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, 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 Justice Department 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 the District of Columbia 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.”

36th on access and affordability

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.

50th on avoidable hospital use and cost

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.

40th on prevention and treatment

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.

40th on healthy lives

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.

47th on income disparity and 31st on racial equity

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.