Temporary worker James Dickerson applied for Medicaid because it is cheaper than his current health plan. Sharon Coleman, a home health assistant, is looking forward to getting insurance covering the hospital stay. Danielle Gaddis, a medical student who is about to enroll, no longer worry about going to the doctor will make her debt.

After voters in Oklahoma and Missouri approved the expansion of the federal state public health insurance program for low-income people in 2020, all three of them belonged to the new Medicaid program for approximately 490,000 people. In these two states, people with incomes up to 138% of the federal poverty level—about $18,000 per year for individuals—now get free insurance even if they don’t have a disability.

But the experience of newly qualified people in these two states-estimated 215,000 People in Oklahoma and 275,000 In Missouri-great changes have taken place.Oklahoma has Enrollment exceeds 210,000 People, and Missouri has registered Less tThere are 20,000.

The difference comes down to the methods adopted by the two states, both of which are led by the Republican Party and have refused to expand the Medicaid program for many years.

Once Oklahoma voters approved the expansion, it was quickly accepted: the legislature Misappropriation It is funded by the state budget of $164 million. In June of this year, one month before the start of the program, applications were opened, and within one month, 113,000 People have been approved.

More than 100,000 Oklahomaians have signed up for Medicaid

In August, Oklahoma State Secretary of Health and Mental Health Kevin Corbett Tell the state legislator Regarding one of the registrants: a 62-year-old woman was able to arrange appointments with doctors and dentists for the first time in 20 years.

“It really changes lives,” Corbett said. “We are very satisfied with what we can do.”

other States that have expanded Medicaid in recent years Seeing a surge in enrollment in the first month. The combined number of Louisiana’s Medicaid and Child Health Insurance plans has increased by more than 255,000; Virginia has added nearly 184,000; Idaho has added approximately 45,500 registrants, which is about half of the expected number of newly qualified persons; Montana added more than 23,000, accounting for 51% of its expected total. On the other hand, only about 7% of newly eligible people in Missouri are enrolled in the Medicaid program.

“You can expand Medicaid in the book, but there are many ways to set up barriers to prevent people from participating,” said Sidney Watson, Director of the Health Law Research Center of St. Louis University.

Expansion has been a difficult process in Missouri.legislature Refusal of funding The plan approved by voters prompted Republican Governor Mike Parson to announce in May that the state would “withdraw” its expansion plan.Then, in August, a judge Order The state started accepting applications, and it did. But Missouri will not start processing them until October 1.

Missouri Supreme Court revokes Medicaid expansion decision

Marcilil said the state has a responsibility to promote the plan, and what Missouri did was only the legal requirement of the court order in August.Criticism has been Echo of othersAccording to the Kansas City Law Professor at the University of Missouri, this whipping means that many newly qualified Missourians may not know that they are eligible for Medicaid. Ann Marie Marcilil.

Heather Dolce, a spokesperson for the Missouri Department of Social Services, which oversees Medicaid, said the department has promoted the expansion of the Medicaid program by updating its website, sending emails to family support program participants, and posting on social media.The department’s Facebook and Twitter accounts showed a number of posts about expansion, including two tweets Released the day after release KCUR article This shows that the state’s outreach work is progressing slowly.

At the same time, Oklahoma’s efforts include Outreach activities, TV interview, more than video with social media Activity.

In Missouri, without strong advertising, most outreach activities went to clinics such as Affinia Healthcare in St. Louis. When James Dickerson went to see a doctor about an ear infection, he saw a leaflet about the expanded Medicaid program at the front door of an Affinia clinic.

The 59-year-old is engaged in various jobs through temporary agencies, and he is eager to sign up. In 2014, when he underwent spinal surgery due to a work-related injury, he had good experience in Medicaid.

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At Affinia, Dickerson met Sunni Johnson, a certified application consultant, who got all the information she needed to send in the application in about five minutes. Most clinics like this have experts who can help patients enroll in health insurance and other assistance programs.

According to federal law, Missouri must determine whether an applicant is eligible for the program within 45 days. But Michelle Davis Reed, the lead qualification and registration coordinator of the Northwest Health Services Center in St. Joseph, Missouri, said in November that some of the applications she submitted in August had not yet been received. deal with.

Dolce said that as of November 17, there were 32,000 Medicaid applications pending in the state. She did not directly answer questions about the number of employees processing applications, but said that overtime is being used.

In Oklahoma, 144,000 Among the 210,000 Medicaid extension enrollees, there was no insurance before. When the state assesses whether people applying for other benefit programs are now eligible for Medicaid, the rest are admitted.

A Missouri plan that could be a candidate for this reprocessing is The gateway to healthier, A temporary insurance plan used by Sharon Coleman in St. Louis. Gateway covers approximately 16,000 residents in St. Louis City and St. Louis County, whose income is up to 100% of the federal poverty line.

Angela Brown, CEO of the St. Louis Regional Health Commission, which manages Gateway, said she believes that at least 90% of participants are eligible for Medicaid after the expansion, but bureaucratic barriers make it more important to encourage patients to directly participate in Medicaid than to join Medicaid directly. simple. The process required to move them into the new system. Gateway sent a text message to Coleman and other recipients, urging them to apply.

After receiving the alert, 60-year-old Coleman, who provides home care for the elderly, went to Affinia to participate in the Medicaid program. She suffers from high blood pressure, but other aspects of health are good-she said she has not been to the hospital since her son was born 40 years ago. Coleman was relieved to know that if she had to leave now, her bills would be paid by Medicaid. Gateway only covers elementary, specialist and urgent care.

“I can go to the emergency room now and don’t worry about them sending me bills that I can’t pay,” Coleman said after visiting admissions expert Johnson.

In Oklahoma, 26-year-old Danielle Gaddis has been out of insurance for two years. During that time, she was afraid of seeing a doctor and afraid of medical expenses. Therefore, when she fell ill recently, she was very happy to participate in Oklahoma’s Medicaid program. Like Dickerson and Coleman, Gaddis applied for Medicaid with the help of experts at the Mary Mahoney Memorial Health Center Health Clinic in Oklahoma City.

“Because of the new crown virus, a cold may be the end of the world, so you are terrified,” said Gaddis, who will start medical school in August after a year of delay.

Gaddis said that when she started her medical training, she always put the uninsured experience first.

“No one should worry,’How long will I have to endure before I go and see what’s wrong?'” Gaddis said. “This is how things get worse.”

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.