Author: Kristi Ressel
An interdisciplinary team of University of Missouri researchers from the Institute of Public Policy, the Truman School of Government and Public Affairs, and the University of Missouri School of Medicine joined forces to study the provider perspective of Medicaid and Medicaid Expansion in Missouri. This study was driven following the 2020 vote to pass a constitutional amendment to expand the state’s Medicaid program (also known as MO HealthNet) to cover the non-disabled adult population (18 to 64) with incomes up to 138% of the federal poverty line (FPL), a major change in state health policy. As of June 2023, there were 351,849 Missouri Medicaid enrollees in the expansion population (Missouri Medicaid Enrollment Dashboard n.d.) with a greater proportion of new enrollees likely to come from rural and other health care workforce shortage areas (Siegler 2020). The Medicaid expansion population will increase demand on health care access and availability, particularly in remote and underserved rural areas of Missouri. This increased demand may expose cultural and capacity barriers among existing providers to accept and care for new Medicaid enrollees.
The purpose of this study was to explore the experience and perspectives of Medicaid providers in Missouri and the factors that make them more or less likely to take on new Medicaid patients following expansion. The team drew on rich, original data from interviews with primary care providers, specialists, and dentists in rural Missouri conducted during the first phase of the study to develop a quantitative survey for providers across the state. Key themes from interviews showed that participants had generally favorable views about Medicaid expansion and increased access to healthcare, though they were concerned about capacity within their practice and the health care workforce. Participants also reported challenges working with the Medicaid program, challenges treating Medicaid patients, and having received little formal training on Medicaid or expansion. The goal of the survey phase of this study was to elaborate on these themes for both rural and non-rural Missouri providers.
The survey study findings are consistent with themes emerging from the interviews: participating providers are generally favorable toward Medicaid, Medicaid patients, and expansion as a policy. At the same time, they identify significant problems with the Medicaid program (e.g., low reimbursement rates, high administrative burden) and difficulties with Medicaid patients (particularly failure to show up for appointments). They also admit to having only modest knowledge about expansion as a policy, and express openness to attending a training to learn more. In terms of patient load and capacity, respondents report increases in the number of patients seen per month that are consistent with increased coverage rates due to both expansion and the recently concluded Public Health Emergency (which allowed many Missourians to keep continuous Medicaid coverage who would otherwise have lost eligibility). Overall, though, they indicated that they, or at least their practices, still have excess capacity to accept new patients. These findings offer important insights into the views and experiences of Missouri providers, and the ability of the state’s health care system to provide care for newly covered residents, though the small sample and its divergence from the population of providers on some dimensions are important caveats.
A copy of the full report can be found here.
References:
“Missouri Medicaid Enrollment Dashboard.” n.d. Washington University in St. Louis Institute for Public Health. https://public.tableau.com/views/CaseloadCounterDataoverTime/CaseloadCounterDBshrunk?:embed=y&:showVizHome=no&:host_url=https%3A%2F%2Fpublic.tableau.com%2F&:embed_code_version=3&:tabs=no&:toolbar=yes&:animate_transition=yes&:display_static_image=no&:display_spinner=no&:display_overlay=yes&:display_count=yes&:language=en-US&:loadOrderID=0 (July 21, 2023).
Siegler, A. 2020. Missouri Medicaid Basics. Missouri Foundation for Health.
Funding: This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $12,095,043 with 10 percent financed by non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. This project was also supported by funds internal to the University of Missouri assigned to Kristi Ressel.
Project Team Members: Kathleen Quinn, PhD, Jake Haselswerdt, PhD, Emmie Harcourt, MPA, Sara Gable, PhD
Contact: Kristi Ressel, resselk@missouri.edu