Health Forward Foundation

Missouri Panel to Study Medicaid Eligibility and Reform

INDEPENDENCE, Mo. – Separate panels of Missouri lawmakers are scheduled to spend the next weeks and months considering expansion and reform of the state’s Medicaid program.

“I just think this is a great opportunity to figure out a way to pay for (the Medicaid program), plus make it a better system,” said State Rep. Noel Torpey, an Independence Republican. “And if we make it a better system, why wouldn’t we expand it?”

Torpey is chair of a 50-person panel that includes legislators and community representatives that has been charged by House leadership to study Medicaid eligibility and reform. The panel is expected to report its findings to a House interim study committee later this summer.

The Senate also has a Medicaid study committee, focused on possible program reforms, that is chaired by Sen. Gary Romine, a Farmington Republican. That panel has area representation that includes Sen. Paul LeVota, an Independence Democrat, and Sen. Rob Schaaf, a St. Joseph Republican.

Given the willingness of Senate leadership to include expansion proponents on the panel, LeVota said, the Romine committee appears to be a serious attempt to craft compromise Medicaid legislation.

“I think this is a sincere effort,” LeVota said.

Torpey has scheduled the first hearing of his committee to begin at 9 a.m. Wednesday on the campus of Metropolitan Community College — Blue River, 20301 E. 78 Highway in Independence. He said he expected to hold six meetings around the state before wrapping up the panel’s work in mid-August.

As of Friday, the schedule for the Senate committee, was for initial meetings to be held in Jefferson City on Monday and Tuesday this week.

The federal health-reform law is driving the various discussions.

The Affordable Care Act commits the federal government to paying 100 percent of the costs of newly eligible Medicaid beneficiaries in states that expand program eligibility for adults up to 138 percent of the federal poverty level.

That full match would be in place for years 2014 through 2016. Ultimately, the federal match would fall to a 90 percent with the state covering the remaining 10 percent.

In Missouri, parents must be at or below 19 percent of the federal poverty level to be eligible for Medicaid. In Kansas, the threshold is 32 percent.

Researchers in both Missouri and Kansas have concluded each state could add hundreds of thousands of beneficiaries to Medicaid at minimal state expense compared to the federal contribution.

Torpey said legislation proposed this year by Rep. Jay Barnes, a Jefferson City Republican, included good Medicaid reforms. Particularly noteworthy, he said, were incentives to encourage Medicaid enrollees to use primary care doctors instead of going to the emergency room for services.

Torpey said he expected his hearings would touch on a variety of topics, including better transparency on the costs of medical care, improved reimbursements for physicians, and ways to expand services into underserved rural areas.

LeVota said a workable compromise would be including the reforms in the Barnes bill while increasing Medicaid eligibility to include those earning up to 138 percent of the poverty level.

“We want to pull down the federal money,” he said of Senate Democrats. “That means full expansion, and that is the No. 1 priority. It’s going to be difficult to agree to something that doesn’t have that in it, and very easy to agree to something if it’s in there.”

Earlier this year, the Senate Appropriations Committee refused to endorse legislation from LeVota that would have simply raised eligibility to cover those earning up to 138 percent of poverty, a threshold included in the Affordable Care Act.

At the time, LeVota expressed frustration, noting that more than two-dozen witnesses testified in favor of his bill versus one opponent.

He said Republican leaders perhaps resisted expansion efforts during the session because they felt bullied by Gov. Jay Nixon, a Democrat, who campaigned throughout the state in the spring for Medicaid expansion.

“And now they have a little bit of time to do it their way,” he said. “We are going to have a full conversation about the value of expansion. I feel very confident of that.”

But Schaaf said he had “no interest in putting more able-bodied people on welfare.”

Any Medicaid expansion efforts, he said, should focus on low-income seniors and the disabled.

And he questioned the need for more study of Medicaid reform, saying the state had not followed through with previous ones.

“If somebody stands up the first day (of the Senate study committee) and says, ‘Well the only way we are ever going to agree to do anything is if we expand Medicaid,’” Schaaf said, “then I would say, ‘Well boys, let’s go home,’ because I’m not going to be in favor of expanding Medicaid.”

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