IPP Presents Medicaid Expansion work at MU School of Medicine Health Science Research Day & Missouri Department of Health and Senior Services Rural Health Day Conference
Wednesday, January 11, 2023 - 10:51 am

Authors: Emmie Harcourt – Graduate Research Assistant & Kristi Ressel – Senior Research Analyst

On Friday, November 18 IPP Graduate Research Assistant Emmie Harcourt will present a poster at MU’s 2022 Health Sciences Research Day on behalf of the research team examining Medicaid Expansion and the rural Missouri health care workforce. Her poster, titled Medicaid Expansion in Missouri: The Rural Provider Perspective, outlines preliminary results from the first phase of this study and outlines her role as lead interviewer of the qualitative phase of the project.

On Thursday, November 17 IPP Senior Research Analyst Kristi Ressel will present a session at the Missouri Department of Health & Senior Services Missouri Rural Health Day conference on behalf of the research team examining Medicaid Expansion and the rural Missouri health care workforce. Her session, also titled Medicaid Expansion in Missouri: The Rural Provider Perspective, outlines preliminary results from the first phase of this study.

Project Background

The Institute of Public Policy is working with Principal Investigator Dr. Kathleen Quinn, Associate Dean for Rural Health at the MU School of Medicine, to conduct a study on health care providers’ experiences with the changing landscape of rural health care capacity and need following Medicaid expansion. In 2020, Missouri voters passed a constitutional amendment to expand Medicaid to cover the adult population (18 to 64) with incomes up to 138% of the federal poverty line. Estimates of the size of the expansion population range from 225,000 to 275,000, with a greater proportion of new enrollees likely to come from rural and other health care workforce shortage areas (Missouri Medicaid Basics, 2020). While previous Medicaid research has primarily focused on enrollees, this study expands on a small body of emerging research on the health care providers available to care for Medicaid enrollees. This project includes two phases: key informant interviews and an online survey with rural Missouri health care providers. 

Key Informant Interview Themes

During the first phase of this project, key informant interviews were conducted with 17 health care providers between July and October 2022 (2 were excluded due to sample criteria; 15 interviews were analyzed). Preliminary findings suggest:

Rural health care providers in Missouri have generally favorable views on Medicaid Expansion and increasing access to healthcare:

“Health care is one of the few rights, in my opinion, that all people should have, along with education, clean water. I mean, there are certain things that they should have, and healthcare is, I believe, one of those things. So, yeah, I'm certainly in favor of Medicaid Expansion.”

Rural health care providers in Missouri worry about the capacity to care for new Medicaid enrollees, both at their practice and in the overall health care workforce:

“But right now, there aren't those providers out there. So yes, people have access, but do they actually have access? Because there aren't enough providers to provide the care for the number of people that are enrolled. So access in my mind there is a bit of a misnomer.”

Rural health care providers in Missouri experience challenges working with Medicaid, such as low reimbursement rates and high levels of administrative burden:

“Just because there's more people eligible to have it doesn't change the fact that it's not an insurance plan that's easy to work with.”


Rural health care providers in Missouri report issues with treating Medicaid patients, such as high no-show rates for appointments:

“One of the biggest challenges we often run into is getting patients to show up.”


Rural health care providers in Missouri are unlikely to have received formal training on Expansion or Medicaid in general:

“I honestly can't say that I've received any formal training on Medicaid expansion in the last two years.”

“Virtually none. I mean, I can't even point to anything. I knew that it was in the works, but as to the details, I don't know much about it even.”

Next Steps

During phase 2 of the project, we will conduct an online survey with a larger sample of Missouri health care providers using themes that emerged in the key informant interviews. Final results from this study will be used to inform policy makers, providers, and other partners via a summary report, peer-reviewed publication, and data dashboard. The data dashboards will be developed in partnership with the MU Center for Health Policy (CHP).

Funding Statement

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $12,095,043 with 10 percent financed with nongovernmental sources (Grant # 6 T99HP33557-03-02). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. PI: Kathleen Quinn, PhD.


Research Team

Jake Haselswerdt, PhD

Truman School of Government Public Affairs

University of Missouri



Kristi Ressel, MPH

Institute of Public Policy

University of Missouri



Emmie Harcourt

Institute of Public Policy

University of Missouri



Kathleen Quinn, PhD

School of Medicine

University of Missouri



Questions on these presentations can be directed to Emmie Harcourt at harcourtme@missouri.edu and Kristi Ressel at resselk@missouri.edu.