Future of ACA Blocking Efforts to Modernize Missouri’s Medicaid Enrollment System

A proposal to modernize Missouri’s Medicaid eligibility and enrollment system has turned into another Jefferson City debate about the federal health care reform law.

At issue is approximately $50 million in federal funding available to help upgrade the Medicaid computer system. Gov. Jay Nixon is seeking authority from the General Assembly to access those funds.

The Medicaid system is so outdated that it’s difficult to find technology staff able to run it, Missouri Budget and Planning Director Linda Luebbering said in a fiscal 2013 spending request sent in February to the chairmen of the House Budget and Senate Appropriations committees.

Because a portion of the funding would come through the Affordable Care Act, some Republicans in the General Assembly suspect that Nixon, a Democrat, is using the Medicaid upgrade as a backdoor effort to begin establishing a health insurance exchange.

An exchange is an electronic portal designed to give individuals and small businesses access to affordable health insurance plans offered competitively by private insurers. They are key components of the Affordable Care Act, President Obama’s health reform measure.

Under the act, states must have an exchange operating by 2014. States have the option of designing and operating their own system or the federal government will do it.

Critics of the law contend that compliance implies acceptance of the Affordable Care Act. They also argue that it’s premature to implement the law, since challenges to its constitutionality are pending before the U.S. Supreme Court.

GOP legislation moving through the Missouri General Assembly would authorize ballot language asking voters to prohibit the governor from unilaterally implementing a state exchange.

House Budget Committee Chairman Ryan Silvey, a Kansas City Republican, acknowledged that politics played a role in his opposition to the $50 million allocation, which is not included in the House-passed version of the budget.

Silvey said the February letter from Luebbering did not represent a formal request from the administration, and that it needed to come in the form of a governor’s amendment from Nixon.

The governor has had no problem reaping positive publicity in the past by submitting popular budget amendments but has resisted that in this case because polls show that Missouri voters dislike the Affordable Care Act, Silvey said.

“The issue there was, he wanted to do it, but he did not want to have to take any credit for it,” Silvey said, “so part of it was, ‘No, if you didn’t put it in your budget, and you want it in your budget, you need to ask for it – be a man about it.”

Silvey said he agreed that the Medicaid computer system needs modernization, but that the state should hold off on any items related to the Affordable Care Act until the Supreme Court rules this summer.

The current Senate version of the budget includes the authorization to spend the $50 million, after Nixon submitted an amendment to the Appropriations Committee on March 28 and the committee added the money. But, Silvey noted, the funding could very well draw fire when it comes to the Senate floor from those opposed to establishing an exchange. The bill could come to the floor perhaps as early as this week.

Luebbering said the entire Medicaid upgrade carries a price tag of about $107 million, which the state would cover through a combination of state and federal funds.

Not only would a new system allow for better data analysis and reduce the potential for fraud, she said in her letter, the federal government would reward Missouri for modernizing its equipment by upping its spending match from 50 percent to 75 percent.

Critics such as Silvey have questioned how the administration can say the funding is for a Medicaid upgrade when it’s coming through a program of the Affordable Care Act called the “State Planning and Establishment Grant for Health Benefit Exchanges.”

Luebbering said the federal dollars for the project would be a combination of regular Medicaid funds and Affordable Care Act money earmarked specifically for establishing an exchange.

She said if the General Assembly authorized the Department of Social Services to access the $50 million, the department would only spend the Medicaid portion to begin upgrading the computer system. She said the department would not spend any of the Affordable Care Act funding unless it got a green light from the General Assembly on the exchange.

Rep. Bert Atkins, a Florissant Democrat, said Republican opponents seem driven more by scoring points with voters and their dislike of the health reform law. He unsuccessfully attempted to add the $50 million to the House budget when it was up for floor debate on March 20.

“I think politics are a major factor in the roadblocks being thrown up,” Atkins said.

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