Kansas City needs to prepare for a public health emergency that could be as challenging as the COVID pandemic for safety-net providers, local health and community leaders warn.
When new federal work requirements and more frequent eligibility checks take effect next year, thousands of Missourians are expected to lose access to MO HealthNet, the state's version of Medicaid.
That will strain area hospitals and health clinics and reverberate across the economy with higher costs and poorer health.
During a March 20 roundtable discussion hosted by Kansas City Mayor Quinton Lucas at the Samuel U. Rodgers Health Center, more than two dozen local health and community leaders, city officials and state representatives said the community needs to work now to help stem Medicaid losses in the state.
Public education and support, like offering help with filling out and filing Medicaid paperwork, could help more people keep coverage, they said.
D. Rashaan Gilmore, president and CEO of BlaqOut, a health provider that serves the city's Black LGBTQ+ community, urged government and community leaders to develop a central hub where people could turn for help.
"That would allow us to say … 'If you're on Medicaid or need to be or you were kicked off, come here, call this number, scan this QR code,'" Gilmore said.
After all, he and other leaders said, Kansas City has done it before. During COVID, a regional response and recovery fund raised and distributed $23.8 million to help the community weather the public health emergency.
Jeron Ravin, CEO of Swope Health, said the city needs to rediscover some of the community partnerships that developed during the pandemic.
"There were so many opportunities and partnerships that got deconstructed as we got further and further away from the emergency," he said, "and this is as much an emergency."
The savings and cost of work requirements
Medicaid work requirements, which President Donald Trump signed into law last summer under his "One Big Beautiful Bill," are designed to help trim the federal budget by $326 billion over 10 years. Other policy changes are expected to generate another $585 billion in federal Medicaid spending cuts.
But the savings will come at the cost of more people losing health insurance. Work requirements could lead to 5.3 million people losing Medicaid nationwide by 2034, according to the Congressional Budget Office. And other Medicaid policy changes could add another 5 million people to that count.
Those policies include a new requirement for states to check participants' eligibility for Medicaid twice a year starting in 2027. Currently, a yearly check is required. That added burden will make it difficult for some people to maintain benefits even when they are meeting other criteria.
According to current estimates, 150,000 people in Missouri could lose Medicaid coverage. And most of those would come from the 355,000 in the state's voter-approved Medicaid expansion group — the group that will be subject to new work requirements.
Missouri and 40 others states have expanded Medicaid coverage to include a broader cross section of low-income adults under a provision of the Affordable Care Act. Kansas has not adopted Medicaid expansion, but 13,000 people in the state could still lose coverage thanks to federal changes, according to the Reach Healthcare Foundation.
Missouri's expansion coverage is enshrined in the state's constitution, thanks to an amendment voters passed in 2020. But legislation in Jefferson City could undo that, raising more questions about how many people could be kicked off the government coverage.
On top of changes to Medicaid, the recent expiration of enhanced tax credits that heavily subsidized the cost of health insurance sold through the Affordable Care Act marketplace, will add to the country's uninsured numbers In coming years.
And Kansas City's safety net is already dealing with changes to food assistance. Last year's federal legislation also added work requirements for people who receive SNAP, the Supplemental Nutrition Assistance Program.
For Kansas City's safety net — hospitals, clinics and other nonprofit organizations — it all adds up to greater needs and providers that are straining under the weight of trying to meet them.
More uninsured patients will push hospitals and clinics to provide more free care. And since people without insurance tend to avoid or put off care, it's also likely to be more expensive care.
Helping people keep Medicaid
Medicaid, in particular, is a key support for safety-net providers. University Health, the city's safety-net hospital, has more Medicaid patients than any other hospital in the state, and it counts on the government program for half its revenue. Community health clinics, such as Swope, Sam Rodgers and KC Care, rely on Medicaid reimbursements to treat other uninsured patients for free.
Kansas City's safety-net system is worth protecting, said Kamera Meaney, chief health policy and government relations officer at University Health.
"I say it a lot to my staff and pretty much anyone who will listen," she said. "There are very few cities that are as fortunate as us with our safety-net system."
That's why, leaders said, helping people meet new requirements to remain on Medicaid must be a priority.
Beginning next year, people in the expansion group who are 19 to 64 years old must do 80 hours of work or community service every month or be enrolled in school at least half time. The law exempts certain groups, such as caregivers and people who are pregnant, disabled or medically frail.
According to KFF, the health research organization, only about 20% of the people who will be subject to the new work requirements aren't already meeting them by working or going to school, or qualifying for an exemption.
But local health leaders said they fear people will lose Medicaid even if they are complying because they won't know about the new requirements or because they can't manage the cumbersome paperwork.
Stacy Mayer, CEO of Seton Center, said her organization is working to help people navigate the system by hiring health navigators who can help with enrollment. And it is trying to eliminate obstacles by exploring ways to provide more affordable child care.
But small organizations like hers need help, she said. "We're a 30-person staff."
University Health wants to help as many people in the city stay on Medicaid as it can, Meaney said. The hospital has 37 employees dedicated to processing Medicaid applications and, on average, files 650 a month.
"We're telling the state we're happy to do more than that, not just for our patients, but for anyone who needs it," Meaney said. "But they're going to have to support us in those measures."
The city will also help as much as it can, said Marvia Jones, Kansas City health director. That might include helping communicate information about new Medicaid requirements to the public.
"Whatever we need to do to get folks a little bit more ready," she said.
But Jones also warned that the health department is dealing with financial fallout from federal funding cuts over the last year. Now state cuts also seem likely. That means the department's capacity to help will be limited, she said.
"The city is having to try to figure out how to be the safety net to the safety net," she said.
Crumbling assistance already felt
Community groups that work with people in need of assistance said they expected the demand only to increase.
Hilary Cohen Singer, executive director of Jewish Vocational Services of Kansas City, a refugee resettlement agency, said that during last year's government shutdown, which temporarily suspended SNAP benefits for everyone, the community saw how vulnerable people really are without safety-net services.
"We got to see what the immediate impact was going to be," she said.
Even during that short stretch, there wasn't always enough help to go around. Medicaid cuts will likely have an even bigger impact, she said.
"I would imagine the great partnerships that we have (with other community organizations) are going to be strained by how much more utilization refugees are going to have in emergency rooms and in free services," Singer said.
Lucas told the gathering he hoped the roundtable discussion would lead organizations to look beyond the obstacles to find ways to work together to solve difficult problems.
"People still need access to care," Lucas said. "We need to make sure that we find a way to get it to them. To the extent we don't, there will still be long-term costs, whether it's borne by those with already busy emergency departments or whether it's borne long term in our death statistics."
This story was originally published by The Beacon, a fellow member of the KC Media Collective.
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