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THE SENIOR EFFICIENCY BLUEPRINT: WHY MISSOURI LOSES FIXED-INCOME CITIZENS TO STATES LIKE ALABAMA
To: Representative Chad Perkins, Speaker Pro Tem (Missouri House of Representatives)
From: John Dady, Lincoln County Constituent (iwriteyoushare.com)
Chad,
Following up on our conversation at the event, I wanted to put the exact policy blueprint in your hands. You are the Speaker Pro Tem. You oversee legislation. But like most lawmakers in Jefferson City, you have been kept in the dark about how your own state's safety net actually grinds down the seniors living right here in your district.
As I mentioned to you at the event, I am moving to Alabama because Missouri's current system simply does not treat dual-eligible seniors very well at all.
Below is the raw, unvarnished math showing how Missouri deliberately penalizes low-income seniors, contrasting it with the Alabama model that protects them. If you want to stop losing citizens and actually fix this system, this is where you start.
1. The Core Policy Error: The 85% Bottleneck
When a senior qualifies for both Medicare and state Medicaid, they are known as "Dual Eligible."
To qualify for standard, full state Medicaid (MO HealthNet for the Aged, Blind, and Disabled), Missouri has chosen to suppress its income limit to a strict 85% of the Federal Poverty Level.
The Missouri Trap: Because Missouri caps the baseline at 85%, the maximum income a single senior can bring in to qualify cleanly is a strict $1,131.00 a month.
The Alabama Standard: Alabama sets its baseline at the full 100% of the Federal Poverty Level, which is $1,350.00 a month for an individual.
My gross Social Security check is $1,266.00 a month. In Alabama, my check fits safely under the 100% poverty line, meaning I qualify for maximum assistance with zero penalties. But because Missouri uses the artificial 85% bottleneck, the state flags me as being over income.
2. The Cruelty of the Missouri "Spend Down"
Because Missouri flags my income as exceeding their artificial 85% threshold, they force me into a broken, bureaucratic extortion system called the Spend Down.
To determine the exact size of this penalty, the state runs a specific mathematical calculation. They take my gross income ($1,266.00), subtract the standard General Income Disregard ($20.00) to find my official countable income ($1,246.00), and then subtract Missouri's strict 85% income limit ($1,131.00). This leaves an exact total of $115.00, which becomes my mandatory monthly spend down penalty.
Every single month, Missouri locks my medical card. To activate my healthcare coverage for that month, I am forced to do one of two things: 1. Physically mail a check to Jefferson City for exactly $115.00 out of my fixed budget, or 2. Collect, track, and submit $115.00 worth of paper medical receipts to prove I am sick enough to get help.
It acts as a mandatory monthly penalty just because my Social Security cost-of-living adjustment pushed me past an outdated state cap. It forces seniors to pay a premium to the state just to access the care they already paid into their entire working lives.
3. The Age 65 "Eligibility Cliff"
The bureaucracy gets even more volatile when a citizen reaches retirement age. While a person under 65 qualifies for Medicaid based on a rigorous medical definition of disability, turning 65 shifts them into the "Aged" category.
For seniors who work part-time, this transition creates an immediate financial cliff. Under various pre-65 disability programs (such as Ticket to Work or specific state disability waivers), workers are allowed much more generous income allowances.
The exact month a citizen turns 65, Missouri terminates those specialized worker protections and drops them into the standard elderly spend down bracket. If that senior continues to work part-time to survive, their monthly spend down invoice from Jefferson City can instantly spike from a baseline amount to $157.00 or more overnight. The system literally punishes you for growing older.
4. The "Earned Income" Disregard: Penalizing the Will to Work
Let’s say a senior in Missouri needs extra cash to handle a real-world crisis—like fixing a transmission or replacing an unreliable vehicle.
By federal mandate under the Social Security Act, when a senior takes a part-time job, the state caseworker's computer must apply an Earned Income Disregard Worksheet to calculate "Countable Income": Take gross monthly wages, subtract the standard $65.00 work exclusion, cut the remaining balance in half (50%), and add that final number to the Social Security check to find the official "Countable" total.
If I make $800.00 a month at a part-time job, the formula says the state can only legally count $367.50 of it.
How Alabama Handles It: Alabama utilizes a clean, stair-stepped tier system for Medicare Savings Programs (SLMB and QI). When my countable income rises, I slide cleanly into a higher tier. My state-paid doctor copays drop off, but the state is still legally required to pay my $202.90 monthly Medicare Part B premium. One one locks my card, no one demands a monthly check, and I can save my $800.00 to buy a car.
How Missouri Handles It: If I earn that same money in Missouri, the state adds that $367.50 straight onto my existing Spend Down deficit. My monthly invoice from Jefferson City skyrockets from $115.00 to over $482.00 a month.
Missouri completely wipes out the financial benefit of working. If a senior tries to earn money to improve their life, Missouri raises their Spend Down invoice and takes the cash right back.
5. The Administrative Waste of Asset Testing & The "Revolving Door"
There is a final piece of structural waste in Jefferson City you need to look at immediately.
Right now, Missouri enforces a strict asset limit of $6,068.80 for a single senior applying for Aged, Blind, and Disabled Medicaid. If a senior manages to scrape together a tiny emergency nest egg in a checking or savings account that crosses this arbitrary line, they are disqualified.
But here is what your budget analysts aren't telling you: Missouri is burning millions of taxpayer dollars in administrative waste just to audit the bank accounts of the poor.
The High Cost of Bureaucracy
To enforce this $6,068.80 cap, the state of Missouri pays for a massive, automated electronic Asset Verification System (AVS). Every month, state caseworkers and automated software spend time and money pinging financial institutions, checking bank statements, tracking property deeds, and forcing seniors to submit mounds of financial paperwork. You are spending hard-earned taxpayer money on administrative overhead just to ensure that poor people stay poor.
The Costly "Revolving Door" of Re-Applications
When you kick a senior off coverage for exceeding the asset limit by a few dollars, they don't stop needing healthcare. Instead, they are forced to completely drain that tiny emergency savings safety net just to pay for a doctor or a basic life emergency.
Once they drop back below that arbitrary limit, they turn around and reapply for the exact benefits that were just taken away from them. This creates massive "churn" in the system. The state spends significantly more tax money paying caseworkers to process the exact same senior's paperwork multiple times a year than it ever "saves" by denying them. It is an expensive, redundant circle of government waste.
The Alabama Efficiency Model
Alabama realized that running a massive state apparatus to police the asset records of low-income seniors was a complete waste of government resources.
Alabama completely eliminated the asset test for the Medicare Savings Programs (QMB, SLMB, and QI). They only look at a senior’s monthly income. By cutting out the asset-checking bureaucracy, Alabama slashed the administrative workload for state workers, eliminated the need for expensive bank auditing contracts, and ended the costly revolving door of re-applications.
The Legislative Fix
Chad, seniors are packing up and leaving this state because Missouri's Medicaid rules treat a modest Social Security check like luxury wealth.
If you want to fix this in the next legislative session, the solution is simple:
Eliminate the 85% FPL Bottleneck: Sponsor a bill to raise Missouri’s Aged, Blind, and Disabled Medicaid baseline to match the federal 100% FPL standard used by Alabama and the majority of the country. This automatically erases the unfair spend down penalties for lower-income seniors.
Abolish the Spend Down Trap for Premium Tiers: Create a clean, seamless transition for seniors who work part-time so that their premiums remain covered under SLMB and QI guidelines without triggering a cash invoice penalty from the state.
Abolish the Asset Test for Premium Assistance: Follow the Alabama model. Stop spending millions in state resources to chase pennies, and stop penalizing seniors for keeping a basic emergency fund.
You now have the blueprint. The ball is in your court.
Sincerely,
John Dady
citizensagainsttyranny1776@gmail.com
iwriteyoushare.com