As Congress deliberates over $715 billion in reductions to Medicaid over the forthcoming decade, a new resource from Washington University in St. Louis is assisting in grounding the national conversation in empirical evidence.

Initiated earlier this year, the Medicaid Policy Analysis Lab has started publishing a series of relevant policy briefs illustrating how legislative choices affect individuals — particularly in Missouri, where Medicaid enrollment ranks among the highest in the country. The lab operates under WashU’s Center for Advancing Health Services, Policy & Economics Research (CAHSPER).

Congress aims to enact comprehensive budget and tax legislation prior to Memorial Day.

“Our objective is to provide facts and statistics that promote informed decision-making,” stated Timothy D. McBride, the Bernard Becker Professor at the School of Public Health and co-director of CAHSPER.

Trends in Missouri Medicaid

Among the laboratory’s initial publications are three briefs examining Missouri-specific trends:

• Rural-urban disparities: Rural residents in Missouri are significantly more inclined to depend on Medicaid than their urban counterparts — 23.8% versus 15.8% — yet they endure a higher uninsured rate (9.5% compared to 6.8%).

• Employment status: Almost two-thirds of Missourians aged 19 to 64 enrolled in Medicaid are gainfully employed. Those who are unemployed frequently cite significant obstacles including illness, disability, caregiving duties, continued education or retirement.

• Shifts in Disability: Some individuals who may have qualified for disability benefits instead opted for enrollment in Missouri’s Medicaid expansion initiative. This transition has helped decrease state expenditures, as Medicaid expansion outlays receive a greater federal matching rate than other Medicaid expenditures.

CAHSPER also offers a Missouri Medicaid Enrollment Dashboard, a public resource that visualizes enrollment statistics by region, county, and managed care organization. The dashboard monitors enrollment patterns in real-time and has become a trusted reference for policymakers and media professionals.

U.S. Sen. Josh Hawley, R-Mo., referenced the dashboard in a May 12 New York Times editorial titled “Don’t Cut Medicaid.” Hawley mentioned that approximately 21% of Missouri’s populace is currently enrolled in Medicaid — a figure obtained from CAHSPER’s publicly accessible tracking tool. Views of the WashU Medicaid dashboard spiked by 300% following Hawley’s mention of its data in the editorial, soaring from an average of 70 views per day to over 1,400 within five days.

“It’s encouraging to observe our work being referenced as a reliable source for information like this,” remarked McBride, who was the center’s director when the dashboard was created. He also acted as the principal investigator on the grant that financed the dashboard and the lab’s recent policy briefs.

McBride co-leads the Medicaid Policy Analysis Lab alongside Abigail Barker, a research associate professor at the School of Public Health, who developed and oversees the dashboard.

“Missouri Medicaid has a long-standing commitment to transparency by publishing comprehensive data on all aspects of enrollment, but that information is often difficult to access as tables in monthly PDF documents,” Barker noted. “We aimed to present that data visually, in a user-friendly format that stakeholders can easily grasp — and which allows for quick reference to essential statistics, like the one cited by Senator Hawley.”

A broader objective

CAHSPER co-director Karen Joynt Maddox, MD, an associate professor of medicine at WashU Medicine and public health, collaborates with McBride to steer the center’s overarching mission: closing the gap between research and policy by generating applied, data-informed insights that influence real-world decisions and enhance public health.

As discussions about Medicaid and health insurance gain momentum, the center’s output is frequently referenced in state and national media for its clear and accessible analysis. CAHSPER’s resources and briefs elucidate what proposed alterations could signify beyond mere fiscal impacts.

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