Missouri Minute: Sports betting bill heads to House floor; lawmakers assess Missouri Medicaid

Good morning, MBA readers,

Since mid-2018, Missouri has seen a 13% dip in Medicaid enrollment, which has reportedly saved the state millions of dollars. One prevailing explanation in Jefferson City was that an improving economy has empowered more Missourians to seek private health plans. That narrative, however, has begun to shift this week as Republican lawmakers and state officials turn the blame to a flawed system for gatekeeping the public option.

In a legislative hearing Tuesday, state health officials testified that they had a “very limited” system to check who was actually eligible for Medicaid from January 2014 until the summer of 2018. That corresponds with recent trends in Missouri’s Medicaid enrollment, which climbed from around 840,000 in October 2014 to a peak of 997,000 by April 2017. Once the screening system began working properly, the state began purging the rolls of people who were not eligible. Since July 2018, the state has dropped around 125,000 people from Medicaid.

This trend is widespread, with enrollment drops in 37 states, but it is more pronounced in Missouri than anywhere else. According to a report from the left-leaning Center on Budget and Policy Priorities, Missouri shed 10.5% of its total Medicaid rolls and 12.8% of children enrolled in the program between March 2017 and March 2019, the sharpest cuts in the nation. About 80% of the nearly 103,000 people dropped in that period were children.

A flawed screening system and a high threshold for eligibility are the likely culprits for the above trends. Missouri remains one of the 14 states that have not yet implemented Medicaid expansion under the Affordable Care Act. The 2010 health care law called for expanding Medicaid to cover those earning up to 133% of the federal poverty line, but the Supreme Court in 2012 made that expansion optional. Today, Missouri maintains one of the lowest eligibility caps in the nation at 122% of the federal poverty line, higher than only the 118% caps in Texas and Alabama.

All of this could play a role in November if a measure to expand Medicaid makes its way to Missouri’s ballot. The new explanation for why so many were dropped from the state’s Medicaid rolls comes as Missouri Democrats ramp up their criticism of Gov. Mike Parson’s administration, and already it can be sees shaping their message and agenda. At least one new House bill would give children continuous 12-month Medicaid coverage, and State Auditor Nicole Galloway has made Medicaid expansion a flagship issue for her gubernatorial run.

Read on for more about Missouri’s Medicaid program and other business news from around the state.


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Sports wagering bill heads to Missouri House floor
The bill, which would legalize sports betting and slot machines, cleared a Missouri House committee Tuesday and is headed for debate on the floor. The bill would limit the use of video slot machines to “entertainment districts” like Kansas City’s Power & Light District and Ballpark Village in St. Louis. (Missourinet)

Krewson asks Bi-State to rethink rejected Loop Trolley plan
St. Louis Mayor Lyda Krewson on Wednesday called on the Bi-State Development Agency’s board to reconsider a rejected plan to reboot the shuttered Loop Trolley. She expressed concern that the Federal Transit Administration could sue to recover $25 million in federal grants if there is no “way forward” for the trolley. (St. Louis Post-Dispatch)

Hartzler opposes Medicare negotiating prices with drugmakers
U.S. Rep. Vicky Hartzler, a Republican, has voiced her opposition to a Democratic bill that would allow Medicare to negotiate cheaper prescription prices with drug manufacturers. Hartzler, who represents Missouri’s Fourth District, is the co-sponsor of another bill aimed at addressing drug prices. She argues the Democratic proposal could “stifle innovation” in pharmaceutical and life sciences research. (Columbia Missourian)

St. Louis law firm takes on Shell Oil in 401(k) case
Law firm Schlichter Bogard & Denton is representing four participants in Shell Oil’s 401(k) plan in a lawsuit challenging the $10.5 billion plan’s fees and handling of confidential data. The firm has previously negotiated settlements in similar cases against Boeing, Lockheed Martin and multiple universities. (St. Louis Business Journal)

New York state pension fund might divest from Arch Coal, Peabody
The third-largest state pension program is considering whether to divest from 27 coal companies including St. Louis’ Arch Coal and Peabody Energy, potentially affecting $98 million in holdings in the next two months. New York state officials are said to be in talks with companies that make at least 10% of their revenue from coal production about whether they are working to working to adopt cleaner energy sources. (Reuters)

Federal judge denies deal to relieve public defender workload
A U.S. district judge has rejected a deal between Missouri’s public defender system and the American Civil Liberties Union of Missouri that would have capped public defenders’ caseloads to about 173 hours per month. The public defender system is seeking $61 million in state funding this year, up from the current budget of $51 million. (St. Louis Public Radio)

New Waddell & Reed advisers bring $250 million assets
The Overland Park, Kansas-based financial services firm has hired five independent financial advisers who bring 125 years of combined experience and $250 million in assets. The company had nearly $70 billion in assets under management at the end of 2019. (Kansas City Business Journal)

Lambert officials, business groups working to lure London flights
Recently unveiled emails confirm that local business groups Civic Progress and AllianceSTL are working with St. Louis airport officials to court British Airways for a nonstop flight to London. St. Louis Lambert International Airport leadership said the airport is prepared to cover landing fees for 18 months for a carrier that starts flights to Europe, likely totaling $800,000 to $1.5 million. (St. Louis Business Journal)

Missouri flunks lung association tobacco control test
The state, which has the lowest tobacco tax rate in the U.S., received an “F” for its efforts to get people to stop smoking, according an annual report from the American Lung Association. While the report criticized state lawmakers for taking “little action” to reduce tobacco use, it applauded local governments that raised the minimum age to buy tobacco products from 18 to 21. (Kansas City Star)

Trump accuser claims stake in St. Louis Railway Exchange project
Lev Parnas, a central figure in the impeachment trial against President Donald Trump, was reportedly promised a 50% stake in the partnership that would own the high-profile development of the Railway Exchange building in St. Louis. In 2017, Parnas and an associate sued Hudson Holdings, the company behind the project, claiming they were cut out of the deal after the pair arranged a $10 million loan to Hudson from a Hungarian firm. (St. Louis Post-Dispatch)

Nestlé Purina announces five startup prize winners
The St. Louis-based petcare company has selected five out-of-state startups for the 2020 class of its annual Pet Care Innovation Prize program. Each startup won a $10,000 grant and will take part in a weeklong accelerator program at Purina headquarters in St. Louis. (St. Louis Post-Dispatch)

‘Shark Tank’ casting call coming to KC next month
ABC’s “Shark Tank” is planning an official casting call Feb. 21 in Kansas City. The event is part of the Shark Tank Diversity Tour, but the casting call is open to all would-be entrepreneurs seeking investment. (Startland News)

St. Louis-area bank names new president
Rick Parks will replace Gary Hemmer as president of First National Bank of Waterloo when Hemmer retires on June 30. Parks previously served as senior vice president of commercial banking for the Bank of Edwardsville. (St Louis Business Journal)

Lawsuit blames St. Louis-area oil refineries for 24-year-old’s cancer
Tyler Orlandini, who is represented by the Dysart law firm in St. Louis, has sued 12 current and former operators of oil refineries in the area, claiming pipeline leaks and a “toxic plume” of dangerous chemicals caused his cancer. Orlandini, who has acute lymphocytic leukemia, is seeking at least $500,000 from defendants including BP, ConocoPhillips and Shell. (The Telegraph)


Say that again

“There’s been a lot of headlines made about how many children had been kicked off the rolls in the last year. But we don’t spend a lot of time going back far enough to talk about how those numbers actually increased in the first place.”

That’s state Rep. David Wood, R-Versailles, who said a flawed screening system is to blame for the sharp drop in Missouri’s Medicaid enrollment, the St. Louis Post-Dispatch reports. State officials told lawmakers this week that, for years, Missouri failed to adequately screen Medicaid enrollees for their eligibility, resulting in a spike in enrollment. In 2014, the state introduced a new system to determine Medicaid eligibility under the Affordable Care Act, but that system was reportedly not working properly until 2018. The Department of Social Services also cut 300 positions hoping the new technology would streamline the process. “We were doing very limited, very few reviews during that time frame,” said Patrick Luebbering, the department’s chief financial officer and former director of its Family Support Division.


Go figure

12%

That’s how much the number of people receiving opioid prescriptions in Missouri’s Medicaid program dropped in 2019, to a total of about 110,000 patients, the Associated Press reports. In the same year, the quantity of pills prescribed dropped 25% to about 23 million pills and overall potency of those prescriptions dropped 30% to around 253 million milligrams of morphine. That’s a substantial decline from the peak in 2010, when roughly 183,000 Missouri Medicaid patients received nearly 52 million pills with potency equal to 726 million milligrams of morphine. MO HealthNet, which administers the state’s Medicaid program, said the figures reflect lower opioid use for short-term prescriptions after an injury or for chronic pain. Preliminary data suggests a 10% reduction in opioid deaths in Missouri in 2019, said Randall Williams, director of the Missouri Department of Health and Senior Services.


Hello, my name is

NEXT Missouri

That’s the name of a new policy coalition looking to renew funding for the beleaguered Missouri Technology Corporation, Startland News reports. NEXT Missouri is comprised of 17 policy-focused organizations and is backed by the Economic Development Corporation of Kansas City. Quinten Messbarger, vice president of the Missouri Innovation Center in Columbia, said boosting funding for the MTC is vital to supporting early-stage startups and startup competitions like LaunchKC, which was previously bankrolled by the agency. In recent years, the MTC has seen its budget reduced, jeopardizing the future of its programs. NEXT hopes to change that by highlighting state job data that shows nearly 80% of new Missouri jobs were created by startups. The group hopes to grow its membership to 5,000 individual entrepreneurs and 50 organizations by 2022.


It’s been a pleasure doing business with you this morning.


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