The clock has sprung forward, birds are singing, the sun is (sometimes) shining … spring is upon us! As the season turns, both the Missouri and Kansas legislatures are inching ever closer to the end of their legislative sessions. This is a great time to hit pause and take stock of the health policy picture in both states.
HCF focuses on igniting a culture of health by tackling the pressing health issues facing our community. We do this by advocating for health and wellness and working to ensure that the health of those most in need is prioritized by our elected leaders. Our policy agenda guides our advocacy work and the ways that HCF uses its own voice in support of policy change. (It’s worth noting that our grantmaking dollars support policy changes that aren’t captured on this agenda.)
Below we’ve captured what both state legislatures are debating that coincide with our policy agenda.
Policy agenda: Maintain and advance access to health coverage for low-income, vulnerable, and uninsured residents of Kansas and Missouri.
In Kansas, Senate Bill 38, which would expand KanCare (the state’s Medicaid program), was voted out of the Senate Public Health and Welfare Committee. However, there has been no further movement on the bill as Senate leadership will not bring it before the full Senate for debate and vote. HCF offered testimony in support of expansion, which you can read here.
In Missouri, there has been no traction on the many MO HealthNet expansion bills that have been filed, however, we have seen activity on bills that would make incremental changes to the program. Of note:
- The House is considering HB2280, which would extend MO HealthNet benefits for pregnant women to provide substance abuse treatment for up to one year after giving birth. The bill is making good progress through the House, but still has a long process ahead in the Senate. HCF offered supportive testimony (available here).
- Both the Missouri House (HB1856) and Senate (SB561) are considering bills to add work requirements to the MO HealthNet program. HCF and many other health advocates are encouraging our elected leaders to tread carefully in this arena. We testified in opposition to the House bill, which was much more aggressive in its requirements. Fortunately, many of those provisions have been amended. We have shared these talking points with lawmakers to inform their thinking on work requirements.
Policy agenda: Ensure adequate reimbursement for school-based health services.
Our work around reimbursement for school-based health services has been focused on administrative rule changes that would allow MO HealthNet to reimburse for eligible services provided to Medicaid recipients in school settings. Missouri’s current policy does not allow for reimbursement of services on school property. You can learn more about this issue in our publication Sustaining School-Based Health Services in Missouri.
Over the past few months, we have been in regular communication with the Missouri Department of Social Services and are hopeful that this rule change will be adopted in the coming months.
Policy agenda: Encourage Cass and Lafayette counties to opt into the regional prescription drug monitoring program.
Cass, Lafayette, and Clay counties have opted into the regional prescription drug monitoring program. Although the state of Missouri does not have a statewide program accessible for public health purposes, we are pleased that the entire HCF service area is now served by a prescription drug monitoring program.
Policy agenda: Support funding of a state infrastructure that is adequate to administer, maintain, and analyze data from Medicaid programs.
The IT system that powers Missouri’s Medicaid business intelligence system — including billing and payment functions and integration with those using the system — is old and broken, leaving the state unable to efficiently operate its Medicaid program. For FY2018, the MO HealthNet Division has requested $236,407 of general revenue funds to be matched with federal funds and support seven new employees who will prepare for system implementation. The House Budget Chair’s recommendation would only fund two of the seven requested positions.
Policy agenda: Explore policies that will enhance access to safe, affordable, and healthy housing.
The exploration of safe, affordable, and healthy housing is a new policy focus for us. Our current efforts are concentrated on developing a deeper understanding of housing as a health issue and familiarizing ourselves with the organizations and policies in this space. Over the last few months, HCF has met with some of the local organizations that play critical roles at the intersections between health and housing. These include affordable housing developers, community and neighborhood organizations, direct service providers, government representatives, and other experts. We are learning about the unique contributions of each organization and how they contribute to healthier individuals and communities.
Housing policy at the federal, state, and local levels is also informing our work as we move forward. The current funding threats to HUD programs have the potential to be the largest retrenchment of federal housing aid since the U.S. Housing Act was enacted in 1937. At the state level, the decision by the Missouri Housing Development Commission to discontinue using state money to match the $140 million in federal low-income housing tax credits has inevitably led to more severe shortages in affordable housing across the state. Locally, Kansas City, Missouri, is in the process of developing a comprehensive housing policy that will lead the city’s housing efforts for years to come.
We will continue learning from our partners and exploring housing policies to decide how HCF can use its voice to complement the work already being done and advocate the link between housing and health.
Policy agenda: Work with partners to develop a coalition that can advocate for local public health funding.
Missouri ranks last in the nation in per capita spending on public health services, spending only $5.88 per person each year. Our work to expand public health funding has focused on the statewide transformation of Missouri’s public health system. Best practices in public health have evolved and now focus on five foundational components that include:
- Communicable disease control
- Chronic disease and injury prevention
- Environmental public health
- Maternal, child, and family health
- Access to and linkage with clinical care
Many of the state’s local public health agencies are providing quality services that match or exceed national standards for essential public health services, but limited funds and regional challenges prevent the state from providing the public health system its residents deserve. To improve the overall infrastructure and prepare Missouri for future public health challenges, HCF has supported the work of the Missouri Public Health Association and its partners to develop a roadmap for the future of public health.
Many options are being discussed, including regional sharing of resources, better coordination, and developing a unified voice and vision for public health in Missouri. Workgroups and committees are forming to identify action steps and to develop a comprehensive plan. Additionally, HCF is meeting with public health agencies in our service to identify ways to better advocate for investment in public health infrastructure.