In Kirksville, Missouri, an entire floor of the hospital sits empty. The community could easily fill beds with patients — if only it could hire nurses and other workers to tend to them.

Just up U.S. 63 near the Iowa border, the Schuyler School District can’t keep teachers on the payroll.

A manufacturer wants to open its doors in the area, but worries about finding workers.

Although the open jobs may suggest otherwise, plenty of people want to live in rural Missouri — if they could find somewhere to live. The housing shortage across the state makes that difficult and thwarts efforts to draw workers and fuel local economies.

In smaller communities, homes are often old and need thousands of dollars in renovations to become livable, or they are newly built and more expensive than what many people can afford.

The rise in institutional investors that own and rent out single-family homes makes things worse, said Paula Hubbard, a real estate agent in Bolivar, Missouri.

“We face the same dilemma that everyone faces across the country,” Hubbard said.

But in a small town like Bolivar, every housing unit counts.

“We feel it on a smaller scale,” Hubbard said. “The difference of one, two or three houses has a reverberating effect in our community.”

Missouri’s affordable housing dilemma

Missouri’s population is consistently growing, though some parts of the state are seeing more growth than others.

And while the population grows, the supply of affordable housing wanes. A 2020 report from the Missouri Housing Development Commission found a shortfall of nearly 128,000 affordable rental units in the state. For every 100 low-income households in Missouri, only 31 affordable units were available.

The report stated that rural affordable housing projects aren’t perceived as a priority, despite 48% of the agency’s spending going to rural areas.

Another 8,300 affordable units will likely lose their status as affordable housing units by 2030 and consequently no longer qualify for tax credits, said Jeff Smith, the executive director of the Missouri Workforce Housing Association.

When those tax credits — handed out to developers in return for keeping rents low — expire, the landlords can charge higher market rates.

And new housing units aren’t built at a rate that matches the low-income units that sunset.

“At the rate we build through (the program),” Smith said, “we don’t come anywhere close to replenishing the number of units that lapse out of affordability each year.”

In Hubbard’s area, the hospital is in the middle of an expansion. But she’s concerned about where the staffers who will work in that hospital will live.

“As far as entry-level affordable homes, it’s almost impossible,” Hubbard said. “In every instance, it is a struggle to find someone the right house.”

Developers get subsidies for building low-income housing, and they see demand to build new homes for upper-middle class families. In the meantime, those who fall outside of those categories are short on options.

It’s a chronic problem in Missouri. With interest rates high, homeowners don’t want to sell, leaving inventory low. And homebuilders aren’t keen to drop a brand-new development into a small community when they aren’t sure enough people can afford to buy them.

Housing experts point to the idea of the “missing middle housing,” like smaller homes or duplexes that more people can afford. It’s housing that isn’t eligible for tax credits or other construction subsidies. Despite the demand, those styles of homes aren’t popular among developers.

A nonprofit regional planning commission in northeast Missouri thinks it has found a path to catalyze growth.

How northeast Missouri wants to solve its housing shortage

The Northeast Missouri Regional Planning Commission covers six counties in the top right corner of the state, including Adair, where Kirksville is located.

The group conducted a housing needs study and found that the area had the capacity for another 450 housing units. Employers and real estate agents who responded to the survey said they mostly need housing for workers.

To meet that demand and with buy-in from local electric cooperatives, the planning commission created a fund to build homes in the $180,000 to $240,000 range.

The commision wants to start with one home in each of the six counties it covers. The homes will be sold to the first eligible buyer, so bidding wars that drive up the prices won’t be a factor. To minimize the strain on local utilities, they’re building on lots where homes have been demolished or abandoned.

Derek Weber, the executive director of the planning commission there, said that 65% of the homes in the area were built before 1960. Those homes have a median price of $90,000. Another 20% of the homes in the area were built after 2008 and have a median price of $400,000.

That leaves a sizable gap when it comes to affordable homes.

“The middle 10% is your workforce housing,” Weber said, “and there’s just no stock.”

Because Missouri’s regional planning commissions are nonprofits, they and others who use the potential state program to build homes won’t profit when they sell them. Instead, the purchase price of one home goes to building another. And so on. Local lumberyards and construction companies will still get paid, but developers won’t make a profit from the sale of the homes.

Weber stole the idea from Nebraska. In 2017, Nebraska passed a rural workforce housing grant, which created a nearly $30 million fund to distribute to nonprofits across the state to build housing units to help attract workers to rural areas.

The northeast planning commission broke ground on its first project in March. And it wants Missouri to expand the program across the state.

Republican Rep. Greg Sharpe, who represents the area in Jefferson City, introduced legislation that mirrored Nebraska’s program during the 2024 legislative session.

During a hearing on the legislation, Michael Scheib, the CEO of Tri-County Electric Cooperative, a partner on the project, said that the Schuyler School District and area hospitals are interested in purchasing one of their homes.

“When we sit down with superintendents, they’ll say, ‘We get a teacher for one or two years, but the housing isn’t very good,’” Scheib said. “Schuyler schools are actually thinking about buying one of those houses and making it where a couple of young teachers could live in that house.”

Hospitals are eyeing the same approach when it comes to finding housing for their traveling nurses, he said.

“That’s my neighbors that can’t be served at that hospital because they can’t get nursing,” Scheib said, “because they don’t have places for those nurses to live.”

The planning commission and its partners believe that the undertaking is a way to slowly stir growth in their communities.

“We’re not looking to make a profit. We are looking to grow northeast Missouri,” Weber said during the hearing. “We’re trying to serve our community and create a way to bring a workforce to our region.”

With limited traction on the bill in 2024, Weber thinks next year will bring better luck. After the groundbreaking and as the word spread across the state, other groups like the Southeast Missouri Regional Planning Commission are watching to see if they could mimic the structure.

Despite all of the need for housing across Missouri, Weber said he felt that lawmakers in Jefferson City didn’t realize how bad the problem is.

“From the lawmakers I’ve spoken with, they look at it like it’s not their priority to get involved,” Weber said. “I don’t think they’ve attached the amount of homes we have to the workforce needs.”

The post Why rural Missouri schools and hospitals might become homebuyers appeared first on The Beacon.

Summer may be half over by the time Kansas families get extra food aid meant to see them through long hot days when school breakfasts and lunches disappear.

For Missouri families, the aid may not arrive until a new school year is well underway.

But that still beats the 13 states where families won’t be getting any help with summer groceries because state leaders skipped the federal government’s new $2.5 billion summer food assistance program known as Sun Bucks.  

Public health advocates, pointing to growing food insecurity among low-income Kansans and Missourians, said they are pleased — and somewhat surprised — that this time conservative politicians in their states accepted federal aid.

“It was surprisingly pretty easy,” said Christine Woody, food security policy manager with Empower Missouri. “I thought there was going to be a lot of pushback.”

Missouri and Kansas, both controlled by Republican-dominated legislatures, could have done as  they did with Medicaid expansion and opted not to accept federal dollars, advocates said. Missouri voters later passed a ballot measure that expanded the low-income health insurance program anyway. But Kansas still hasn’t opted in. 

The states also could have followed the lead of Iowa, where Republican Gov. Kim Reynolds rejected the summer food aid, saying the program didn’t do enough to ensure that kids got nutritional food. Or Texas, which turned down the federal program because state bureaucrats said it came with too many technical hurdles and required too many matching state tax dollars.

Instead, Kansas agreed to take part almost as soon as Congress passed funding for the summer food assistance program in December 2022. And Missouri made its participation official earlier this year, just before a deadline.

The program will provide an additional $120 per child for summer groceries to an estimated 266,000 Kansas children and 429,000 Missouri children. Even if the dollars won’t reach families at the start of the summer, and possibly not before summer is over, the money will still help.

“I personally know kids whose only meal for the day is what they have in school,” said Ruchi Favreau, director of nutritional services for the Kansas City, Kansas, public schools.

The extra dollars this summer will extend a lifeline for them and thousands of other kids around the state.

“It can make a huge difference,” said Karen Siebert, public policy and advocacy adviser for Harvesters Community Food Network, which works with food banks in Missouri and Kansas. “Especially now with food inflation where it is, even if it’s not here for the summer, hopefully in arrears, (the extra money) can help.”

The climbing cost of food, combined with the end of pandemic-era government aid programs, contributed to a sharp rise in the number of Americans considered to be living with food insecurity. The term describes people who don’t have enough to eat and don’t know where their next meal will come from. 

The national anti-hunger advocacy group Feeding America’s May report says 13.5% of Americans met the criteria for food insecurity in 2022, the most recent year data is available, compared with 10.4% in 2021. 

That amounts to 44 million Americans, or one in every seven people, and includes 13 million children. That is a major jump. In 2021, the report said, about 34 million Americans were considered food insecure. 

Feeding America estimates that 13% of Kansans faced food insecurity in 2022, compared with just under 10% in 2021. That included about 131,430 children or 19%, up from 94,000 or about 13% in 2021.

In Missouri, the group estimates that about 15% of the population faced food insecurity in 2022, compared with 11.6% the previous year. In 2022, that number included almost 255,000 children, close to 19%, compared with 177,000 children or almost 13% in 2021.

Dr. Heidi Sallee, a St. Louis pediatrician who is the incoming president of the Missouri chapter of the American Academy of Pediatrics, said she sees the consequences of food insecurity every day when patients come in with iron deficiency anemia. The condition, often caused by an unhealthy diet, means kids don’t have enough red blood cells carrying oxygen to their organs and brain.

“They’re more tired,” she said. “They don’t have as much energy. And it can affect their development and learning.”

She hopes the extra food aid coming to families through the summer EBT program will help parents buy meat and green leafy vegetables, foods they need to reverse iron deficiency anemia.

“Our bodies absorb nutrients through fresh food,” she said.

But fresh food can be difficult, if not impossible, for many families to afford during the summer. Families increasingly rely on public schools to feed their children breakfast and lunch. When summer comes and those meals go away, many families run into trouble. Sun Bucks is supposed to help cover the gap.

Similar to food aid offered to poor families during the COVID pandemic, the summer EBT program gives families extra money through an electronic benefit transfer card. The benefit comes to $40 per month for each eligible child.

Children 7 to 17 years old are eligible if they received food assistance through SNAP (the Supplemental Nutrition Assistance Program, sometimes called food stamps), Temporary Assistance for Needy Families (TANF) and/or foster care benefits at any point during the school year. Children who qualify for free and reduced-price lunch at school also qualify.

Funds will be loaded on existing food assistance accounts or issued as separate EBT cards, which families can spend at grocery stores or markets. Children already enrolled in food assistance programs will automatically get the summer bump, so cumbersome paperwork won’t be necessary.

Federally subsidized summer meals will continue to be offered through some schools and organizations like the Boys and Girls Clubs. And free meals-to-go are available in some areas. But those established programs were leaving behind thousands of kids whose families lacked easy access to transportation, advocates said. Summer EBT cards, which will be mailed directly to qualifying families, give parents more flexibility to buy groceries so their children can eat at home.

While the federal government bears the bulk of the cost associated with the summer EBT program, which is administered through the U.S. Department of Agriculture’s Food and Nutrition Service agency, states pay half the cost to administer it. That comes to $1.9 million in Kansas. In Missouri, the state will spend $1.3 million this summer and has budgeted $6.6 million, which still needs approval, for next year.

Kansas families will begin seeing payments from the summer EBT program at the end of July. And families with children who qualify who don’t receive payments automatically can put in an application after Aug. 12.

Missouri waited longer to opt into the summer program. Funding wasn’t approved until May and approval from the USDA is still pending. That’s why Missouri families probably won’t be getting their summer payments until sometime in the fall.

Next, anti-hunger advocates said they will be watching debate around the $1.5 trillion federal farm bill that funds the SNAP program. Republicans on the House Agriculture Committee want to effectively cut the program by limiting changes to the formula used to determine benefits. 

In an editorial published May 27 in The Kansas City Star, U.S. Rep. Mark Alford of Missouri’s 4th District, a Republican who sits on the House committee, said SNAP had become too large. The program, he wrote, “was never intended to become a lifestyle but rather a life vest.”

Meanwhile, Missouri will have to revamp how it administers its SNAP program after a federal judge ruled in May that the Department of Social Services’ long wait times, denial of benefits and other issues had violated federal laws.

The post Missouri and Kansas families will be getting money for kids’ summer meals — eventually appeared first on The Beacon.

Kansas Governor Laura Kelly dedicated this year’s fall to traveling around her state and talking with constituents and community leaders about expanding Medicaid.

In a state where 60 rural hospitals are at risk of closing, forcing the legislature to expand Medicaid would be a lifeline, she said in an interview with The Daily Yonder. Her new campaign, “Healthy Workers, Healthy Economy” aims to help residents understand what Medicaid expansion could mean for rural hospitals, rural residents, and the state’s economy.

“There’s no doubt that Medicaid expansion is not enough to rescue rural hospitals,” she said. “But without Medicaid expansion, there is no doubt that rural hospitals will close.”

In 2013, the Affordable Care Act expanded Medicaid coverage to most adults with incomes up to 138% of the Federal Poverty Level, or about $41,400 a year for a family of four. To date, nine states – Alabama, Florida, Georgia, Kansas, Mississippi, Tennessee, Texas, South Carolina, and Wyoming – have not expanded Medicaid.

North Carolina’s Governor Roy Cooper signed legislation into law that directed the state to expand Medicaid, but the implementation of that expansion has been stalled awaiting legislative action.

Kelly said since 2013, Kansas has seen eight of its rural hospitals close. The latest, Herington Hospital in Herington, Kansas, closed on October 9 after 104 years. The hospital said the decision stemmed from lengthy financial struggles and low patient volumes.

More could follow. According to a study released in July by the Center for Healthcare Quality and Payment Reform (CHQPR), more than half of Kansas’ rural hospitals, 60 out of 104 (58%), are at risk of closure. The report found that the states with the most rural hospitals at risk of closing are Kansas, Texas, Tennessee, Mississippi, Georgia, and Alabama – all of which have failed to expand Medicaid.

Study after study has shown that health outcomes for rural residents in states that did not expand Medicaid are worse than outcomes for their counterparts in states that did expand Medicaid. In 2020, a look by Kaiser Family Foundation at more than 400 studies done since 2013 found that states that did expand Medicaid saw improvements in healthcare access, financial security, and health outcomes among other things.

Kelly said Kansas only needs to look to its neighbors to see the benefits.

“We can only judge the impact of not expanding Medicaid by looking at the states around us that have,” she said. “It’s clear that Kansas has sicker populations and populations with more mental health issues.”

Brian Barta, CEO of William Newton Hospital in Winfield, Kansas, (population 11,726 in 2021), said failure to expand Medicaid impacts more than just rural residents. His hospital saw revenues decline after the pandemic. According to reports, the hospital had $41.5 million in total patient revenue in 2022, with $49.3 million in total operating expenses. Even with $3.5 million in grants and other revenue, the hospital still ended 2022 being $4.3 million in the red.

“It is estimated that Medicaid expansion will help over 150,000 Kansans and continued failure by the state legislature to support Medicaid expansion undermines the physical, emotional, and economic health for all of Kansas,” Barta said during a September press event announcing Kelly’s “Healthy Workers, Healthy Economy” campaign.

The closure of a rural hospital impacts more than just rural residents though, Kelly said. Closed rural hospitals mean communities lose much-needed jobs and tax revenue.

“When a rural hospital closes, it impacts not just the physical health of our communities, but it also impacts the economic health of our communities,” she said.

Kelly said expanding Medicaid is her number one priority for the 2024 legislative session. While some other governors have taken action through executive order, Kelly said her hands are tied. Under the previous administration, legislation was passed that required any Medicaid expansion could only be done by the legislature. So far, she’s tried five times to get that kind of legislation passed.

And while it’s not the first time she’s fought this fight, this time, she said, she’s taking it to the voters.

“Expanding Medicaid and ensuring that every Kansan has access to affordable, high-quality health care is the smartest, sanest way to keep our state moving forward,” Kelly said. “I encourage every Kansan to call their legislator and tell them to demand that legislative leadership give them a chance to vote for Medicaid expansion.”

She said she recognizes that her efforts may not influence legislators and that constituents may not either. But with every legislative seat up for re-election in 2024, if she can’t move legislators, she hopes her efforts will at least influence the outcome of the election, she said.

The post Expanding Medicaid to Help Rural Hospitals a Priority for Kansas Governor appeared first on The Daily Yonder.