Missouri Medicaid Committee Working on Expansion Plan

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JEFFERSON CITY - The Interim Committee on Medicaid Transformation met Wednesday morning at the State Capitol to create a plan for Medicaid expansion. The meetings are focused on manage care.

Representative Jay Barnes (R-Jefferson City) proposed an overhaul to expand Medicaid eligibility and offered incentives to those already on Medicaid.

"The average mid-Missourian who has a private health insurance plan has to make decisions based on the services they're going to receive. That's not true in the current Medicaid program, either in the state of Missouri or anywhere in the country," Barnes said. "We need to get recipients thinking more like participants."

Barnes said his proposal is something unique to not only Missouri, but the whole country.

"No state in the nearly 50 year history of the Medicaid program has introduced the idea of cost-consciousness to Medicaid recipients where those recipients get to share a portion of money they save for tax payers by making good, health conscious decisions," Barnes said.

One example Barnes gave was not going to the emergency room when a patient does not need emergency care.  

Medicaid covers more than 870,000 Missourians, and is geared toward seniors, people with disabilities, pregnant women and certain families with children. Eligibility standards vary between groups.

For example, to be eligible, a single parent with two children is limited to an income of $3,711 a year.

Barnes said Missouri can increase the market-based Medicaid to 100 percent of the federal poverty level and then help subsidize health care plans for working Missourians who fall in the coverage gap, or between 100 percent and 138 percent of the federal poverty level.

If Missouri expanded Medicaid, the coverage gap would be closed completely, ensuring an option for every Missourian.

Representative Chris Kelly (D) said the committee is trying to come up with the best plan for both medical care and tax payers.

"Critical to that is finding a way to have the recipients have a way to financial vested interest in the result," Kelly said. "If you decide to not go to the emergency room instead of seek some preventive care, we're looking for ways to build financial incentives into that."

Kelly said dental care is one of the worst areas of health care delivery.

"Especially for poor kids. Many dentists provide care to poor kids for free, but we still have too many poor kids untreated," he said. "The Medicaid program's reimbursement rate for dentists is inappropriately low."

Wayne Lee has been on Medicaid for more than 20 years. He suffers from epilepsy, experiencing multiple seizures every week, making it impossible for him to hold a job.

"At one point, I was having 50 or 60 each week," Lee said.

Lee said Missouri needs to expand Medicaid.

"Not for those already on Medicaid, because we won't be affected," Lee said. "But it does need to be expanded for the people who do not have health insurance and are not making enough money to purchase health insurance."

Lee said if Missouri chose to expand Medicaid, the state could have received more than $15 billion between 2014 and 2020.

By expanding Medicaid, 351,000 additional Missourians would be eligible to qualify for coverage.

Barnes said there is no date for when he will release the first draft of a bill for 2014.