By David A. Lieb
JEFFERSON CITY - Members of a special Senate committee looking at ways to "transform and reform" Missouri's Medicaid program demonstrated Wednesday that little has changed in the partisan battle over the government-funded health care plan for the poor.
Democrats sought to include expanded eligibility for the program in a list of recommendations being considered by the committee and walked out of the room when Republicans didn't want to make it their first topic of discussion.
Republicans, who hold a majority on the Senate Interim Committee on Medicaid Transformation and Reform, later voted to keep Medicaid expansion out of the report that is to be released in advance of the 2014 session.
The outcome mirrored numerous other votes taken earlier this year, when the Republican-led Legislature repeatedly defeated efforts by Democratic lawmakers and Gov. Jay Nixon to expand adult Medicaid eligibility.
"Until we reform and transform the current Medicaid program, no one's in a position where they feel comfortable expanding anything," said committee chairman Sen. Gary Romine, R-Farmington.
Democrats argued that expanding Medicaid eligibility to low-income adults lacking health insurance is an integral part of transforming the program. They wanted to add wording to the report saying the Legislature should consider seeking federal approval for a Medicaid expansion plan.
After the committee voted down the Democratic recommendation, Sen. Paul LeVota, D-Independence, acknowledged that the prospects of expanding Medicaid in 2014 appear slim.
"They're just stuck in their dogma," LeVota said of Republicans on the committee.
LeVota and the two other Democratic members of the committee - Sens. Jamilah Nasheed and Joe Keaveny, both of St. Louis - left the room as the committee discussed more than a dozen other recommendations included in a draft report.
Missouri could get additional federal money under the new federal health care law if it expands Medicaid to adults earning up to 138 percent of the federal poverty level, about $32,500 for a family of four. Missouri's Medicaid program currently covers custodial parents earning up to 19 percent of the poverty level, or about $4,475 annually, and doesn't cover adults without children in their homes.
The first recommendation in the Senate panel's draft report is to expand managed care statewide for parents, pregnant women and children in the Medicaid program. Managed care policies currently are used for those groups in a fewer than half of Missouri's counties. The committee also recommended that elderly and disabled Medicaid enrollees be covered through regional "accountable care organizations" and have a primary care physician who is part of that organization.
But those recommendations faced opposition from Republican Sen. Rob Schaaf, a physician from St. Joseph. He questioned whether managed care plans actually would have a 3 percent cost savings, as cited in the draft report. "I'm not convinced that it would save us any money," Schaaf said.
Some of the committee's other recommendations include providing dental coverage to adult Medicaid recipients, finding ways to reduce emergency room visits and doubling the amount of assets that elderly and disabled residents can have before exceeding Medicaid eligibility thresholds.
A special House committee also is developing recommendations for Medicaid legislation. The committee chairman, Rep. Jay Barnes, R-Jefferson City, has outlined a package of potential changes that include managed care plans, expanded eligibility for adults, reduced eligibility for children and financial incentives for Medicaid recipients to avoid emergency room visits. His analysis shows that the changes could save Missouri money in the long-run.