The antiquated business model that Medicaid is currently operating under is not meeting the needs of many people in communities that really depend on it, such as those in rural areas. Missouri's failure to take advantage of the Affordable Care Act resulted in missed opportunities to update the program's core infrastructure, putting the state behind most peers. The report notes Missouri's laggard status has a silver lining - we can learn from best practices implemented in other states. Such practices include investing in management, information technology, and high-quality data to fulfill the state's role of administering a complex program that accounts for about one-third of Missouri's budget. Other needed changes include shifting to "investing in the rural and safety net infrastructure, including primary care and behavioral health."
Among potential initiatives to accomplish this shift are better payments for financially vulnerable rural and safety-net providers and global budgets for rural hospitals. The report notes that about 60 percent of rural hospitals lost money in 2016.
Global budgets are an innovative approach being used effectively in Maryland and Pennsylvania
that could be used to respond to the dire situation of many rural Missouri hospitals. This is just one example of the report's many ideas for improving virtually every operational aspect of Medicaid.
The report's explicit emphasis on a comprehensive, long-term approach to Medicaid improvement is encouraging. Implicit are the state's responsibilities to care for the most vulnerable Missourians through this program and the need for fundamental improvements in the program's value for the people it serves: low income children, pregnant women, persons with disabilities, and the low-income elderly -
in sum, about one in six Missourians, almost 1 million people
While the financial and administrative implications are two very important aspects to be considered when enhancing our state's Medicaid system, what needs to remain at the forefront is the significance of this program for the people of Missouri. Our communities deserve better health outcomes and relief from the costly burden of care. Ensuring that health care is affordable and accessible to all - especially the neediest - should be our highest priority and something that we're all pushing for.