Can Missouri afford to expand Medicaid coverage, as the Affordable Care Act calls for?
Can it afford not to?
Those questions were posed to Ryan Barker, vice president for health policy for the Missouri Foundation for Health.
"We do not lobby," said Barker, who added that the bylaws of the foundation prohibit it from doing any more than research and education on such topics as the Affordable Care Act.
Barker has been discussing the pros and cons of expanding Medicaid to low-income parents and low-income childless adults, but took no position on whether the Missouri Legislature should change its mind and join other states in that expansion.
Medicaid is not a subject that grabs the typical reader's or listener's interest, but here s a quick review of what it is and where it came from, followed by Barker's explanation of why the state is faced with the question of expanding the program.
Medicaid started along with Medicare as part of Title XIX of the 1965 Social Security Act.
Medicare is a federal program, while Medicaid was meant to be a program for the so-called "disadvantaged," or those living below poverty.
Medicaid is jointly run by the states and the federal government, so every state's Medicaid program is different. Missouri's Medicaid program is called MoHealthNet, a change in name that occurred in 2007.
Missourians enrolled in Medicaid number 900,000 (of 6 million population). That is a little less than the national average. About 58 million people nationally are covered by Medicaid.
Medicaid is focused on specific population groups: Single parents with dependent children and the aged, blind and disabled.
Eligibility for Medicaid benefits is determined by income in relation to the federal poverty line.
Missouri is one of the most generous states in its benefits for children, Barker said. Children 0-18 are eligible if their families make 300 percent of the federal poverty level.
However, their parents are eligible only if they make 18 percent or less than then federal poverty level.
Pregnant women receive benefits if their income is no more than 185 percent of the federal poverty level.
Blind people are eligibility if they make 100 percent of the federal poverty level.
Blind and disabled people are eligible at 85 percent of the federal poverty level.
What is the 2013 federal poverty level? For a single person it is $11,490; a couple, $15,510; a family of three, $19,530, and a family of four, $23,550.