CHCM co-hosts “Medicaid at Risk Part II” panel in partnership with the Brown School at Washington University in St. Louis

On August 1, the Community Health Commission of Missouri (CHCM), in partnership with the Brown School at Washington University in St. Louis, hosted the second part of our “Medicaid at Risk” town hall series. This conversation, which focused on navigating the path forward together, built on the momentum from Part I, where panelists and community members laid the groundwork for understanding the scope of proposed threats to Medicaid. 

Co-moderated by Riisa Rawlins, CHCM CEO and Robert Gibson, CHCM Policy & Advocacy Director, the event was an invigorating conversation for advocates, students, policymakers, and other attendees committed to the wellbeing of the Missouri safety net.

Panelists included:

• Timothy McBride, Bernard Becker Professor and Co-Director of the Center for Advancing Health Services, Policy & Economics Research, School of Public Health at Washington University in St. Louis
• Earlene K. Bolton, Senior Outreach Coordinator, Legal Services of Eastern Missouri
• Amy Blouin, President and CEO, Missouri Budget Project
• Sheldon Weisgrau, Vice President of Health Policy & Advocacy at the Missouri Foundation for Health

If you were unable to attend the virtual panel, please find the recording below, or continue reading for a summary of the event, key takeaways from panelists, and next action steps. A summary of the below information is also available as a PDF download here.

For additional information about CHCM’s advocacy efforts to protect health access for the safety net in Missouri, visit our Protecting Medicaid Access page.

Medicaid at Risk: Key Takeaways

If the proposed changes move forward, between 100,000 and 170,000 Missourians could lose coverage. Families would face impossible choices: Should I pay for health care, or should I pay for food and rent? For many, if the care is not urgent, health will become a lower priority—leading to poorer outcomes, preventable deaths, and greater financial hardship.

Not only would these cuts harm individuals’ health and financial stability, but reduced Medicaid funding would dramatically impact Missouri’s economy and health care system. Medicaid brings billions in federal funding into Missouri each year, and losing it would create ripple effects across communities and industries.

• Provider Risk: Rural hospitals, nursing homes and health providers could face closure and make health care less accessible with longer commute times. Job losses among doctors, nurses, mental health professionals, social workers, and other health workers would further strain the economy.
• Community Consequences: Cuts would add pressure on schools, local governments, and families already under stress.
• Risk to aging and disabled population: 50% of Medicaid spending supports aged and disabled residents. Two-thirds of nursing home residents rely on Medicaid. Cuts could devastate long-term care facilities.

Ripple Effects Across Missouri 

• Rural hospitals: Many operate on zero to negative margins and cannot survive even the slightest funding cuts. 
• Post-COVID: Hospitals are still short-staffed and also struggling with recovering financially. 
• Mental health providers: Services expanded under Medicaid could be rolled back, especially in rural areas. 
• Affordable Care Act gains: Up to 65% of ACA coverage gains might be reversed. 

Who Will Be Most Affected?

Missourians most likely to be most heavily impacted by these changes include:

• Low-income families already living pay-check to pay-check.
• Racial minorities who face disproportionate barriers to accessing care.
• Children. More than 50% of children in Missouri are covered by Medicaid.
• Seniors dependent on Medicaid for nursing home care
• People with disabilities, who account for half of Medicaid spending.
• Rural residents, where access to care is already limited.

Work Requirements

Although the bill focuses heavily on adding work requirements, losing coverage because of these rules would harm entire households—including children and seniors. Most Medicaid recipients already work. These requirements simply add complex paperwork, red tape, and administrative barriers, disproportionately stripping coverage from eligible recipients. 

Why do work requirements not work for Missouri?

During the Medicaid unwinding, 27% of eligible people lost coverage due to administrative challenges alone. The system is already strained by once-a-year verification, which comes with long processing time and hours of call waiting. Moving to a twice a year verification coupled with the responsibility of work requirements is is unrealistic about would overwhelm the state’s system

Monthly reporting is particularly unrealistic for:

• Cancer patients, people with mental health challenges and those with other chronic diseases or caregiving responsibilities.
• Shift workers, people in hospitality, and other with unpredictable working schedules

When Arkansas implemented a similar policy, eligible residents lost coverage due to administrative hurdles and no increase in employment or cost saving were observed.

Missouri’s Department of Social Services is already short-staffed, as shown by its failed request for two hundred additional employees to manage demand.

False Narratives

Claims that most Medicaid recipients commit fraud or abuse of the system are misleading. Most alleged fraud occurs on the provider side, such as overbilling—not among recipients. Systems already exist to prevent overbilling and abuse. This debate is not about fraud; it’s about cutting a program that is critical to Missouri’s entire health system.

Questions raised by audience members:

• What challenges will people face with work requirements?
  • Long call center waits, random cut-offs, outdated systems, language barrier
• How do we protect Medicaid so eligible people do not lose access?
  • Focus on removing barriers, not adding them. Most already qualify.
• What are nursing homes doing and what happens to them and seniors if the bill is implemented?
  • They are advocating at the legislative level. Seniors may lose care, and most nursing homes will shut down with devastating consequences for health and safety.
• What about SNAP?
  • Cuts also threaten SNAP, worsening food insecurity and overall health.

Call to Action 

The Town Hall closed with a clear message: your voice matters. 

• Elevate lived experiences. Show that Medicaid impacts real lives, not just statistics. Pair the numbers with the stories to move legislators
• Call your legislators. Let them know how cuts would affect you. 
• Join advocacy events, press conferences and meetings to keep Medicaid in the spotlight. 
• Stay engaged. Every effort counts, whether big or small. 

Sheldon Weisgrau shared that the value of storytelling for Medicaid advocacy is “just a great example about how humanizing something and connecting it to a person changes this abstract conversation that folks have to something that is much more real.”

The bill and proposed Medicaid cuts threaten to strip coverage from up to 170,000 Missourians, close rural hospitals, weaken nursing homes, and unravel decades of progress. This fight is not about fraud or paperwork. It is about protecting families, children, seniors, and communities across Missouri. 

For our state, Medicaid is a safety net. Protecting it means protecting us all.