It’s now a law in Missouri that, if you’re on Medicaid, and you miss your doctor’s appointment without notifying the doctor 24 hours in advance, you can be charged a fine. The charge for the first missed appointment is $5, the second is $10 and the third is $20. Way to go, state legislature: You’ve just added a new poverty crime to the books.
The new law also allows providers in Missouri Health Net [Missouri’s name for Medicaid] to refuse to schedule new appointments until the missed appointment fee is paid.
Those fees may not sound like a lot to someone earning a middle-income paycheck or above, but they count. They’re a way of nickel-and-diming people who can afford it least. And they can be a barrier to healthcare for people who are financially disadvantaged.
Fortunately, the fee is unlikely to win approval from the federal government.
“They’ve consistently told states they cannot impose a missed appointment fee. I’m not sure that will ever be approved,” said St. Louis University School of Law Professor Sidney Watson of the Center for Health Law Studies.
But in Missouri, passing a law that is unconstitutional, or inhumane, or in violation of federal rules typically does not deter the Republican-dominated state legislature. Apparently, in their quest to pander to the worst instincts of their voter base, they like to go on record as being in favor of these extreme measures. Case in point: The Missouri legislature just enacted—over Democratic Governor Jay Nixon’s veto—a law that removes the need for a permit or any training if you want to carry a concealed gun. The law also institutes the “castle doctrine” or “Stand-Your-Ground” principle that allows you to shoot first, and ask questions later, if you feel—in any way—threatened. That law resulted in national media dubbing Missouri the “Shoot-Me” state.
The new missed-appointment fee is only the latest in the laundry list of poverty crimes that plague low-income people in Missouri, and elsewhere. Around here, you can pile up lots of fees—traffic fines, court costs, appearance costs—then get arrested for non-payment and put behind bars until you bail yourself out for a few hundred dollars. Then you get fired for not showing up to work, and lose your paycheck, which puts you back into the non-payment cycle.
Moral of the story: Don’t be poor in Missouri. But don’t count on your elected officials to help you, either.