The Problem
Medical debt affects nearly one in five Missouri households, pushing families to delay care, face housing instability, or struggle with daily necessities. Even when hospitals offer financial help, most patients never hear about it or don’t know how to navigate the process, leaving many to shoulder bills they should not have to pay. Missouri Foundation for Health’s statewide research shows how widespread this information gap truly is.
At the same time, a review of hospital financial assistance and collections policies across Missouri reveals inconsistent rules and uneven protections from one hospital to the next, creating confusion and leaving many families unprotected. And when patients can’t pay, the consequences are severe: recent research from Care Over Collections’ founders documents how physician groups in St. Louis have sued patients, disproportionately affecting communities of color and lower-income neighborhoods.
Together, these findings paint a clear picture – Missouri families are navigating a fragmented, often punishing system, and fixing it requires transparency, fairness, and fundamental safeguards.
Our Approach
We continue to explore the scope and impact of medical debt lawsuits focusing on community member experiences in St. Louis and Central, Southeast, and Southwest Missouri.
We convene community members and elevate community member stories and experiences to work towards solutions to reduce medical debt.
We collaborate with clinicians and health care providers to explore strategies to prevent medical debt, perceived medical debt, and the fear of medical debt from creating barriers to care.
Our Team
Mary is the co-founder and director of the Care Over Collections Project: Missouri. A St. Louis–based social worker and researcher, she documents how medical debt lawsuits shape health and financial inequities across the state. Mary is a co-author of a JAMA Network Open study exposing racial and economic disparities in medical debt litigation. She brings years of experience helping patients navigate billing systems and is committed to building a more transparent, equitable landscape for Missourians.
Kathryn is our co-founder and Medical Debt Strategist, supporting Care Over Collections in advancing community-informed solutions to medical debt. She is a co-author of a JAMA Network Open publication analyzing disparities in physician-driven medical debt lawsuits, and she brings experience in program development, health access, and strategic planning. Kathryn’s work centers on translating data into practical reforms that help individuals and communities.
LaPortia leads outreach and community engagement for Care Over Collections, ensuring the voices and experiences of Missourians guide the project’s direction. She builds trust with residents, strengthens partnerships, and connects people to resources while elevating the real-world impact of medical debt. With experience in operations, mediation, and healthcare coordination, and an MBA in Strategic Management, LaPortia brings a strong commitment to racial and economic justice grounded in her Metro East roots.
Lindsay leads the project’s communications and digital outreach, helping Missourians make sense of medical debt and understand their rights and options. She uses storytelling and accessible communication to elevate community voices, challenge harmful systems, and push for a more transparent and just medical billing landscape. With experience in communications, operations, and risk management – and her own firsthand experience with medical debt lawsuits – Lindsay brings a grounded, people-focused approach to education and advocacy.
Press
Click here to see the video and article of this KSDK “5 On Your Side” interview with Director Mary Shannon, from July 18, 2025.
Click here to listen to the St. Louis Public Radio radio segment, and read the related article from July 23, 2025.