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Medicaid health workers still underpaid despite expansion

"The people that care for disabled and elderly and mentally ill are dramatically underpaid in comparison to not just other states, but also the private sector"
Credit: St. Louis American
The work of nurses and health care workers who provide direct care to Medicaid patients has been exhausting as the ongoing pandemic continues and many remain underpaid.

ST. LOUIS — Direct care providers for Medicaid patients have been underpaid for years and are currently struggling with exacerbated staffing problems. The expansion could alleviate the staffing issues.

State Rep. Peter Merideth, the ranking Democrat on the House Budget Committee, said Missouri can expect substantial revenue increases to Missouri coffers from federal sources as a direct result of Medicaid expansion, according to information provided to the General Assembly by DSS on Oct. 6.

“We have a crisis that has been growing in our state in that the people that care for disabled and elderly and mentally ill are dramatically underpaid in comparison to not just other states, but also the private sector and other jobs,” Merideth said in a phone interview. 

Missouri officially implemented the Medicaid expansion on Oct. 1 after Republican legislators attempted to gut funding through the budget process in an ill-conceived attempt to undo the will of voters. The state has already started processing Medicaid applications for those newly eligible for the program.  

Merideth said some legislators believe the problem with underpaying providers stems from raising minimum wage.

“Now, a few Republicans have tried to blame the rising minimum wage,” Merideth said.

“But the reality is that if jobs like WalMart or fast-food chains pay people more, whether it is because of a raise in minimum wage or because the economy is demanding it right now, then our employees that are paid through reimbursements from Medicaid are not getting those kinds of raises.”

The Missouri Supreme Court unanimously upheld the constitutionality of Medicaid expansion in July, vindicating Missouri voters and reiterating the points made by Democratic legislators who fought to respect voters’ decision.

However, a bill that would increase pay for Medicaid workers was not passed, which is exacerbating the crisis.

“An estimated $30 million for consumer directed services would get healthcare providers who serve those on Medicaid up to $15 an hour and we managed to get it into the budget, but the governor vetoed it without good reason,” Merideth said. “He’s putting off this crisis and undervaluing people doing these jobs.”

“We have so much money right now that it is ridiculous, and we should be putting it into paying these workers what they deserve,” Merideth said.

The increase in money is a big relief, but it may not be enough to mitigate the dire situation. If turnover rates continue to increase for the direct care providers, then the crisis will worsen. 

“We want to avoid a crisis where we can no longer find people to provide healthcare to those on Medicaid,” Merideth said. “It’s not going to matter that we are getting all of this money from federal sources to pay for this expansion population, if we don’t have providers willing to do the work because we don’t pay enough money to do it.” 

Additionally, House Republicans removed $1.9 billion allocated for the Medicaid expansion in April. However, federally-sourced funding for the Medicaid expansion will be spread over the next two years. 

“Because of our state’s decision to expand Medicaid coverage to hundreds of thousands of Missourians, our state will receive nearly $1.1 billion in enhanced FMAP funding over the next two fiscal years,” Merideth said. “This is in addition to the billions in federal reimbursements that will pay for expansion itself - an extra billion provided by Biden’s American Rescue Plan to newly expanding states that we can spend however we want.” 

“On top of all the other revenue and savings our state will receive by expanding, Missouri leaders should act now in using this money to strengthen our health care infrastructure for the future.”