Missouri's Department of Social Services anticipates as many as 200,000 Missourians will lose their Medicaid benefits over the course of the next year, because their income has increased and they no longer qualify.

While the public health emergency was in effect, states could not remove anyone from their Medicaid rolls, but as the Medicaid "unwinding" has begun, the department is resuming annual renewals.

Kim Evans, director of the family support division for the Department of Social Services, encouraged everyone to be sure the state has their current contact information so they don't miss important forms and requests for information. They can do it in a number of ways.

"Individuals can go online and report that, at mydss.mo.gov, they can fax that to us, they can scan it to us," Evans outlined. "On our website we have a live chat, and somebody can report it to us that way also."

Evans pointed out there is also a resource center in every county for those who would like help in person. She explained the renewals will be processed the month the person originally qualified, beginning with June. The first round of annual renewal forms will be sent out the first week of May and must be returned by June 30.

Evans noted two circumstances will cause a person to receive a form.

"If we cannot verify the person's information, or the information we receive makes them totally ineligible for Medicaid, we will send an annual renewal form," Evans pointed out.

She stressed if people do not return their form on time, they risk a break in coverage. After the due date, they have 90 days to submit their information to have their case reopened.

Evans added the state is opening a new customer portal in early May, where all future forms and notices will be placed. She encouraged everyone to sign up once it is available.

"So they will be able to access this form that they'll be able to review, make changes," Evans explained. "Then they can submit that directly to the agency. That is really how we want everybody to complete their forms, because that populates the system."

Those who no longer qualify for Medicaid will be referred to the Marketplace to look for an insurance plan that works for them.


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Today is National Caregivers Day, recognizing those who help friends or family members who are living with an illness, injury or disability.

A 2024 report painted a picture of Montanans who rely on public assistance, a picture largely populated by caregivers.

The report, commissioned by the Headwaters Foundation, found about one in four Montana families, or 120,000, received income-based public assistance in a given year after Medicaid expansion. It noted most are working families with children, or family members who are older or disabled.

Bryce Ward, founder of ABMJ Consulting, compiled the report.

"It's not hard to imagine how they got into this situation," Ward pointed out. "They're just low-income workers or the people for whom it's hard to work. They're old or disabled, or they have kids or other caregiving responsibilities."

Medicaid expansion is getting a lot of attention in the current Montana Legislature. House Bill 245, which would continue the program beyond its original June sunset date, was referred to the Senate Committee on Finance and Claims yesterday after passing the House earlier this month.

A big takeaway from the report is there is no "typical" participant in public assistance and many who need it use it for brief time periods. Ward cautioned conversations in the policy and media spaces can have what he called a "dehumanizing element." He hopes the report will change it.

"These populations include all the different types of people in Montana," Ward stressed. "You probably know lots of people who have, or are on, income-based public assistance."

The median family of three with income around the poverty line receives about $400 a month in benefits, according to the report.


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South Dakotans passed Amendment F on Election Day, opening the door to impose work requirements on people who qualify for expanded Medicaid benefits.

Opponents said it could interrupt health treatment for those fighting cancer and other diseases. Any bill outlining work requirements for Medicaid would still need state passage and federal approval.

A report from the Congressional Budget Office on the effects of a similar rule finds it would reduce federal spending, decrease the number of people with health insurance and would not increase employment.

Ben Hanson, South Dakota government relations director for the American Cancer Society Cancer Action Network, said it would also cost the state.

"For the most part, state health departments will tell you, you're not going to save money by doing this," Hanson asserted. "You're going to wind up spending more to create a bureaucracy to oversee this new set of forms and paperwork they have to fill out, for an already qualifying population."

President-elect Donald Trump approved work requirements in 13 states during his last term, all of which were rescinded or withdrawn under President Joe Biden. South Dakota is one of nine states with pending programs or legislation to allow them.

Most adults with Medicaid benefits who are able to work are doing so. According to the health research organization KFF, of those under age 65 who do not have other state-sponsored care, 91% are either working, or not working because they are students, caregivers or are ill themselves. Hanson said, for instance, many people who go through cancer treatment miss work for several months because of its physical toll.

"This could take away your coverage for getting that treatment while you're trying to get better so you can go be an employee again," Hanson noted. "And more importantly, so you can survive your cancer diagnosis."

Hanson added work requirements might also prevent early cancer detection, which leads to more expensive treatment and worse outcomes.


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A new report from the Headwaters Foundation in Montana showed at least half the people who receive public assistance are only enrolled for one year, dispelling a myth recipients are getting long-term government aid.

Nearly two-thirds of people only receive one form of assistance. More than 120,000 Montana families receive government aid every year, based on their income.

Erin Switalski, program director for the foundation, said they wanted to know who the recipients are, why they are enrolled in public assistance programs and for how long.

"People are really receiving public assistance for short periods of time," Switalski reported. "We found that folks primarily are caregivers in the family. So, they might be caring for children; they might be caring for parents or an older adult."

The report found Montana's public assistance programs lift 69% of older adults and 44% of children out of poverty, and the numbers could be higher. The report estimated 40% of Montana families who are eligible for help do not get it because a variety of barriers prevent them from enrolling.

Bryce Ward, founder of ABMJ Consulting, was commissioned by the foundation to do the study, called "Supporting Our Neighbors." Ward said the variety of people on public assistance was surprising and well over half don't receive these benefits for more than a year.

"Those that are in for the longer periods of time are probably those you might imagine, right?" Ward observed. "They's the people who report more disabilities, families with young kids, and single parents."

The report also found 97% of families with children who receive public assistance but have no aging or disabled members in the household have at least one person who works full-time.