by Clara Bates, Missouri Independent
June 18, 2025

Missouri has among the highest rates of antipsychotic drug use in nursing home residents, contributing to the state’s health care system ranking near the bottom nationally in a report released Wednesday. 

The report, published by The Commonwealth Fund, a private foundation focused on health care issues, used data from 2023 to measure every state’s health care access, quality and outcomes across six dimensions. 

Around 15% of nursing home residents nationally are administered antipsychotic drugs, according to the Commonwealth Fund study. In Missouri, that figure was just over 21%. Only Wyoming, North Dakota and South Dakota had higher rates. 

The data, collected by the federal government, excludes residents with schizophrenia, Tourette’s syndrome or Huntington’s disease — conditions for which antipsychotics are generally considered medically necessary.

Studies have found antipsychotic drugs are often administered to residents of nursing homes without medical necessity, posing medical risks and side effects. They’ve also been used for residents with dementia, other cognitive impairments, or behavioral issues to help control their behavior or sedate them without their consent. 

Research has found a link between low nursing home staffing levels and higher rates of antipsychotic drug use. 

The Commonwealth Fund’s findings echo a report last year from the U.S. Department of Justice that found Missouri in violation of federal disability law for unnecessarily institutionalizing thousands of adults with mental illness in nursing homes when they would be better off in a less-restrictive environment. 

Missouri is an outlier nationally in placing people with mental health needs in nursing homes.

The state is still in settlement negotiations with the DOJ over its findings, a spokesperson for the Missouri Department of Mental Health told The Independent. Missouri officials are working with the DOJ to come up with a plan to fix the violations identified in the report. If they can’t reach a resolution, the DOJ could file a lawsuit.

Beyond issues in Missouri nursing homes, the state’s health care system overall ranked 43rd out of the 50 states plus D.C. in the Commonwealth Fund report. While the state has seen improvements in areas like the adult insured population over the years since Medicaid eligibility was expanded, other metrics, like premature deaths from preventable causes, have gotten worse. 

Sara Collins, author of Wednesday’s report and Commonwealth Fund Senior Scholar and Vice President for Health Care Coverage and Access, said in a press briefing that the report “continues to reveal vast geographic variation in Americans’ coverage and access to care, health outcomes and people’s ability to live a long and healthy life.”

Congress is debating a budget bill that could cut millions nationally from Medicaid.

“Federal policy changes, both underway and proposed, threaten to reverse the improvements achieved by states, exacerbate areas of slippage,” Collins added, “and deepen geographic income and racial and ethnic disparities and health outcomes.” 

Missouri’s uninsured rate improved between 2019 and 2023, as was the case nationally: The adult uninsured rate fell from 14% to 11% in Missouri, and kids’ uninsured rate fell from 7% to 5%. Both are now on par with the national average. Missouri implemented Medicaid expansion in 2021. The rate of adults going without care because of cost also declined.

But on the access and affordability category overall, Missouri ranked 36th, with a higher-than-average share of people with medical debt in collections and rate of those with high out-of-pocket medical costs relative to their income.

Missouri especially struggled in the “avoidable use and cost” category, with only West Virginia ranking worse. That includes low primary care spending, high rates of preventable hospitalizations and avoidable ER visits. 

More children in Missouri lack preventative care than the national average. Thirty-five percent of Missouri children lacked medical and dental preventative care from 2022 to 2023. The national average was 32%. 

Children also had trouble accessing mental health care in Missouri, with 24% of kids not receiving  mental health care as needed, while the national average was 20%. 

Missouri was better than average in a handful of categories. For one, the state had fewer adults with substance use disorder who lacked treatment. Nationally, 77% of those adults lack treatment, but in Missouri that number is 73%, or 11th best in the country. 

The infant mortality rate got slightly worse from 2019 to 2023 and ranked 39th in the country.

“Threatened access to reproductive and maternal health care may further worsen infant mortality and sharpen current disparities between states,” the report noted, nationally. Missouri banned abortion until late last year, when it was legalized by initiative petition.

The rate of premature deaths from preventable causes got worse during the same period, and Missouri ranked 43rd in the country.

Additionally, more adults smoke in Missouri than the national average — 15% in Missouri versus 11%, or the 44th ranking. 

Missouri had lower-than-average alcohol deaths. 

Missouri ranked among the worst states — 47th — for disparities in health care based on income. Low-income Missourians are far more likely to report fair or poor health than higher earners, and far more likely to have lost several teeth and/or be obese.

Missouri had slightly worse racial disparities in medical care than the national average.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com.

The post Missouri’s health system among worst-performing in the country, report finds appeared first on missouriindependent.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

This content presents a detailed critique of Missouri’s healthcare system using data-driven analysis and reputable sources like The Commonwealth Fund and the U.S. Department of Justice. It highlights systemic issues such as high rates of antipsychotic drug use, poor healthcare rankings, and violations of disability law, which are often points of concern for more progressive or center-left viewpoints advocating for improved public health policies, social justice, and expanded healthcare access. The coverage is factual and avoids partisan language, but the focus on Medicaid expansion benefits, healthcare disparities, and the negative impact of potential budget cuts reflects a center-left leaning perspective that supports stronger government involvement in healthcare and social services.