verification so that errors like these don’t happen should be a top priority. Medicaid is far too expensive, and its costs are growing at far too an alarming rate for this level of waste to continue. What’s the point of having eligibility rules if they aren’t going to be enforced?

The post Checking Medicaid’s Pulse appeared first on Show-Me Institute.

As many Missouri businesses struggle to find workers, the state’s welfare programs are fostering government dependency.

The Solution

Seize the opportunity provided by the recent passage of the One Big Beautiful Bill Act to reform Missouri’s welfare programs.

Key Facts

• Recent passage of the One Big Beautiful Bill Act (OBBB) offers Missouri new opportunities to reform the state’s welfare programs.
• More than 1 in 5 Missourians are enrolled in government-sponsored health coverage through Medicaid.
• Estimates suggest that upwards of 20% of welfare enrollees may actually be ineligible to receive services.
• Missouri should take advantage of the new flexibility granted to states as the many provisions of the OBBB are implemented in the coming years, focusing on encouraging work and making the programs more efficient.

New Opportunities

After decades of creeping growth in government dependence, Missouri now has a golden opportunity to finally enact meaningful welfare reform. Following the recent federal passage of the One Big Beautiful Bill Act (OBBB), states will be tasked over the next several years with implementing the bill’s many provisions that relate to welfare programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP).

Drastically changing Missouri’s welfare programs will require significant, much-needed computer system upgrades. According to a recent report from the Missouri State Auditor’s Office, the state’s Medicaid agency continues to struggle with determining recipient eligibility. As a result, individuals who are ineligible to receive benefits have remained enrolled in the program for up to 10 years in some cases. State taxpayers have also been footing the bill for benefits for dead recipients due to a lack of sufficient system controls.

As Missouri is upgrading the state’s information systems as required by the OBBB, there’s no better time to address the existing eligibility system issues and take the extra step to further reform the state’s welfare programs to make them work better for program recipients and taxpayers alike.

Continuing Growth

As government spending has grown in recent years, so too has enrollment in Missouri’s various welfare programs. Today, Medicaid is Missouri’s largest government-run program, with more than 1.2 million Missourians—approximately one fifth of Missouri’s population—enrolled. This total represents an increase in enrollment of approximately 50% since the beginning of 2020. Medicaid is not the only program growing in size. Approximately 660,000 Missourians are enrolled in SNAP, otherwise known as food stamps. Estimates suggest that upwards of 20% of all welfare enrollees may not be legally eligible to receive services or are receiving benefits in excess of the amount to which they’re entitled.

Change Incentives to Change Outcomes

Welfare programs shouldn’t encourage dependency, but far too often they end up trapping recipients on government support. After years without enforcing the SNAP or Temporary Assistance to Needy Families (TANF) work requirements, the OBBB requires Missouri to implement “community engagement requirements” for able-bodied SNAP and Medicaid recipients starting in 2027. Missouri should ensure these new requirements are more than just a new bureaucratic hurdle recipients need to clear and are instead offering those who need temporary assistance a clear path back to the workforce.

Welfare Program Enrollment

Following the surge in program enrollment during the COVID-19 pandemic, more than 1.2 million Missourians remain enrolled in Medicaid and more than 660,000 are on SNAP (food stamps).

Reform Can’t Wait

Whether Missouri’s government is ready or not, as a result of the OBBB, substantial changes are coming to the Show-Me State’s welfare programs over the next several years. While many of the bill’s reforms focus on improving program integrity and establish new state requirements with firm deadlines for compliance, some reforms provide states considerable flexibility in how they’re implemented. In these cases, Missouri should take advantage of this newfound flexibility to tailor the reforms to best meet the needs of Missourians, with a focus on maximizing efficiency, minimizing waste, and encouraging work for recipients who are capable.

Policy Recommendations

• Take advantage of newly provided flexibility to meaningfully reform welfare programs in a manner consistent with the goals of the recently passed OBBB.
• Continue upgrading state information systems to encourage greater accountability by minimizing waste, fraud, and abuse.
• Dutifully implement provisions of the OBBB to maximize program integrity while ensuring that productive work is encouraged.

The post Welfare Reform appeared first on Show-Me Institute.

Welfare programs shouldn’t encourage dependency, but far too often they end up trapping recipients on government support. This year, two state lawmakers filed bills aimed at addressing the work disincentives that currently accompany welfare benefits. In theory, these bills sound like good ideas. Unfortunately, the approaches chosen by lawmakers for these bills have some glaring flaws.

Here are some examples:

Good Idea: Ensure welfare recipients aren’t discouraged from seeking work or career advancement.

Wrong Approach: The bills create new transitional benefits for the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) programs that stack on top of the program’s already existing transitional benefit programs. The result is a new layer of costly complexity on top of an already overly complex system.

Additionally, the new transitional benefit would scale benefits based on the recipient’s income. While this may sound like a good idea, the government does not collect real-time income earned by recipients, and checking income is not an easy administrative process. In reality, this change will mean more people are enrolled in state welfare programs longer.

Good Idea: Simplify income reporting to reduce burdensome bureaucracy.

Wrong Approach: The bills require applications for Missouri’s welfare programs to fit onto one page. The problem is, as the state’s department of social services reports, “a one-page form would not capture all of the information federally required to determine eligibility for these programs. FSD would need to follow up with each applicant to obtain the required information to determine eligibility.”

In other words, one page is not enough space to gather the information sufficient to comply with federal law. This increases the likelihood that more individuals will be enrolled in welfare programs than are eligible to receive benefits, only for state authorities to discover this problem after significant tax dollars are improperly spent.

Good Idea: Focus on federally funded programs that states have the flexibility to reform.

Wrong Approach: Since SNAP and TANF are federal programs, the federal government also gets a say in whether they will pay for whatever reforms Missouri enacts. But the reforms for TANF and SNAP outlined in the bill’s fiscal notes will very likely not be approved by the federal government. No other state has anything similar to what is being proposed here. So, if enacted, these reforms and new benefits would be paid for by state taxpayers. All told, the fiscal note estimates the bill would cost more than $200 million per year in new state tax dollars.

Given all of these concerns, it’s safe to say that without significant changes, I think these bills would move Missouri in the wrong direction. They would grow the welfare state, worsen program integrity, and significantly increase costs.

Since there are a number of welfare reforms that could have been proposed that encourage work, improve program accountability, and responsibly spend taxpayer dollars, it is mystifying why such reforms have not been pursued. With less than two weeks remaining in the legislative session, it’s unlikely we will see revisions to the current bills that truly reform the system. Improving Missouri’s welfare state is a difficult but worthy task. Instead of moving forward with bills that could do more harm than good, I hope lawmakers will choose to learn from this years’ experience and carry this important conversation into 2024 with reforms that actually accomplish what they say they want to accomplish.

The post Right Idea, Wrong Approach appeared first on Show-Me Institute.

On August 4, Missouri voters will decide whether the state should become the 38th to expand Medicaid. Proponents of the measure suggest expanding the program would “save” the state money, but a closer analysis suggests the opposite is true: Not only will the program cost the state money, but it will come at the expense of other important budget priorities.

How do proponents create the illusion of savings? Let’s take a look at the numbers.

Today, Missouri’s Medicaid program covers nearly 940,000 people and costs around $11 billion per year. The federal government pays about two dollars for every dollar the state spends, yet the program still consumes nearly 40% of the state’s budget.

If Medicaid were expanded, Missouri’s Department of Social Services projects that more than 285,000 able-bodied adults would enter the program within the first year at a cost of around $2.7 billion. For these new recipients, the federal government’s match would be more generous, at $9 for every dollar Missouri spends instead of the usual $2. But even at that higher match rate, Missouri’s share of the expansion cost would be significant.

To find “savings,” then, expansion advocates rely on several dubious assumptions.

First, federal funding for Medicaid is treated as “free money.” Although Missouri taxpayers are also federal taxpayers, the cost to the federal government is discounted in the “savings” analysis. And with the federal government in a period of historic deficit spending, new Medicaid spending will be debt for our kids and grandkids to pay off.

Second, proponents’ models assume an increase in expansion enrollment that is much lower than what Missouri’s own Medicaid agency expects. We don’t have to look far to see states that have been burned by their pre-expansion estimates of enrollment and associated costs. Illinois, Arkansas, and Louisiana saw initial expansion enrollment dramatically exceed their estimates. If Missouri sees enrollment slightly above the current estimates from the state’s Medicaid agency, the savings vanish even in the pro-expansion models.

Third, advocates forecast the cost for each new enrollee to be less than similar individuals who are already enrolled in the state’s Medicaid program. By underestimating the cost per beneficiary, expansion supporters shave even more costs from their estimates—even though the state knows they’ll cost more.

And fourth, the most dubious of all, expansion advocates assume the number of disabled Missourians on the program will drop by more than 20 percent over the next four years. By enrolling more individuals under the expansion guidelines (where the federal government pays a higher share), supporters assume they can shift some of the state’s existing Medicaid costs to the federal government. The problem is, this type of maneuver is not allowed. Missouri cannot enroll people who are already eligible for Medicaid into the expansion population, so the idea that the number of disabled Missourians in the program could drop by more than 20 percent is simply unrealistic.

We should also keep in mind that when supporters of the proposal say Medicaid Expansion will save Missourians money, they don’t literally mean the program will cost less. The cost of the program grows year after year, even now. What supporters are saying is that they think it will be less expensive to the state than if the state didn’t expand at all.

There are other important unknowns that must be taken into account, including the risk that taking more federal dollars today may put our state in an even worse budgetary bind tomorrow. For instance, if the federal government finally decides to rein in the deficit by reducing its match on the Medicaid expansion population, state taxpayers may be left holding the bag.

Balancing Missouri’s budget around Medicaid is already an incredibly difficult task, especially amidst an economic downturn. Balancing the budget after expansion would be even more painful, because state legislators will have to come up with hundreds of millions of dollars annually to address both traditional Medicaid and the expansion’s costs. These tough decisions are sure to put priorities like education, roads, and public safety funding at serious risk. Suggesting that the state could save money by spending more on Medicaid was always a dubious proposition, but at some point forecasting gimmicks have to give way to common sense.

The post Debunking the Myth of a Costless Medicaid Expansion appeared first on Show-Me Institute.

Nearly five months ago, I wrote about my concerns with the widely cited Washington University expansion model. Last week during testimony before the committee, the Missouri Department of Social Services (DSS) confirmed that my concerns were valid. DSS officials explained in no uncertain terms that it would be illegal to enroll disabled Missourians into the Medicaid expansion population. This means that currently disabled Missourians would only be eligible for the current lower matching rate for federal funds, instead of the much more generous matching federal rate for the expansion population. And as I outlined in February, without that assumption, there’s a billion-dollar hole in the Washington University model’s cost estimates.

DSS also released its own estimates for the budgetary impact of Medicaid expansion. The projections are based on Missouri’s current Medicaid costs, its economic conditions, and what is known about the state’s low-income population, and they show that expansion will cost more than $2.7 billion in total each year. The federal government will pay the majority of that $2.7 billion, but state taxpayers still pay federal taxes. In state general revenue spending, DSS estimates it will cost more than $167 million per year, which will amount to more than $870 million in state income and sales tax dollars between 2022 and 2026.

These estimates are a far cry from “savings,” which is especially important because these costs will come on top of the current Medicaid program’s growth. It is also important to understand why the Washington University expansion model varied so significantly from our own state Medicaid agency’s predictions. In the end, it comes down to a series of faulty assumptions.

Not only were the authors of the model wrong about what could be done with Missouri’s disabled population, but they also vastly underestimated the number of Missourians that would enroll in expansion and the associated cost of their care. Instead of roughly 230,000 newly eligible adults enrolling, DSS suggests the total will be closer to 286,000. And the monthly cost of each new enrollee will be more than $730 per month, as opposed to the Washington University assumption of $425.

With updated DSS numbers and corrected assumptions about disabled enrollment, the WashU model’s conclusion of a financial boon for Missouri is unattainable. Based on this new information, and given the severity of our state’s current economic downturn, it’s time to stop pretending Medicaid expansion will not break Missouri’s budget.

The post Missouri Medicaid Division Confirms Expansion Will Break Budget appeared first on Show-Me Institute.

What’s driving Missouri’s Medicaid value problem? To answer that, it’s helpful to start with the basics and look at who the program is covering and how the cost of care is being paid for. Missouri’s Medicaid program is responsible for the health care costs of more than 850,000 of the state’s most vulnerable residents. The way in which those health care services are provided is called the delivery system. In Missouri, the two primary methods are fee-for-service and managed care delivery systems.

When a Missourian enrolls in Medicaid, their eligibility criterion largely determines which delivery system will be used for their coverage. Individuals classified as aged, blind, or disabled are covered under fee-for-service, while everyone else is enrolled in managed care.

The fee-for-service system works the way it sounds; each time an eligible recipient receives a Medicaid-covered service, the provider of that service is reimbursed by the state at a previously agreed upon rate. Managed care works differently; instead of paying for each individual service, the state pays contracted health insurance companies a monthly rate, and the insurance company then negotiates a rate with providers to reimburse for each service its enrollees receive.

The division of recipients may play an integral role in explaining the existing systemic failure. The current arrangement puts the relatively healthier populations into plans that require monthly payments whether care is provided or not. And the populations with the most complex medical needs  are placed into a system where the state is left deciding rates and reimbursing for each expense.

There’s little evidence to suggest this is the best possible division, or that either of the current systems can increase the value received for each tax dollar spent. Another conclusion from the report mentioned above stated: “. . . methods to pay providers lack incentives to contain costs or enhance quality.” This is another way of saying that reining in Medicaid’s costs or improving the program’s efficiency is unlikely unless policymakers consider reforming the state’s delivery systems.

In other words, the current system is failing in important ways, and that failure cannot be reversed without substantial changes in the way the system is run. In future blogs I’ll expand on the problem and suggest solutions. For now, I’ll ask this question: When will there be a real concentration of effort in Jefferson City to address this problem? Will it receive the attention it deserves in the 2020 legislative session—or will the can be kicked down the road yet another year?

The post Medicaid’s Value Problem appeared first on Show-Me Institute.

Distinguishing between short-term and long-term poverty could be a wise move, but how valuable would a single snapshot be in describing a multi-generational problem? Not very. While Missouri should know who is receiving entitlements and for how long, there is a better way to collect that information than what is being proposed.

Utah’s Intergenerational Poverty Initiative is now in its seventh year and has five years of data that allows the state to more accurately measure intergenerational poverty and the success of its various anti-poverty efforts. It also has a data dashboard that shows current data and the trends in intergenerational poverty since 2014. Unfortunately, similarly precise information is unavailable for Missouri, although there are ways to approximate the extent of cyclical poverty in our state.

For example, in my recent essays, “Intergenerational Poverty in Missouri” and “Creating Pathways for Self-Sufficiency,” I estimated the scope of intergenerational poverty in Missouri with a combination of U.S. Census data and economic mobility data. Such extrapolation gives us a general picture of intergenerational poverty in Missouri, but detailed and up-to-date data would be that much more helpful for policymaking purposes.

The years of data Utah has is important for establishing trends, measuring the effectiveness of programs, and having the ability to direct resources to where they could do the most good—in other words, making the most out of the state’s anti-poverty spending. It is doubtful any of that could be accomplished by the singular study that would be commissioned by this bill.

If Missouri’s policymakers are serious about addressing intergenerational poverty and making wise use of welfare expenditures, they should consider a longer-term initiative like Utah’s. As I explain in my essays, intergenerational poverty harms not just those trapped in poverty, but also the rest of the state via costly welfare spending and slower growth.  Ongoing data collection could be well worth the investment if Missouri would use that information to effectively and efficiently move people up and out of poverty. 

The post Missouri Should Be Measuring Intergenerational Poverty, but How We Do It Matters appeared first on Show-Me Institute.

For calendar year 2018, Medicaid enrollment in Missouri dropped by 71,528, with 56,716 of those no longer enrolled being children (see table below).

State officials have attributed the majority of the decrease in enrollment to an improved economy. But is Missouri’s economy really outperforming that of the rest of the country? Even the chair of Missouri’s Medicaid oversight committee, Dr. Timothy McBride, appears skeptical. In a St. Louis Post Dispatch article, McBride cited the state’s relatively loose eligibility criteria for children (300% of the federal poverty limit or $77,250 for a family of four) and explained that a parent’s change in job would unlikely be enough for that child to lose eligibility.

According to the Post-Dispatch article, advocates for the poor have pointed to the state’s redetermination process as a reason for the drop in enrollees. Redetermination is the process by which the state’s Department of Social Services checks back in with Medicaid enrollees to ensure they’re still eligible for benefits. The article cites long wait times and arduous paperwork to stay enrolled in the program, the implication being this would cause eligible people to abandon the process.

But the federal government has required states to verify each participant’s Medicaid eligibility since at least 2012. If the redetermination process has been occurring regularly for years, how would it suddenly explain such a radical change in enrollment?

One real possibility stems from the state’s adoption of an automated eligibility verification system in 2018.  This new verification system makes it easier for the Department of Social Services to ensure each recipient receives a timely eligibility redetermination; previously the process was done predominantly by hand. But if the new system is better at ensuring Medicaid recipients are eligible, and the state saw a large number of people drop out of the Medicaid program after the system went into effect, it seems to follow that at least some Medicaid recipients had been receiving benefits despite not meeting the eligibility requirements for the program.

Because the state can now send out verification requests faster, more people are being required to prove their eligibility at any given time. It’s possible that the complaints about paperwork and wait times have arisen because the resources available to assist people in navigating the verification process (e.g., help lines) can’t keep up with the higher volume of clients who need help. But if that’s the problem, the solution is not to abandon or slow down the redetermination process—it’s to make navigation of the process easier.

My colleague Patrick Ishmael has written about the potential for wasteful Medicaid misspending on ineligible individuals. Though it may seem obvious, our policymakers cannot begin to get a handle on Medicaid costs if they can’t even ensure that the recipients of covered services are eligible to receive them. Hopefully, this enrollment change encourages further investigation into Medicaid’s program integrity measures.

The post Surprising Change in Medicaid Enrollment appeared first on Show-Me Institute.

Since Medicaid is such a large part of state spending, it is worth taking a closer look at where and how this money is being spent. Below is a map that shows the percentage of counties’ populations enrolled in Medicaid, also known at Mo HealthNet. The data table, provided by the Department of Social Services, can also be sorted by expenditures, enrollees, and percentage of the population for each county.

The data displayed are from FY2016; in FY2017, another $570 million and 26,948 enrollees were added to these numbers. This information could help provide a clearer picture of Medicaid’s costs and the variation in participation rates across counties. With such information, lawmakers and taxpayers can better understand how changes—whether cuts or expansion—to the program would affect the state.

The post Map: Medicaid Spending and Enrollment by County in 2016 appeared first on Show-Me Institute.

While DSS retains final authority, the contractor will evaluate recipients’ eligibility more often than DSS has previously. SB 607  requires the contractor to evaluate welfare eligibility based on “income, resources, and assets”  at least quarterly and “identify on a monthly basis any program participants who have died, moved out of state, or have been incarcerated longer than 90 days.” SB 607 is patterned after a law Illinois adopted that, once implemented, has removed 120,000 people thus far who should not have been on the welfare rolls.

Currently, DSS only determines eligibility annually. Thus someone could move to another state between eligibility checks and could continue receiving benefits for up to a year. As of 2014, Missouri had a large percentage of the adult population on welfare compared to other states, ranking twelfth in participation rates (see the chart above).

Supporters believe this measure could save taxpayers as much as $25 million by 2019. Maybe we should use the money we will save to experiment with successful welfare-to-work programs that other states have implemented. 

The post Making Strides toward Welfare Reform appeared first on Show-Me Institute.

The number of Medicaid cases, including youth in the Children’s Health Insurance Program (CHIP), hit a high point in May with more than 918,000 cases. Since January, the cases have increased by more than 55,000 due to various factors, including the implementation of a new enrollment system and policies in the Affordable Care Act, said Brian Kinkade, director of the department of social services.

Cases hit a low in May of last year with approximately 819,000 enrolled, which Kinkade credited to the Affordable Care Act taking effect in January. They have since steadily increased, but with a more noticeable jump this year.

Missouri’s population is just over 6 million, so having over 900,000 enrollees means that about one in seven Missourians is now in the state's Medicaid program. Part of the year-over-year growth here is attributable to the department fixing a host of technology problems, about which I've written before. 

But much of the topline enrollment growth is connected to the "woodwork effect" of the ACA. The woodwork effect describes what happens when individuals currently eligible for Medicaid but not enrolled become enrolled, thanks to other enrollment drives pushed under the law. Enrollees "come out of the woodwork" and join the program who, but for the ACA, would not have. In fact, much of the cost of the ACA comes from this woodwork population, who on a per-beneficiary basis are considerably more expensive to states than the expanded population. Policymakers should keep in mind that ACA supporters often omit those expanded costs when talking about the law, perhaps because it dispels the illusion of "savings" they regularly tout.

The latest numbers from the Medicaid program serve as yet another reminder that a Medicaid expansion under the ACA is precisely the wrong course for Missourians and for Missouri's budget. Our state leaders must remember that growing welfare rolls are not a mark of success, but of policy failure.

The post Department Testimony Confirms: One-in-Seven Missourians on Medicaid appeared first on Show-Me Institute.

That point was hit out of the ballpark over the past few days.

Last week mid-Missouri’s ABC 17 reported on the story of a pregnant woman who had been trying to sign up for Medicaid benefits, only to have her paperwork lost and her calls unreturned by the Department of Social Services (DSS). When the issue came up at a House hearing, the DSS admitted it had to do better, but it also admitted something astonishing (emphasis mine).

The Department says thirty percent of its callers are having their needs met, which Campbell acknowledges is too low. She says staff are being reassigned to taking calls and other changes are being made to improve that percentage, but [State Rep. Sue] Allen says the situation remains frustrating.

“In a company, in a private business, people would be gone,” observes Allen.

Missouri’s Medicaid program is deeply broken, and yet some of our politicians think now is the time to expand it with Obamacare. It isn’t. In baseball and business, step one would be to fix what is wrong and then build upon successes, not to double-down on a bad system and bad players. That’s what Missouri should be doing: fixing Medicaid, not making an already bad situation worse—especially for the patients the program was supposed to help.

Missouri’s Medicaid system is institutionally well below the Mendoza line. It’s time to rethink the program.

The post Missouri’s Medicaid Program Striking Out Intended Beneficiaries appeared first on Show-Me Institute.

Did the state make the right decision to return the baby in the end? (I certainly think so. I’d be interested to hear from anyone who disagrees.) Should the state have taken the baby away in the first place? (I don’t think so, although some might think the question of the baby’s safety required some type of action.) Should the state have the power even to consider doing what it did in the first place? In other words, should the state have the power to take a child away because of the fear of potential harm (let’s assume it is a legitimate fear), but absent any actual harm?

I think the third question gets tougher. That is not to say I agree with anything the state did here; I am merely posing the question. Should the state have any power whatsoever to remove a child from its parents because of the potential of harm, but before any real harm occurs? The problem here is that we can all come up with hypothetical situations that would probably lead to an answer of “yes” (i.e., the parents are meth addicts), but as soon as you say “yes” you are granting the state the right to make judgment calls. Inevitably, they will at some point use that judgment improperly, just like they did in this example. Let’s discuss this in the comments.

I have a few points I want to make — and I write all of this as a fairly new parent, myself. I think this statement by the mother is one of the most honest statements I’ve read in a while:

“I needed help as a new parent, but not as a blind parent,” Johnson said.

Being a new parent is tough. It was certainly tough for me, and I am about as perfect a physical specimen as you will ever lay eyes on. I can’t fathom being a parent in the situation these parents are in, but I feel certain that the sense a parent has for the well-being of their children will trump the issues those children may face. Practically speaking, I would bet that a home designed for the blind would be just as well baby-proofed as anywhere. If other parts of their lives are a little trickier than they are for the sighted, those are the challenges of life. For example, letting a two-year old Mikaela run around at the park will be hard for parents who can’t see the child. Do they use one of those child leashes? Only go to parks with fully enclosed fencing, like DeMun park in Clayton? Take family or friends along with them?

I don’t know the answers to those questions. I do believe that the family’s love will overcome all these obstacles, and I think the involvement of the state here has been an outrage.

The post Should the State of Missouri Take Children Away From the Blind? appeared first on Show-Me Institute.