Mo. senators reject Medicaid expansion

JEFFERSON CITY - A Missouri Senate committee, designed to revise the state’s Medicaid system, drafted a report ignoring Gov. Jay Nixon’s call to expansion Medicaid eligibility in the plan.

Instead, the Senate Medicaid committee approved a number of recommendations to change the operation of the program that provides health care coverage for the lower income.

The recommendations include provisions to expand requirements for recipients to obtain their services through heath care management organizations and impose penalties for unnecessary use of services such as emergency room visits.

While rejecting the governor's call to expand Medicaid to those below 133 percent of the federal poverty level, the committee did include some expansion recommendations.

It recommended adding coverage for dental care and add incentives for preventive services.

Failure to include eligibility expansion in the committee chair's proposal, however, led the three Democrats on the committee to walk out.

Sen. Joe Keaveny, D-St. Louis, said he felt the recommendations were “short-sided.”

“When I agreed to serve on this committee I thought that we were going to be focused on the big picture, on the elephant in the room, on the expansion of Medicaid,” Said Keaveny. “That's not something that we need to spend 15 minutes at the end of a two hour meeting to talk about.”

The Republican senators sifted through the adoptions while the Democrats were drafting their own proposals. The Republicans outlined changes for the current Medicaid system, which would save the state $14 million per year as estimated in the report.

Currently, managed care companies cover about 408,000 of the state’s 861,121 Medicaid recipients in various areas of the state.

Under managed care, a Medicaid recipient cannot just go to a doctor and get the fees covered. Instead, health care services are managed through a health-care management company that has contracted with the state.

Unlike the Senate committee, the chair of a similar committee in the House reviewing the Medicaid issue has included expanded Medicaid eligibility as part of a broader package to reorganize the Medicaid system.

Recommendations tentatively approved by the Senate committee include:

Expand managed care statewide with services to a Medicaid recipient managed by a primary health care provider.
Use regional organizations to coordinate care and costs.
Improve management of services and costs by "super utiliizers" with high Medicaid costs.
Develop options to merge coverage of those under both Medicare for the elderly and Medicaid for the lower income.
Continue to promote tele-medicine technologies.
Find ways to reduce emergency room use by Medicaid recipients.
Enact a plan to address inappropriate narcotics use.
Implement charges to recipients for inappropriate use of medical services such as emergency rooms.
Provide incentives for preventive services
Encourage health savings accounts for recipients to cover deductible and co-pay charges.
Increase the maximum assets allowed to qualify for some Medicaid recipients.
Provide Medicaid coverage for dental care.
Increase rates for health-care providers.
Change the method of hospital payments to "sustain and support" rural hospitals.
Consolidate the state agencies responsible for Medicaid.