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Missouri and Idaho’s Medicaid programs are handcuffed by Congress

The pandemic is over, and it’s time to end the public health emergency. 

Thanks to the Biden administration’s never-ending continuation of the emergency declaration, pandemic-era policies also continue in perpetuity. 

This is great news if you love big government—bad news for everyone else

For Missouri and Idaho, as long as the public health emergency declaration exists, so do big problems for their state Medicaid programs. 

Two recent Foundation for Government Accountability (FGA) research papers dive into the enrollment surges plaguing Missouri and Idaho’s Medicaid programs. Medicaid expansion and COVID-19 were a one-two punch for these states. One, they expanded Medicaid with ObamaCare, shattering enrollment projections with a surge of able-bodied adults signing up for the program. And two, another surge of enrollment came during the pandemic, with Congress offering extra funding with major strings attached that ban states from removing residents from the program, even if they’re ineligible to receive benefits.

Medicaid is meant to serve the truly needy—the elderly, pregnant women, low-income families, and people with disabilities. It was never intended to be a catch-all for millions of able-bodied adults without dependents. Yet now we have a record number of enrollees. 

Here’s a closer look at the situation in these states:


Issues with Medicaid are nothing new to Missouri. Prior to ObamaCare expansion, the state had one of the largest programs in the country, accounting for nearly 40 percent of the state’s entire budget in 2020. Since 2000, Medicaid spending in Missouri has nearly quadrupled with total Medicaid spending now reaching more than $11 billion.

The state also faces an enrollment crisis. Nearly 300,000 able-bodied adults have been added to the state’s Medicaid program in the past two years alone. More than one in five Missourians are now enrolled in Medicaid.

Thanks to the Medicaid handcuffs since the pandemic began, the are also nearly 500,000 ineligible enrollees on Missouri’s Medicaid program and it’s costing taxpayers approximately $400 million per month. The federal funding doesn’t cover all this added cost.


Like Missouri, Idaho’s Medicaid program started getting out of control after expansion, with the congressional handcuffs making it nearly impossible to get it back under control. 

As of January 2021, there were at least 83,000 ineligible enrollees on Medicaid in Idaho. This means a monthly price tag of tens of millions of dollars, plus budget and enrollment turmoil that will only continue to grow until the public health emergency officially ends. 

What can states do?

Missouri and Idaho aren’t alone in this. Enrollment is surging across the country, and most states are in the same boat. The issues plaguing Medicaid, especially in states that expanded through ObamaCare, are going to take several reforms to even begin to address. 

But the best step states like Missouri and Idaho can take to make dramatic improvements is to remove Congress’s handcuffs. It’s the only way to reduce the deficits and get state Medicaid programs back under control. 

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