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After Court Ruling, Missouri Begins Implementing Changes To Expand Medicaid

STEVE INSKEEP, HOST:

This is a big deal for people in need of health care. Missouri will soon become the 38th state to expand Medicaid. It's a move that will end a nearly decade-and-a-half struggle to deliver health care to the working poor. St. Louis Public Radio's Jason Rosenbaum has more.

JASON ROSENBAUM, BYLINE: Autumn Stultz played a key role in changing Missouri history. The single mom from Springfield was one of three plaintiffs in a case to see if a voter-approved constitutional amendment expanding Medicaid was valid. The result was resounding. The Missouri Supreme Court unanimously decided that the state had to begin enrolling people like Stultz into the program. And to say that Stultz was happy with the outcome would be an understatement.

AUTUMN STULTZ: Elated, blessed. I was overjoyed for all the Missourians to be able to finally receive what we've all been asking for.

ROSENBAUM: Before expansion, a single mom with one kid would have to make less than $3,000 a year to qualify for Medicaid. Because of Stultz and the other plaintiffs, that will soon expand to around $24,000 a year. That means Stultz will have a way to pay for her inhaler, her anxiety medicine and routine doctor visits. And for Kansas City resident Nina Canaleo, being eligible for Medicaid will allow her to pay for critical medication for her multiple sclerosis.

NINA CANALEO: That's one thing I won't have to worry about and an important thing. I mean, you know, it could be me walking or not. And that's huge in somebody's life, considering that I work, and I can't afford to get my own health care.

ROSENBAUM: When more than 53% of Missouri voters approved the Medicaid expansion ballot item last August, it was the culmination of a nearly decade-and-a-half struggle to expand the program. And ultimately, the state's hospitals played a big role in helping fund the 2020 ballot item. Dave Dillon of the Missouri Hospital Association says expansion could steer low-income Missourians away from emergency rooms and into doctors' offices.

DAVID DILLON: You can get those individuals to access primary care when they need it to manage chronic conditions so that those conditions don't get so bad that they need emergency care for them.

ROSENBAUM: One of the big tensions since Medicaid expansion passed was whether the legislature was forced to pay for it. The court decision said they don't have to do anything. But because so many new people now qualify, withholding funding could lead to doctors and hospitals not getting reimbursed. GOP lawmakers like Senator Bob Onder are not happy to be put into that position.

BOB ONDER: Missouri has traditionally made the decision that able-bodied, working-age adults would not be eligible for this particular welfare program. And what's more, we've decided that employers, for instance, should be should be taking care of the people, the lower-wage people who work for them.

ROSENBAUM: Republicans cite long-term costs to Missouri's budget for their opposition to expansion. But Missouri isn't exactly scrounging for cash, especially since expanding Medicaid means Missouri will get roughly a billion dollars from the latest federal relief bill. Republican State Senator Lincoln Hough says it's time to stop delaying the inevitable.

LINCOLN HOUGH: I think when something's put on the ballot and the voters of the state say, we support this, the legislature should listen to them.

ROSENBAUM: Missourians who are newly eligible for Medicaid could start signing up in the coming weeks. And by taking advantage of Medicaid, the state's working poor will be changing the shape of Missouri health care and Missouri public policy for years to come.

For NPR News, I'm Jason Rosenbaum in St. Louis.

(SOUNDBITE OF MOONCAKE'S "SHORT STORIES OF METHUSELAH TREE") Transcript provided by NPR, Copyright NPR.