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End the Medicaid Crisis in the Show-Me State

End the Medicaid Crisis in the Show-Me State

Take Care of Missouri’s Seniors!

By Rev. John Kotovsky
CEO, Lutheran Senior Services

In my work with senior living services, I am constantly called upon to advocate for older adults. It is rewarding work on multiple levels, because it blends my business background with my spiritual calling. Every day, I draw on my experience to help others live life to the fullest.

The state of Missouri is making it harder to do this. The Show-Me State is not providing adequate reimbursement for Skilled Nursing Facility (SNF) Medicaid.  As a result, care may be compromised for our state’s most frail citizens.

In the past two weeks, I have held Town Halls at Lutheran Senior Services communities in Central and Eastern Missouri to inform residents about the state’s SNF Medicaid shortfall. I have also shared this information with local media. The key take-away from these presentations and editorials is that Missouri is short-changing its skilled nursing residents by $25 a day.

According to Missouri’s own formula, $178 is required every day to provide care for every skilled nursing resident in the state. But Missouri pays only $153. The resulting $25 shortfall per patient per day (PPD) puts the Show-Me State in a precarious position. And an embarrassing one.

Despite the fact that Missouri knows the cost of care and sets its Medicaid rate accordingly, it pays just $15.26 out of its general revenue for each of its skilled nursing residents. That is not enough to provide even average care. Missouri’s neighboring states, on the other hand, pay on average $48.22 per day, more than three times the amount Missouri does. Bottom line? Missouri is neglecting its senior citizens.

What happens when Medicaid funds are not there for our seniors? Well, the care is not there, quite frankly. There are fewer Medicaid beds supported and nowhere for skilled nursing patients to go. It’s simple math.

But Missouri has turned this simple math into a complicated formula, resulting in one of the lowest per diems in the United States. Here’s how it works…or doesn’t: The state of Missouri requires all care centers to submit detailed information each year on the cost of care for those Medicaid patients they serve. The numbers submitted by care centers are then used by the state to calculate the reimbursement rate based on its own formula.

Though actual costs for skilled nursing care tend to be higher than the state of Missouri allowance, the state pays $25 less per patient per day (PPD) than its own calculations stipulate. And many skilled nursing providers don’t have the means to make up the difference.

What makes a bad situation even worse is the fact that Missouri is producing seniors at a faster rate than most states. With a higher median age than 28 other states, Missouri is likely to see increases in Medicaid applications sooner. Add baby boomers into the mix, and the problem will be magnified. How will we care for our seniors?

In Lutheran Senior Services’ retirement communities, we use the term “aging in place” to describe a continuum of care that allows seniors to stay in one community as their needs change. But what if our “community” is the state of Missouri? And what if “aging in place” means having nowhere to go?

It is not just the businessman in me that is angered and saddened by our state’s misguided priorities. It is the servant. I am an ordained minister with a responsibility to 11,000 seniors throughout the region.

I do not make it a habit of taking a public stance on political issues. But I will always advocate for seniors. Anyone who feels the way I do must stand up for those who have raised us and led us and taught us. We must demand that our lawmakers reimburse Medicaid for the full SNF amount. This is no time for Missourians to be silent.

Join Reverend Kotovsky in advocating for Skilled Nursing Medicaid. Learn more about Medicaid in Missouri and find legislative contacts and sample letters at


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