A Functional Safety Net Is Economic Infrastructure 

As policymakers consider changes to Medicaid and other safety-net programs, it is critical to recognize the role these systems play in supporting families, communities, and Missouri’s economy. In an op-ed published in the Columbia Missourian, CHCM CEO Riisa Rawlins examines how administrative barriers to coverage can create challenges for eligible Missourians and why a functional safety net is critical to a healthy, stable workforce. Read the full op-ed below.

A Functional Safety Net Is Economic Infrastructure 

As Missouri completes the post-pandemic Medicaid unwinding, a quieter challenge is emerging: many eligible families are losing coverage not because they no longer qualify, but because they cannot navigate the administrative hurdles required to keep it. At the same time, enhanced Affordable Care Act (ACA) subsidies are expiring as lawmakers debate new work reporting requirements for safety-net programs.

Together, these shifts raise an important question for Missouri’s economic future: what happens when the systems designed to keep people healthy enough to work become harder to access?

When we evaluate Missouri’s economic health, we often focus on job growth and business investment. Far less attention is paid to the systems that help families stay healthy enough to work and care for loved ones. Yet administrative barriers are quietly making it harder for many Missouri families to maintain the coverage they depend on.

Recent data from Washington University’s CAHSPER dashboard shows MO HealthNet enrollment holding steady at roughly 1.27 million Missourians. But a closer look tells a different story: enrollment among the adult expansion group has grown, while coverage among children, custodial parents, and Missourians with disabilities has declined, raising concerns that administrative hurdles may be disproportionately affecting our most vulnerable neighbors.

In our work with community partners across Missouri, we see how difficult it can be for families to maintain coverage even when they remain eligible. We recently partnered with Families USA to document the lived experiences of Missourians navigating these systems.

Andrea Martin, a mother of two from Lee’s Summit, worked multiple jobs until a heart attack at 35 forced her onto disability and Medicaid. That coverage allowed her to survive two heart transplants. Today, Medicaid covers the medications that keep her alive

Yet, even for someone with severe medical needs, the system remains precarious. Because her disability income falls just above Missouri’s Medicaid eligibility line, Andrea must spend more than $400 each month before coverage begins.

“I don’t want to die. I don’t want to lose my medication,” Andrea shared. “[My children have] had a hard life watching me almost die every few years. We definitely can’t lose it.”

The stakes are equally high in rural communities, where Medicaid is both a health lifeline and an economic stabilizer.

Hillary Harris, a single mother of three in Sikeston, relies on Medicaid for therapy and medication that allow her to remain an active, working parent. Having once helped others enroll in Medicaid, she understands how deeply it is woven into rural economies. In her community, Medicaid supports providers, transportation services, and local jobs, including for her father, who drives patients to medical appointments.

By early 2025, nearly 243,000 Missouri children had lost Medicaid coverage. Nearly two-thirds of those losses were procedural, driven by missed renewal notices or outdated addresses, not changes in eligibility.

When coverage disruptions happen at this scale, the consequences extend beyond individual families. Urban community health centers and rural hospitals alike rely on stable Medicaid reimbursement to sustain care, and the local economies that depend on it.

This administrative fragility is especially concerning now. With ACA premiums rising sharply, the marketplace is no longer a reliable backup option. When paperwork errors cost families their Medicaid coverage, many are priced out of care entirely, placing additional strain on emergency rooms and rural hospitals.

As lawmakers consider new work and community engagement requirements, Missouri can learn from other states, where research shows most adults enrolled in Medicaid who can work already do. The greater challenge is reporting systems requiring monthly verification. 

For parents juggling jobs and childcare, or individuals managing disabilities—these administrative hurdles can lead to coverage losses even when people remain eligible.

Thoughtful implementation of state policy isn’t just good governance. It is an economic necessity. Missouri should invest in automatic data sharing across agencies so existing wage data can verify eligibility without burying families in paperwork. Clear exemptions for parents, individuals with disabilities, and rural residents facing local job shortages can prevent avoidable coverage disruptions.

Health coverage should not hinge on delayed mail or overloaded call centers. With stronger renewal systems and sustained support for community health workers who help families navigate coverage, Missouri can support a healthier, more stable workforce.

A functional safety net strengthens the workforce, stabilizes healthcare providers, and sustains communities across Missouri.

Andrea, Hillary, and thousands of other Missourians are doing everything they can to care for their families and contribute to their communities.

Our systems should make that work easier, not harder.