How A Broken Medicaid System Kills Vulnerable Patients

What does a person choking on a hot dog have to do with the current debate in Congress over the federal budget? More than one would think.

A recent exposé in one state’s treatment of individuals with developmental disabilities highlights the flaws of our current health care system. While 40 states and the District of Columbia have over the past decade expanded Medicaid to include able-bodied adults under Obamacare, some of society’s most vulnerable have suffered — and died — due to negligence at the hands of a system that should place a greater priority on their care.

Incompetence and Neglect

The analysis, conducted by a nonprofit media outlet in Missouri, examined the recent treatment of those with developmental disabilities. The statistics alone proved bracing. From 2017 through 2023, 74 Missourians with developmental disabilities, nearly one per month, died from an accident while under the state’s care. Another seven individuals took their own lives, nine died via homicide, and 392 individuals with developmental disabilities had an “undetermined” cause of death.

The reporting also digs into just some of those cases, illustrating the poor care these individuals received. Lisa Goodman, the woman who choked and died of asphyxiation, required a special diet due to her inability to eat solid food. Yet her carers gave her a hot dog and left her unsupervised while she ate it, leaving her alone to die.

Another individual, Ronald Scheer, was also left unsupervised in violation of his care plan and instructions. In Scheer’s case, the neglect meant he slid in his wheelchair and inadvertently strangled himself to death on the straps of the chair’s safety belts — straps his carer had not properly secured.

Shocking as they are, these stories came after the 2017 death of another individual, Carl DeBrodie, who died of a seizure on the basement floor as his carers refused to call 911. DeBrodie’s publicized death resulted in criminal convictions for his caretakers and calls for reform among Missouri policymakers.

Yet one nurse who worked within the system for a decade and left in 2020 said, “There’s been no changes into the processes that allowed that [DeBrodie’s death] to happen in the first place.” The mother of a special needs child who fought to have her son leave state care and return home said, “These people are treated less than human.”

Medicaid Is Broken

The common thread running through all these victims? For the “7,500 [individuals] with disabilities like Down syndrome or severe autism, the Missouri Department of Mental Health’s Division of Developmental Disabilities was responsible for [their] care and well-being through residential services. That care is paid for with Medicaid.”

But in Missouri, as in many other states, Medicaid has changed its focus dramatically in recent years. In the summer of 2020, Missouri voters approved a referendum accepting Obamacare’s Medicaid expansion to able-bodied adults. The referendum led to a year of political wrangling, with implementation beginning in 2021.

Obamacare did not create the problems in Missouri’s system for treating individuals with developmental disabilities; those predated the start of expansion in the Show Me State. But expansion brought with it a very clear opportunity cost: Every dollar spent, and every hour of attention by government officials, on able-bodied adults represents a dollar, and an hour of political capital, not focused on fixing the significant problems that have plagued care for the most vulnerable.

Medicaid Needs Reform

Even before lawmakers in Washington have drafted a single specific policy on Medicaid, leftist press outlets are already in a lather over the prospect of potential changes. Their scaremongering headlines advertise a “massive budget shortfall” in Missouri (and elsewhere) if Congress reforms the federal-state program.

But the status quo didn’t work well for people like Lisa Goodman or Ronald Scheer or Carl DeBrodie. The poor quality of the Medicaid system in Missouri killed each of these three vulnerable patients. People like Sen. Josh Hawley, R-Mo., should recognize that buying into the leftist trope about “massive Medicaid cuts” ignores the fact that Medicaid has already harmed some of the most vulnerable in society, including in Hawley’s home state.

Like it or not, government cannot (and should not) be all things to all people. In Missouri, as in other states, governing well involves setting priorities. The expose about the substandard care received by individuals with disabilities serves as a reminder of where those priorities should lie. Hopefully Congress will follow suit.