Impacts of Medicaid Expansion in Two Early Expansion States and the Case for Medicaid Expansion in Missouri

Medicaid is a health insurance program funded jointly by federal and state governments. Each state sets its own terms on eligibility, benefits, and particularities. In general, Medicaid provides health coverage for nonelderly adults who fall under certain income levels based on the Federal Poverty Level (FPL). One of the major provisions of The Patient Protection and the Affordable Care Act (ACA) included having state governments increase the income threshold for Medicaid eligibility to up to 138% of the FPL by January 2014 or risk losing federal funding for current and future Medicaid recipients. However, a subsequent supreme court case made this provision optional. As of 2020, Missouri’s legislature has continually opted out of expansion, missing out on billions of federal funding in the process. This study aimed to evaluate the effects of expansion on various economic and health related outcomes in Arkansas and Colorado in comparison to Missouri, which decided to opt out of the program. Data was collected from 2013-2015 that examined the following: the rate of the uninsured among non-elderly adults, uncompensated care costs, preventive care, and impact on state budget in Arkansas, Colorado, and Missouri. While data from 2009-2015 assessed the coverage disparities between urban and rural counties in expansion and non-expansion states. Arkansas and Colorado both cut the rate of the uninsured by half, upon implementation of Medicaid expansion while Missouri experienced a 2% decrease in the same time frame. The disparity in coverage amongst rural and urban populations have narrowed significantly in Arkansas and Colorado while it has widened in Missouri. Arkansas has seen a significant decrease in uncompensated care costs. Colorado, on the other hand has experienced a decrease in “charity care and bad debt” but is experiencing higher rates of uncompensated care costs due to underpayment in Medicaid reimbursements. Missouri’s rate of uncompensated care costs has increased dramatically in the past five years. Both Arkansans and Coloradans have reported preventive care visits at higher rates than Missourians. State budgets in the two expansion states received net savings in their general fund due to expansion. While having health insurance does not automatically lead to better health outcomes, it is an important part in ensuring people’s access to care. Missouri must learn from expansion states like Arkansas and Colorado and expand eligibility for Medicaid recipients. Further studies should examine the costs of underpayments in Medicaid reimbursements in expansion states