Missouri’s Medicaid expansion — known locally as MO HealthNet — has been available to low-income adults since August 2021, but enrollment workers across the state will tell you the same thing: the people who need it most are often the last ones to apply. As of early 2026, an estimated 200,000 Missourians who qualify for coverage still haven’t signed up. Dolores Peralta, 63, was one of them — until she wasn’t.
A social worker at the Jackson County assistance office in Kansas City suggested I speak with Dolores last February. She had come in — reluctantly, she’d later admit — to ask about a utility assistance program, and the social worker noticed her file had no health insurance listed at all. When I called Dolores to set up a meeting, she paused for a long moment before saying yes. We met at a diner near her apartment on a Tuesday afternoon, and she arrived ten minutes early, which she told me she does for everything. Old flight attendant habit.
A Career Built on Motion, and a Life With No Safety Net
Dolores Peralta has been a flight attendant for 19 years, working regional routes for a contract carrier out of Kansas City International Airport. She described her job with obvious affection — the early mornings, the passengers she’s come to recognize, the sense of being useful. What she described with considerably less affection was her pay stub.
After nearly two decades in the air, Dolores earns roughly $31,000 a year. Her husband Marcus works part-time in building maintenance, adding approximately $14,000 annually to the household. Their combined income of around $45,000 supports themselves and their 17-year-old son, Darnell, who starts college in the fall of 2026. There is no employer-sponsored health insurance through her carrier — a fact she’s lived with for years by simply not going to the doctor unless something felt urgent. And there is, she told me with a flat laugh, no retirement savings at all.
When her landlord handed her the lease renewal notice last October, the number at the top stopped her cold. Her rent was going from $1,150 a month to $1,495 — a jump of $345, or just over 30 percent. She had 60 days to accept or vacate. “I just stood there in the hallway reading it like it was going to change if I kept staring,” she told me. “It didn’t change.”
The Thing About Pride When the Numbers Stop Working
Dolores was direct with me from the start about why she had avoided programs like Medicaid for so long. It wasn’t ignorance. She knew the program existed. She had a clear, fixed idea about what kind of person uses government assistance, and she had spent her whole adult life making sure she wasn’t that person.
After the rent increase, the math stopped working. The new rent of $1,495 consumed roughly 40 percent of her take-home pay alone, before utilities, groceries, or the ongoing conversation about Darnell’s college costs. She hadn’t seen a doctor in three years, not because she felt fine — she didn’t — but because a visit without insurance meant an out-of-pocket bill she couldn’t absorb. She’d had a persistent cough since November and kept telling herself it was nothing.
It was the social worker at the Jackson County office, during that utility assistance visit, who laid out the numbers plainly. At a household size of three with a combined income under approximately $52,000 (138 percent of the 2025 federal poverty level for a family of three), Dolores and Marcus could both qualify for MO HealthNet coverage. Darnell might qualify separately through the Children’s Health Insurance Program. Dolores told me she listened politely and then, initially, dismissed it.
What the Application Actually Looked Like
When Dolores finally agreed to move forward — about three weeks after that first county office visit, after another conversation with the social worker and what she described as a long, quiet argument with herself — the process was more manageable than she expected. That doesn’t mean it was simple.
She applied online through the Missouri Department of Social Services portal in late November 2025. The application required documentation she had to hunt for: pay stubs going back 30 days, proof of Missouri residency, Marcus’s income records, and Darnell’s information for the CHIP portion. She told me she sat at the kitchen table for nearly four hours on a Saturday getting it together.
The approval letter arrived on December 18th, 2025. Both Dolores and Marcus were approved for MO HealthNet. Darnell was enrolled in Missouri’s CHIP program, which covers children and qualifying teens up to age 18 in households that earn too much for full Medicaid but lack affordable private insurance. Coverage was effective January 1st.
The Outcome — and What Remains Unresolved
When I spoke with Dolores again in late February 2026, she had already seen a primary care doctor for the first time in three years. The cough turned out to be related to a sinus condition that had gone untreated; she was also referred to a cardiologist for a follow-up on blood pressure readings that had concerned her doctor. Neither visit cost her anything out of pocket. She said that part still felt strange.
The rent situation has not resolved. Dolores and Marcus signed the lease at the new rate of $1,495 because moving costs and the upheaval for Darnell’s final year of high school felt like more than they could absorb. The $345 monthly increase is still eating into a budget with very little cushion. She looked into the Emergency Rental Assistance program but was told that, as of early 2026, Missouri’s federal ERA funding has been substantially drawn down and local programs in Jackson County are currently paused for new applicants.
What Dolores is most unsettled by, she told me, isn’t the paperwork or even the rent. It’s the time. She’s 63, with no retirement savings and two years until Medicare eligibility. She mentioned this without drama, almost offhandedly, the way someone mentions a weather forecast they’ve already decided they can’t control. “I probably should have thought about all this years ago,” she said. “But I was busy thinking I didn’t need to.”
She isn’t sure what comes next for her financially. She’s still resistant to what she calls “the whole advice circuit” — the idea of sitting down with a counselor and mapping out a plan. What she does know is that she has a cardiologist appointment next month, and that Darnell has applied to three schools and is waiting to hear back. Those two things, for now, are enough to focus on.
Dolores walked me to my car after we wrapped up our second conversation. She had a flight the next morning — a 5:45 a.m. departure — and she seemed ready to be done talking, which I respected. Before she turned back toward her building, she said something I’ve thought about since: she didn’t apply for Medicaid because she finally decided she deserved it. She applied because the math left her no other option. For some people, that’s how it starts.
What happens at 65, when Medicare kicks in and whatever comes after — the retirement savings that don’t exist, the housing costs that haven’t eased — will demand answers she doesn’t have yet, is a chapter that hasn’t been written. I hope someone is there to help her write it.
If you believe you may qualify for Medicaid coverage in Missouri, you can check eligibility and apply through the Missouri Department of Social Services. The federal Medicaid program overview is available at Medicaid.gov.
Related: When COBRA Costs More Than Rent: One St. Louis Man’s Battle to Stay Insured at 58
Leave a Reply