In the lobby of the Samuel U. Rodgers Health Center Downtown Campus, a clinic in northeast Kansas City, Missouri, Jim Torres offers what should be an easy sell.
For patients passing through to doctor appointments, Torres wants to sign them up for Medicaid 鈥� no strings attached. But he got off to a rough start.
鈥淭he first day, it looked like no one knew they were eligible,鈥� Torres said. 鈥淣o one knew to ask for it. And to be quite honest, we were unsure as to go about helping them apply.鈥�
After years of Republican opposition, Missouri voters last year approved a ballot measure to . But it still took a lawsuit and a before Missouri's state government agreed to enact and fund that expansion.
Now, advocates say the state is doing little to help get eligible residents signed up.
'A little slower on this'
Following an from a Cole County Circuit Court judge, Medicaid coverage has been available to anyone in the state who makes up to 138% of the federal poverty level. For an individual, that鈥檚 about $18,000 per year.
Studies have estimated that means about for health care coverage.
However, the Missouri Department of Social Services said it would be unable to process applications until October. As of mid-November, though, only about 16,000 people have actually been enrolled.
That鈥檚 not a big surprise to Timothy McBride, a health economist as Washington University鈥檚 Brown School and one of the leading experts on Missouri Medicaid.
鈥淲hen I go around, and a lot of people know I know about expansion, people say 鈥楬as that started yet?鈥欌�� McBride said.
McBride says that processing these applications adds a lot more work for the Department of Social Services, which was already understaffed. So far, though, the turnaround for enrollees has been about a week, which McBride says is a fairly quick pace.
鈥淲e鈥檙e always a little different from any other state,鈥� McBride said. 鈥淲e may just be a little slower on this.鈥�
'Not making a proactive effort'
When it comes to actually getting people signed up, some health care advocates say that Missouri is dragging its feet 鈥� even by the standards of other Republican-led states.
Studies produced by McBride and others have estimated that expansion would not only reduce Missouri's rate of uninsured residents, it would also provide Medicaid expansion could , due to increased federal spending, and by eliminating the need for state health spending related to behavioral health and criminal justice.
Despite those benefits, most GOP state leaders, including Gov. Mike Parson 鈥� a vocal opponent of Medicaid expansion 鈥� haven鈥檛 done much to promote the program now that it's law.
Missouri's lack of outreach stands in contrast to states like Louisiana, where .
In Missouri, this search has largely fallen to health care nonprofits, but Missouri Foundation for Health vice president Sheldon Weisgrau says the state would be in a much better position to do that work.
鈥淭here are people who are known to the state,鈥� Weisgrau says. 鈥淭he state has information about their income, but the state is not making a proactive effort to reach out to them and enroll them. And they鈥檙e leaving that to the outside partners to get the word out.鈥�
It's still early yet, and eventually more people will get enrolled in Medicaid, regardless of outreach. A spokesperson for the Missouri Hospital Association said that hospitals will be able to sign up uninsured patients who show up for emergency care.
And sign-ups will also probably increase after the federal COVID-19 public health emergency ends. When that happens in January, Missouri will be allowed to remove people from its Medicaid rolls who are no longer eligible, and it鈥檚 likely that many of them will sign up under expansion.
But Weisgrau says this process would happen much faster if the state took an active role. That鈥檚 what happened in Oklahoma, which also expanded its Medicaid this summer.
Oklahoma then worked to find people currently enrolled in state health care programs that could switch to the expanded Medicaid rolls. Thanks to those efforts, more than , and the state is now drawing down more federal money as a result.
鈥淚t鈥檚 really in the state鈥檚 best interest to get those people moved into the new group as fast as possible,鈥� Weisgrau says.
Filling the gap
Last week, Missouri officials said they would , but McBride says this effort appears to have only just gotten started.
The Missouri Department of Social Services didn鈥檛 respond to questions from KCUR about its outreach efforts. In response to queries, spokeswoman Heather Dolce sent links to and to the department鈥檚 .
For now, spreading the word about Medicaid expansion has fallen to nonprofit workers like Jim Torres.
Based on what he鈥檚 seen so far, Torres says he expects little help from the state in making his pitch to potential recipients.
鈥淭hey may very well be eligible for full Medicaid 鈥� we鈥檙e talking doctors鈥� visits covered, prescriptions, hospitalizations, behavioral health and dental,鈥� Torres said. 鈥淭his is really good coverage at virtually no cost.鈥�
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