Happy New Year LeadingAge Missouri Members!

Missouri’s new Governor, other statewide officials, and members of the General Assembly are now sworn in and at work in your State Capitol. Preparation, installment, and celebration have given way to policymaking. And Medicaid is top of mind!

That’s not surprising, as Medicaid enhancements for SNF and HCBS members are always on LA MO’s public policy advocacy agenda. 2025 is no exception. We will zealously advocate for higher SNF and HCBS reimbursement. But we have our work cut out for us to secure even modest Medicaid rate increases for FY 2026. Why? Because lower State revenues, the end of federal COVID money, higher government operating costs (due to inflation and pent up demands), and the new Administration’s priorities are conspiring to create a tough budget environment. We must work smart and hard from top to bottom to support our SNF and HCBS members. Our advocacy efforts begin next week at the top – with the new House Budget Committee Chair, who is critical to all budget decisions. Later, on March 12, we hope you will join colleagues to support bottom up “grassroots” advocacy by registering here for LA MO’s Public Policy Advocacy Day at the Capitol. It’s educational, fun, and impactful!

LA MO and its members will thoughtfully, forcefully make the case for higher Missouri Medicaid rates. But any Medicaid conversation – indeed, my focus today – must also include the future of Missouri’s Medicaid program in the face of policy proposals by the incoming Trump Administration and new Congress.

LeadingAge has secured Trump Administration transition documents listing options that may dramatically restructure the federal/state Medicaid partnership. Designed to cut federal spending and allow for new priorities, the proposed Medicaid reforms and spending reductions envision massive Medicaid cost shifting from the Federal to State Governments. These Medicaid policy options are listed in both transition and legislative documents, but more fully explained in this LeadingAge article. It’s a jolting read! For auditory learners, the proposals are also explained on this recording of a recent Policy Pulse Call. Importantly, nearly all of the Medicaid reform options will create substantial holes in most state budgets and require states to raise revenues (taxes), cut spending elsewhere, or make programmatic changes (like reducing provider rates, covered services, or covered populations) to sustain existing Medicaid programs.

If enacted, the Medicaid proposals portend substantial, challenging increases in Missouri’s financial obligation to MO HealthNet, Missouri’s Medicaid program. How Missouri – historically averse to higher Medicaid spending or taxes – will cover vastly more of its Medicaid costs is a “multi-billion-dollar question” and one critical to Missourians cared for by our members. The different federal proposals to cost shift will have different impacts in Missouri. But one proposal commands early attention and advocacy – Limits on Provider Taxes. MO HealthNet financing currently relies heavily on assessed provider taxes that are federally matched at a high level. Limiting provider taxes to support MO HealthNet will have devastating consequences. The education of Missouri and Federal policymakers must start now.

As always, LA MO is collaborating with LeadingAge at the federal level to ensure a viable MO HealthNet continues to meet the healthcare needs of lower income Missourians. LeadingAge members from Missouri and across the nation will descend on Washington DC to meet in-person with Congresspersons on April 9 to ensure Medicaid’s continued viability. Learn more about participating in LeadingAge’s annual Lobby Day during the Leadership Summit here. In addition, right now all LeadingAge members are encouraged to communicate with your U.S. Representatives and Senators about preserving Medicaid. This Action Alert makes it easy. Please communicate today. Together we can preserve sound Medicaid policies for the long-term care residents we both serve and cherish. They deserve nothing less than our best advocacy efforts.

Yours in service,

Bill