Lauren Crome, health policy analyst for Clay County Public Health Department, presented in the Thursday, September 4, 2025, SAFE meeting at the Excelsior Springs Hospital, a Missouri Patient Guide in response to the Reconciliation Bill Changes from the Missouri legislature. All changes will be effective January 1, 2027, except where noted. In addition to the Patient Guide, they have also put together a guide for providers, outlining key changes.
Missouri Medicare: How to Navigate the New Rules for Patients
Medicare Savings Programs (MSPs)
• Medicare Savings Programs are state-run programs that help people with low incomes pay for Medicare costs.
• New rules that were supposed to make it easier to enroll in MSPs are being blocked. This means 1.3 million low-income Medicare patients nationwide could lose help paying for Medicare costs like premiums, copays, and services. This is effective immediately.
Physician Payment Adjustments and Automatic Spending Cuts
• Doctors will see a temporary 2.5% increase in Medicare reimbursement. This is intended to protect patient access to care, but only lasts January 1, 2026 – January 1, 2027.
• Due to budget rules, Medicare is scheduled to lose $500 billion over 2026-2034 unless Congress acts. This could affect services or provider participation in the future.
• Begins 2026 unless Congress makes changes
Why This Matters for Patients
• Losing MSP coverage means you may have to start paying Medicare Part B premiums ($185/month in 2025) and higher out-of-pocket costs.
• Coverage interruptions can delay care, especially for patients who need medications, dental services, transportation, or long-term care.
• While the short-term physician payment bump may help access, long-term cuts could make it harder to find providers who accept Medicare.
The Department encourages citizens to do the following:
• Check their mail for notices from Social Security, Medicare, or Medicaid.
• Re-enroll in Medicare Savings Programs as soon as possible if you receive a termination notice.
• Ask your healthcare providers about changes to costs and coverage in 2026.
• Stay informed – use resources below to find the answers to your Medicare questions
Help is Available:
• Missouri CLAIM: 1-800-390-3330 (free Medicare counseling)
• KFF Medicare Updates: kff.org/medicare
• Medicare Rights Center: medicarerights.org
Missouri Medicare: Key Changes for Providers
• Medicare Savings Programs (MSPs) Enrollment
New federal rules to simplify enrollment/renewal in MSPs will no longer be implemented, effective immediately.
An estimated 1.3 million low-income Medicare beneficiaries nationwide could lose support with premiums, cost-sharing, and supplemental benefits.
Higher risk of coverage gaps
Expect more patients facing premium burdens, unpaid balances, and delays in seeking care.
• Temporary Physician Payment Adjustment
A 2.5% increase in the Medicare Physician Fee Schedule conversion factor applies for services between January 1, 2026 – January 1, 2027.
Short-term relief only; payments revert afterward unless extended.
• Sequestration Cuts (Deficit Reduction)
Unless Congress intervenes, Medicare will face automatic spending cuts totaling ~$500 billion (2026-2034).
Potential impacts include downward press on reimbursement, hospital payment updates, and Medicare Advantage/Part D subsidies.
Why This Matters
Uncompensated Care:
• Patients losing MSP coverage are more likely to delay care and present to emergency departments in crisis.
• Many of these patients’ balances are likely to remain unpaid.
Access Strain:
• Hospitals, rural providers, and FQHCs may see higher uncompensated care loads, especially where dual-eligible patients are concentrated.
Temporary Payment Boost:
• The 2026 physician rate increase may ease pressure briefly but creates uncertainty about long-term financial stability.
Program Stability:
• Sequestration cuts risk further squeezing provider margins and limiting participation in Medicare.
What Providers Can Do
• Screen for Eligibility: Encourage patients to reapply for MSPs/Extra Help annually to avoid lapses.
• Prepare for Unpaid Costs: Plan for higher rates of patient financial assistance and charity care needs.
• Monitor Reimbursement: Adjust practice and hospital financial planning for the temporary 2026 payment bump and potential sequestration cuts in 2026+.
• Advocate: Engage with state associations (e.g., Missouri Hospital Association, Missouri Primary Care Association) to keep legislators informed and encourage Congressional fixes.
For more information:
• Missouri CLAIM (Medicare counseling for patients): 1-800-390-3330
• Kaiser Family Foundation Medicare Updates: kkf.org/medicare
• Missouri Hospital Association Policy Briefs: web.mhanet.com
Missouri Medicaid: How to Keep Your Coverage Under the New Rules
Work and Activity Requirements
• Adults age 19-64 in Medicaid expansion must complete 80 hours/month of work or approved activities.
• Must report hours monthly to the state
• Exemptions: people who are pregnant or disabled, caregivers for young children, and medically frail patients.
• Apply for exemptions as soon as you qualify – do not wait until you lose coverage.
Eligibility Redeterminations
• Effective July 1, 2026
• Medicaid eligibility will be checked every six months (or more often if records don’t match).
• Keep contact info updated with MO HealthNet.
• Respond to all Family Support Division (FSD) letters right away.
• Submit proof of income and forms before the deadline to avoid termination.
Retroactive Coverage Shortened
• For most adults, Medicaid will cover only one month of past bills (two months for some groups).
• Apply as soon as you think you qualify – don’t wait for bills to pile up.
New Co-Pays for Some Adults
• Adults with income 100-138% of the Federal Poverty Level may pay up to $35 per service.
• Ask providers if a co-pay applies before your visit.
The Department encourages everyone to Start Now to Avoid Coverage Loss:
• Common causes of loss: missing work-report deadlines, ignoring renewal forms, outdated contact info, missing income documents.
• To prevent this:
Sign up for an online FSD account to track status.
Mark renewal/reporting dates on your calendar.
Keep proof of document submission (email confirmations or certified mail receipts).
This information was last distributed on August 22, 2025. For any updates that may be made, please refer to the Clay County Public Health Department.
Missouri Medicaid: Key Changes for Providers
Work and Activity Requirements
• Medicaid expansion adults (ages 19-64, income at or below 138% FPL) must complete 80 hours/month of work or qualifying activities.
• Monthly reporting required; missing reporting will trigger coverage termination
• Likely to cause churn and coverage gaps, even for eligible patients, due to paperwork and verification delays.
Provider Action:
• Implement coverage status checks at every appointment starting in late 2026.
• Train front-line staff to ask about work reporting and exemptions.
• Create quick referral pathways to community organizations for patients at risk of losing coverage.
Increased Eligibility Redeterminations
• Effective July 1, 2026
• Medicaid eligibility verification required every 6 months (previously annual).
• Many patients will lose coverage due to procedural denials (missed mail, incomplete forms).
Provider Action:
• Encourage patients to update their contact information with FSD.
• Add reminder prompts in EHR for follow-up visits during redetermination months.
• Prepare for higher self-pay volume and assist patients with re-enrollment.
Retroactive Coverage Reduction
• Retroactive coverage window reduced to 1 month for most adults, 2 months for some groups (previously 3 months).
Provider Action:
• Verify coverage before delivering non-emergency care.
• Accelerate Medicaid applications for uninsured patients – especially those admitted to inpatient care.
New Co-Pays for Certain Adults
• Adults with income between 100-138% FPL may be charged up to $35 per service.
Provider Action:
• Adjust billing systems for new co-pay collection and patient notification.
• Prepare scripts for staff to explain co-pays to patients without discouraging care.
Provider Tax Reduction and Funding Changes
• Phased in 2027-2031*
• Missouri provider tax cap reduced from 6% to 3.5% – may reduce Medicaid funding to hospitals, especially rural and safety-net providers.
• Limits on supplemental and directed payments could cut DSH and uncompensated care funding.
Provider Action:
• Reassess Medicaid payer mix and long-term financial planning.
• Engage in state-level advocacy to maintain supplemental funding.
Home and Community Based Services Impact
• Increased administrative requirements and reduced funding may expand HCBS waitlists.
Provider Action:
• Notify HCBS patients about possible delays.
• Partner with community agencies to maintain service continuity.
Anticipated Coverage Loss in Missouri
• Estimated 130,000-170,000 Missourians could lose coverage in first year of implementation.
• Disproportionate impact on rural areas, children, and patients with disabilities.
Provider Action:
• Develop continuity-of-care plans for high-need populations.
• Educate patients proactively about changes starting in 2026.
Key Dates for Providers:
• Now – 2026: Update patient intake processes; train staff on upcoming changes.
• July 1, 2026: 6-month eligibility redeterminations begin.
• January 1, 2027: Work requirements, co-pays, and reduced retroactive coverage take effect; HCBS waitlists may grow.
• 2031: Full provider tax cut in effect – possible financial strain on rural and safety-net hospitals.
Resource Links
• Missouri MO HealthNet Provider Info: dss.mo.gov/mhd/providers
• Providers Billing Manuals and Bulletins: dss.mo.gov/mhd/providehttp://dss.mo.gov/mhd/providersrs/bulletins
• Missouri Hospital Association: web.mhanet.com
• Cover Missouri (patient enrollment help): 1-800-318-2596
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