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Democrat says she feels Medicaid process is being rushed

February 21, 2005
By: Ben Welsh
State Capital Bureau

JEFFERSON CITY - Pitchers and catchers have reported, hope springs yet again in hearts across America. It's budget season.

And legislators in state Capitols from Denver to Dover are busy swinging away.

The same goes in Jefferson City where Missouri's General Assembly is in the early innings of this year's budget battle.

So far, Gov. Matt Blunt is batting 1.000 on his young career. The Springfield Republican has never lost an election. But now the 34 year old rookie governor faces a new test in his first budget.

Blunt, who ran on a no new taxes platform, has proposed slashing state spending by $1.1 billion. The centerpiece of the cuts is a reduction in Medicaid eligibility that would throw nearly 90,000 Missourians off state health care.

But Blunt's plan must still make it through House and Senate committees and win approval in both chambers before it slides safely back onto his desk.

While there's little reason to believe that he's going to strike out (both the House and Senate are firmly in Republican control), Blunt may not get the pitch he's looking for.

Last year a less severe Medicaid cut was gutted in the Senate. Republicans who represent rural areas, where more than half of Medicaid recipients live, may be reluctant to sign on.

"I don't think ever in time there has been a governor's budget that came out exactly like it started," said Rep. Jodi Stefanik, R-Ballwin, who chairs an appropriations committee on social services. "He said this is a starting point."

Thanks to terms limits, legislators today are not as experienced in the budget process as their long-serving predecessors. At a meeting of Stefanik's committee Monday, a representative of the Department of Social Services spend more than two hours walking lawmakers through how Medicaid enforces its eligibility requirements.

Rep. Margaret Donnelly, D-St. Louis, said she thinks that lack of familiarity makes it harder to sort out something as complex as Medicaid.

"I believe that [Blunt] has used an ax to make very arbitrary decisions about who we should cut," Donnelly said. "It's difficult if you have not been repeatedly looking at budgets to know how you might look at it differently."

After watching more than a month go by before holding their first hearings, House members may now have to scramble to get the budget out before the Legislature closes in May.

"We took way too long to get going at the beginning," Donnelly said. "As a result we're going to find ourselves maybe making hasty decisions we'll regret later."

Medicaid is a program which provides health care to poor and disabled Missourians. It is funded by a combination of federal and state money.

Throughout the 1990s Missouri's Medicaid rolls swelled. When the late Democratic Gov. Mel Carnahan took office in January 1993, just over 510,000 Missourians were enrolled in the system. According to the state's latest estimates, nearly 1 million are covered today. The program's $4.8 billion price tag accounts for more than 28 percent of Missouri's total budget.

In an effort to trim a program he called "financially unsustainable," Blunt proposed slashing Medicaid rolls and eliminating a number of smaller programs. Blunt's proposed 2005 budget, which he unveiled at his first State of the State address last month, would reduce the income threshold from 75 percent of the federal poverty level to 30 percent. The income cap for a family of four on Medicaid would drop from $14,137 per year to $5,655. All told, the cuts would drop 89,046 people from the program, half of them elderly and disabled.

"If we don't get after the eligibility then certainly the program is doomed." Stefanik said. "We need to do the reform to save the program for the neediest."

Jefferson City isn't the only Capital in the country where elected officials are mulling over Medicaid cuts.

Tennessee is the only state which spends a higher percentage of its budget on Medicaid than Missouri, according to data provided by the National Association of State Budget Officers. Their Democratic Gov. Phil Bredesen is fighting for massive cuts he says are necessary. Bredesen's original proposal called for dropping 323,000 adults out of the system but compromises may force that number down.

And in Washington D.C. last week, President George W. Bush issued his new federal budget. It calls for $60 billion in Medicaid cuts over the next ten years, a measure that could force more states to consider eligibility rollbacks in the future.

Along with the Medicaid cuts, Blunt's budget proposes cutting 1,194 state jobs, boosting lower education spending by 4.7 percent and replacing 11 state-run motor vehicle branches with private fee offices.