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Being Low-Income and Uninsured in Missouri: Coverage Challenges during Year One of ACA Implementation

Executive Summary
  1. A Health Maintenance Organization, or “HMO”, is an organization that provides comprehensive  health services using a fixed payment structure or capitated rates.

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Introduction
  1. Licata R and Garfield R. The Uninsured at the Starting Line in Missouri: Missouri findings from the 2013 Kaiser Survey of Low-Income Americans and the ACA, Kaiser Family Foundation, 2014. Available at http://kff.org/uninsured/report/the-uninsured-at-the-starting-line-in-missouri-missouri-findings-from-the-2013-kaiser-survey-of-low-income-americans-and-the-aca/.

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Background: ACA Implementation in Missouri
  1. Majerol M, Newkirk V, Garfield R. The Uninsured: A Primer – Key Facts About Health Insurance and the Uninsured in America. Kaiser Family Foundation, 2015. Available at http://kff.org/report-section/the-uninsured-a-primer-what-was-happening-to-insurance-coverage-leading-up-to-the-aca/.  

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  2. Licata R and Garfield R. The Uninsured at the Starting Line in Missouri: Missouri findings from the 2013 Kaiser Survey of Low-Income Americans and the ACA. Kaiser Family Foundation, 2014. Available at http://kff.org/uninsured/report/the-uninsured-at-the-starting-line-in-missouri-missouri-findings-from-the-2013-kaiser-survey-of-low-income-americans-and-the-aca/.

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  3. Washington University of St. Louis and Saint Louis University, For the Sake of All: A report on the health and well-being of African Americans in St. Louis and why it matters for everyone.  2014. Available at http://forthesakeofall.org/publications/.

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  4. Zuckerman S, Miller D, Shelton Pape E, “Missouri’s 2006 Medicaid Cuts: How Did They Affect Enrollees and Providers?” Health Affairs 28(2), 2009. Available at http://content.healthaffairs.org/content/28/2/w335.full.pdf+html.

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  5. Ku L, et al. “Coordinating and Integrating Care for Safety Net Patients: Lessons from Six Communities,” George Washington University, Washington, DC (May 2012). U.S. Census Bureau, 2010 Census. Available at https://publichealth.gwu.edu/departments/healthpolicy/DHP_Publications/pub_uploads/dhpPublication_618A2D24-5056-9D20-3D475D756ACE11FB.pdf.

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  6. Regan E, “Medicaid expansion in Missouri continues to look unlikely”, Southeast Missourian, January 7, 2015, available at http://www.semissourian.com/story/2153650.html.

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  7. Disproportionate Share Hospitals are hospitals that receive federal funding for providing care to high numbers of uninsured patients. See Rudowitz R, “How do Medicaid Disproportionate Share Hospital (DSH) Payments Change Under the ACA?” Kaiser Family Foundation, November 2013. Available at http://kff.org/medicaid/issue-brief/how-do-medicaid-disproportionate-share-hospital-dsh-payments-change-under-the-aca/.

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  8. See Kaiser Family Foundation, “State Exchange Profiles: Missouri,” Updated December 2012.  Available at http://kff.org/health-reform/state-profile/state-exchange-profiles-missouri/.

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  9. See Musumeci M, “Are Premium Subsidies Available in States with a Federally-run Marketplace? A Guide to the Supreme Court Argument in King v. Burwell,” Kaiser Family Foundation, February 2015. Available at http://kff.org/health-reform/issue-brief/are-premium-subsidies-available-in-states-with-a-federally-run-marketplace-a-guide-to-the-supreme-court-argument-in-king-v-burwell/. See also Levitt L and Claxton G, “The Potential Side Effects of Halbig,” Kaiser Family Foundation, July 2014. Available at http://kff.org/health-reform/perspective/the-potential-side-effects-of-halbig/.

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  10. Missouri HB 1243. Full text available  http://www.house.mo.gov/billtracking/bills151/billpdf/intro/HB1243I.PDF.

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  11. Licata and Garfield.

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  12. Kaiser Family Foundation, “Marketplace Enrollment as a Share of the Potential Marketplace Population, April 2014.” Available at http://kff.org/health-reform/state-indicator/marketplace-enrollment-as-a-share-of-the-potential-marketplace-population-2014/.

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  13. Shapiro J, “Analysis of health plan sign-ups shows success, challenges,” St. Louis Post-Dispatch, October 12, 2014. Available at http://www.stltoday.com/news/special-reports/mohealth/analysis-of-health-plan-sign-ups-shows-success-challenges/article_036afa47-27d9-5495-83a5-28e2042a8f4c.html.

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  14. Liss A, “Missouri still processing Medicaid applications from HealthCare.gov,” St. Louis Post-Dispatch, October 14, 2014. Available at http://www.stltoday.com/news/local/govt-and-politics/missouri-still-processing-medicaid-applications-from-healthcare-gov/article_bb172e79-00e8-5125-9b7a-893315b5ccd8.html.

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  15. Galewitz P, “Feds demand Medicaid backlog fix from Missouri,” St. Louis Post-Dispatch, July 10, 2014. Available at http://www.stltoday.com/news/special-reports/mohealth/feds-demand-medicaid-backlog-fix-from-missouri/article_f07075fa-ea6c-5cbe-94ed-829a7f9a6f61.html.

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  16. Young V, “Missouri’s Medicaid enrollment system improving, officials say,” St. Louis Post-Dispatch, February 3, 2015. Available at http://www.stltoday.com/news/local/govt-and-politics/virginia-young/missouri-s-medicaid-enrollment-system-improving-officials-say/article_c49d049c-ee14-5ae7-b443-1fbf8f6da55d.html.

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  17. Kaiser Family Foundation, “Total Monthly Medicaid and CHIP Enrollment.” Available at http://kff.org/health-reform/state-indicator/total-monthly-medicaid-and-chip-enrollment/.

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  18. Young V, “Medicaid enrollment is actually dropping in 6 states,” MedCity News, June 2, 2014. Available at http://medcitynews.com/2014/06/states-seeing-fewer-medicaid-cases/.

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Who are the low-income uninsured in Missouri?
  1. Licata and Garfield.

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  2. See Ku L and Broaddus M, “Coverage of Parents Helps Children, Too.” Center on Budget and Policy Priorities, October 20, 2006. Available at http://www.cbpp.org/files/10-20-06health.pdf. See also Sommers B, “Insuring children or insuring families: do parental and sibling coverage lead to improved retention of children in Medicaid and CHIP?” Journal of Health Economics, November 2006, Vol. 25 No. 6.

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  3. See Decker S, Kostova D, Kenney G, and Long S, “Health Status, Risk Factors, and Medical Conditions Among Persons Enrolled in Medicaid vs Uninsured Low-Income Adults Potentially Eligible for Medicaid Under the Affordable Care Act.” JAMA, June 26, 2013. Available at http://jama.jamanetwork.com/article.aspx?articleid=1699906.

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How do the low-income uninsured access care?
  1. Licata and Garfield.

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  2. For those who have been uninsured, or enrolled in MO HealthNet, or privately insured for all of 2014, the time period for this is “since January 2014.” For those who became uninsured, enrolled in MO HealthNet or became privately insured during 2014, the time period for this is “since becoming uninsured” or “since gaining your current coverage.”

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  3. Agency for Healthcare Quality and Research. CAHPS Item Set for Addressing Health Literacy.  Available at: https://cahps.ahrq.gov/surveys-guidance/item-sets/literacy/index.html.

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How does coverage affect financial security?
  1. Licata and Garfield.

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Why are people still uninsured and what are their coverage options?
  1. Young V, February 3, 2015.

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Policy Implications
  1. Garfield R and Young K. People Who Gained Coverage in 2014: Implications to Access to Care and Financial Security, Kaiser Family Foundation, Forthcoming.

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  2. Shin P, Sharac J, Barber Z, Rosenbaum S, and Paradise J, “Community Health Centers: A 2013 Profile and Prospects as ACA Implementation Proceeds.” Kaiser Family Foundation, March 2015. Available at http://kff.org/medicaid/issue-brief/community-health-centers-a-2013-profile-and-prospects-as-aca-implementation-proceeds/.

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  3. Ibid.

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  4. Medicare Access and CHIP Reauthorization Act of 2015, H.R. 2, 114th Cong. (2015).

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  5. Young V, February 3, 2015.

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