This monthly legislative update recaps the 2021 legislative sessions in Kansas and Missouri. We welcome the opportunity to collaborate with partners that share similar interests. Contact us if there are opportunities to work together to strengthen our collective advocacy voice.
Even in the midst of a pandemic, Kansas had a productive, albeit somewhat controversial, legislative session. Gov. Laura Kelly used her veto power to reject a historic number of bills, and although the Legislature was able to override most of her vetoes, there were still many compromises as a result.
Sine Die was held on May 26, but the Legislature will have plenty of work to do during the interim session to address COVID recovery funds and redistricting, among other topics. Medicaid expansion was again not passed, but there was some positive movement in health care access. Here is a recap of of what transpired throughout this session that relates to Health Forward’s policy agenda:
Despite the support of the governor, 2021 was not the year for Medicaid expansion in Kansas. Gov. Kelly introduced a bill that tied Medicaid expansion to medical marijuana. Although assigned to a committee, the bill did not receive a hearing. Sen. Dinah Sykes and Rep. Brett Parker attempted to amend bills in their respective chambers to add expansion, but both bills were ultimately defeated. Nonetheless, there is continued commitment and great work happening on the part of advocates across the state to expand access to 165,000 Kansans that fall into the coverage gap.
The Kansas Hospital Association, in conjunction with the Alliance for a Healthy Kansas, released an updated version of the Leatherman Report on the Economic Impact of Expansion in Kansas. Among other highlights, the report finds that in the first year of implementation, Kansas can expect between $35 million to $44 million in state revenues, between $26 million to $33 million in local government revenues, and create 13,593 new jobs.
Rural Emergency Hospitals and Mental Health
Gov. Kelly signed a Senate Substitute for HB 2208, establishing a new model for providing behavioral health services — the Certified Community Behavioral Health Clinic (CCBHC). This makes Kansas the first state to pass legislation identifying the CCBHC model to solve mental health and substance abuse issues. The bill sets a new designation of CCBHC for community mental health centers to achieve, which would open the door for health centers in Kansas. While six health centers are currently working toward the new designation, we expect all 26 existing community mental health centers eventually will receive the new designation.
HB 2208 also allows for rural emergency hospitals to benefit from higher Medicare reimbursement rates. The bill would allow existing facilities to provide around-the-clock emergency and outpatient services without delivering inpatient care. Congress established rural emergency hospitals as a new Medicare provider type starting Jan. 1, 2023. This provider type will furnish certain outpatient hospital services in rural areas to be reimbursed at enhanced reimbursement rates.
Health Care Access
In recognition of the merit and convenience of some of the adjustments made during the pandemic, SB 283 extended certain COVID health measures to March 21, 2022. These measures include the expanded use of telemedicine and the ability for the Board of Healing Arts to grant temporary emergency licenses. Health Forward is supportive of expanding the scope and reach of telemedicine to increase access to health services for hard- to- reach populations. This bill also extends the immunity from civil liability for providers and people who conducted business from COVID-19 claims.
Infant and Maternal Death
Two similar bills regarding the study and investigation of maternal deaths in Kansas were introduced in the House (HB 2108) and Senate (SB 42) during this session. Neither bill was signed into law. They would have required the secretary of health and environment to establish an external committee to review Black maternal death cases. According to the CDC, “Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women.” Health Forward views these bills as an important step toward racial and health equity in Kansas. Racial disparities in maternal health are a byproduct of health inequities; we hope to see them receive attention next session.
Supplemental Nutrition Assistance Program (SNAP)
Earlier this session, Health Forward, along with a coalition of over 30 organizations led by Kansas Action for Children, submitted coordinated testimony in favor of HB 2371. The bill would have removed cooperation with child support from the requirements for food and child care assistance, and also exempted adults enrolled in school from the work requirement for child care assistance. Removing these eligibility requirements for access to public benefits would be a much-needed relief for all Kansans facing financial hardship exacerbated by the pandemic. An individual’s ability to receive critical support, such as SNAP, should not be connected to their ability to pay child support. Cooperation requirements leave families more vulnerable and threaten children’s lives as well as custodial and non-custodial parents’ well-being. The bill received a hearing, and was voted favorably out of committee, but did not have success thereafter.
Public Health Authority
Back in March, Gov. Kelly signed SB 40 into law, which extended the State of Disaster Emergency and allowed the state to provide hospitals with PPE, support food banks and pantries, and continue COVID-19 response. The bill also included problematic provisions that revoked all executive orders related to the pandemic and stripped appointed local health officers of their power to impose restrictions and left the decisions to the elected county commissioners. While she did not agree with some of the provisions she signed into law, Gov. Kelly expressed her commitment to working with legislators and local leaders to ensure the health and safety of Kansans.
COVID-19 Vaccine Distribution
Kansas continues to vaccinate in all phases, and expanded eligibility in March to anyone age 12 and up.
As of June 2, 2021:
- 42.2 million doses of the vaccine have been administered
- 1.2 million residents (42.3 percent of total population) have initiated vaccination
- 38 percent of Kansans 18+ have completed vaccination.
After an eventful year, the 2021 Missouri Legislative session wrapped up on Friday, May 28. While this session was productive in its passage of legislation, it leaves many issues still unresolved. Most notable and important to Health Forward is the Legislature’s failure to appropriate funds for the expansion of Medicaid, per the constitutional amendment passed by voters in August 2020. Second, the Federal Reimbursement Allowance, which is normally renewed without opposition, was not passed during session. Discussions about how to distribute recovery funds are ongoing. Here is a recap of of what transpired throughout this session related to Health Forward’s policy agenda:
Last August, 53 percent of Missouri voters passed a constitutional amendment to expand Medicaid to individuals 138 percent of the federal poverty level. According to the constitutional amendment, implementation is mandated to commence by July 1, 2021. The Legislature, however, declined to allocate funding for expansion this session after a series of attempts and legislative maneuvers.
A lawsuit was filed on May 20, seeking declaratory injunctive relief to require the Department of Social Services (DSS) to start enrolling eligible Missourians on July 1. A hearing will be held June 18, after which the Circuit Court of Cole County may decide whether and when to begin expansion enrollment. Health Forward is monitoring this lawsuit as it progresses and is hopeful for a court ruling requiring DSS to begin enrollment soon.
Federal Reimbursement Allowances (FRA)
The FRA is a public/private partnership that has evolved over the years to maximize federal matching dollars and reduce the burden of MO HealthNet on state general revenue. The FRA is normally renewed without opposition, but the Senate failed to reach an agreement on the final day of session. Its failed passage (see bill text here) places a significant hole in the state’s budget. It is not yet clear whether there will be a special session on this issue.
Prescription Drug Monitoring Program (PDMP)
After nearly a decade of persistent efforts to create a statewide PDMP, Sen. Holly Rehder’s SB 63 was passed and signed by Gov. Mike Parson on June 7. Missouri has now become the 50th and final state to have a statewide PDMP program. In addition to creating a statewide program, the bill also includes language extending the RX Cares Program, an initiative of the Missouri Board of Pharmacy to educate residents about how Missouri pharmacists can assist with drug safety. Health Forward provided supportive testimony earlier this session and has been a long-time advocate for the creation of a statewide PDMP. We are pleased that the Legislature is supportive of this important legislation, and has taken action toward implementation. The legislation will go into effect on August 28, 2021.
Public Health Authority
Several public health authority bills circulated during this legislative session around local public health authority. Many of the bills would have limited the ability of local public health departments to make critical decisions during times of emergency. Ultimately a compromise was reached and added to HB 271, which includes provisions that, under a declared state of emergency, any closure or partial closure to a business can only be in effect for 30 days before needing a majority vote of the governing body of the political subdivision making the order to authorize an extension. The bill is awaiting Gov. Parson’s signature.
Also included within HB 271 was language found within SB 108, that would allow for two or more municipalities to form broadband infrastructure improvement districts for the delivery of broadband internet service to the residents of the municipalities. Reliable and accessible broadband access is a critical component of achieving health equity, and an issue on which Health Forward is keenly focused
Public Health Data
Earlier this year, Health Forward worked with Sen. Barbara Washington to draft language for SB 543, which was introduced in late February. The bill requires DHSS, local public health departments, all health care institutions, and all laboratories to collect and make publicly available demographic data that includes:
- Primary language
- Gender identity
- Disability status
- Socioeconomic status
The bill received a hearing in May, where our director of policy and strategic initiatives, McClain Bryant Macklin, offered supporting testimony, but it ultimately was not voted on. The disaggregation of data is a necessary piece for accurately identifying health inequities in Missouri, and a critical component of policymaking to address systemic injustices. We will continue working alongside Sen. Washington throughout the next few months to strengthen provisions within the bill, and build a coalition of support around this important issue for the 2022 session.
Supplemental Nutrition Assistance Program (SNAP)
The pilot program allowing SNAP recipients to use their funds at local farmers markets for fresh fruits and vegetables was set to expire this year. Health Forward went on record in support of extending the program, and ultimately advocates were able to find an alternative vehicle for this legislation in HB 432. after HB 594 stalled. This program extends an opportunity for individuals to access healthy foods in a sustainable way, benefitting both SNAP recipients and farmers alike.
HB 517 would have raised the age of purchasing tobacco to 21 across the entire state, but contained some concerning language that preempted municipalities from enacting their own tobacco regulations and innovating at the local level. Local governments know what is best for their own communities, and passed their own versions of Tobacco 21 ordinances and smoke-free laws locally.. Language from this bill ultimately did not make it onto any successful legislation. We strongly support policies that combat the harmful effects of tobacco use, and we hope to see legislation that supplements the positive changes municipalities have made in the last few years.
COVID-19 Vaccine Distribution
Missouri continues to vaccinate in all phases, and expanded eligibility in March to anyone age 12 and up.
As of June 2, 2021:
- 4.5 million doses of the vaccine have been administered
- 2.57 million residents (41.8 percent of total population) have initiated vaccination
- 44.3 percent of Missourians 18+ have completed vaccination