Missouri's Innovative Medicaid Reforms

At the recent National Conference of State Legislatures (NCSL) summit in Seattle, I had the opportunity to present to legislators from across the country on Missouri’s innovative work in oral healthcare and caring for children with asthma. Joy Krieger, Executive Director of the Asthma and Allergy Foundation of America– St. Louis Chapter (AAFA-STL), has worked to improve asthma services for many years, and I was pleased she attended the conference and presented with me.

The Missouri legislature has authorized and funded Medicaid reimbursements for high-risk children with severe asthma to receive education and home assessments. Through these services, children and their families will gain a better understanding of how to manage the disease and remove asthma triggers from the home. Seemingly simple changes, such as stopping an asthma patient from eating in their bedroom, can have far-reaching health benefits. This was the first law of its kind passed in the nation, and Missouri’s pioneering approach could become a model for other states to better serve children with asthma.

In 2011, Joy and I worked together on the passage of House Bill 1188, which allowed schools to stock asthma rescue medicine in case of an asthma emergency. As Executive Director of AAFA-STL, Joy oversees the organization’s programming, which includes providing local schools with asthma-related medical equipment. Last year 176 schools received equipment, and 83% of the children treated with AAFA-STL’s supplies were able to return to the classroom.

Asthma affects approximately half a million Missourians and is the leading reason children in our state are forced to visit the emergency room. Unfortunately the ER treats the symptoms, not the underlying triggers, of an asthma attack, so kids are forced to visit the ER repeatedly without any true health improvements. Asthma hospitalizations cost Missouri about $100 million each year, and much of this expense could be avoided through preventative asthma services, such as education and home assessments. The return on each dollar invested in asthma education is $7.69 to $11.67. For environmental assessments, a dollar investment can yield between $5.30 and $14.

At NCSL I also presented on Missouri’s initiatives to improve oral healthcare for low-income individuals. Dental health is closely tied to overall wellness, but too many Missourians lack access to basic preventative dental services. Almost half of Missourians live in a designated Dental Health Professional Shortage Area. In 2012, only 61.8% of Missouri adults had visited a dentist or clinic in the last year, which was below the national average of 65.5%.

Mo HealthNet provides dental coverage for Medicaid-eligible children and adults who are pregnant, blind or in a nursing facility. To broaden access, the legislature funded dental benefits for Medicaid-eligible adults without current coverage in the FY 2016 budget. Using tax amnesty revenue, Mo HealthNet will be able to cover preventative, maintenance, restorative and emergency dental services for adults. The General Assembly had appropriated funds for adult dental benefits in last year’s budget, but the Governor withheld this money.

In order to improve patient access to dental professionals, I filed a bill allowing dental hygienists, under an agreement with a dentist, to offer preventive dental hygiene services directly to patients at sites beyond the dentist’s office. This option could help broaden access to care in underserved areas. While the bill did not receive a vote in committee this year, I plan to refile it in 2016.

Missouri’s asthma and dental programs demonstrate the value of targeted state investments as opposed to reckless, blanket spending. These services are proven to enhance patient wellness while generating a financial return on investment. To use Missouri’s limited resources wisely, the legislature will continue to prioritize programs with measurable outcomes and verified successes.