The measure heard by the House Governmental Accountability Committee would expand Medicaid coverage to 138 percent of the federal poverty level as proposed by Gov. Jay Nixon, but only if the federal government agreed to several restrictions and requirements for the current Medicaid program.
Several of the proposed changes would require waivers from the federal government to adjust the state's Medicaid program.Joel Ferber, attorney from Legal Services of Eastern Missouri, did not agree with the waivers.
“You can easily do 95 percent what you’re trying to do with or without a waiver,” Joel Ferber said. “But, by conditioning all of these reforms that you want so much, waivers that you’re not going to get, it just seems like a very potentially not very productive endeavor."
The major changes in the state's current system for medical coverage under Medicaid would include:
Personal Responsibility by Participants
Medicaid recipients would be responsible to pay at least 1 percent of their total income for Medicaid coverage.
In addition, recipients would have to participate in workforce participation unless they were deemed “elderly, disabled or medically frail.”
The bill's sponsor, Rep. Noel Torpey, R-Jackson County, said the work requirements in his bill would push the envelope. But, he said he thinks that is a good thing.But some expressed concern to the committee that many individuals may need medical help before they can start looking for jobs.
Combating Substance Abuse
Any person convicted of a crime involving alcohol or controlled substance abuse would be required to complete an assessment by a treatment provider. Courts would be allowed to use the recommendations from the treatment provider in the sentencing process.
Torpey said this provision is to give the courts more influence in the matter.
“So many horrible things happen when adults are abusing alcohol and drugs,” Torpey said. “And, I think this is just one more tool to give the departments to help fight this”
Director of Missouri’s Medicaid program, Joe Parks, said the assessment would improve health care.
“It would be good for them, good for their families, good for their communities,” Parks said.
Rep. Jay Barnes, R-Jefferson City, said this provision garnered support when it was in the Medicaid bill last year.
Health Care Cost Transparency
Health care providers would be required to give an estimated cost of a procedure when requested by a patient.
Parks said this provision would help people make better decisions because they would know how much their procedures will cost.
The Department of Social Services would be required to implement an automated process that ensures individuals applying for benefit programs are eligible for those programs.
Increasing Access to Care for Children
The Department of Social Services would be required to create incentive programs and apply for waivers for expanded support for rural health clinics.
It would require that children are covered before their caretaker can be covered.
Rep. Gina Mitten, D-St. Louis County, said she was concerned how this would affect divorced parents in a custody battle. She said she is worried about the parent who does not have custody not being able to get coverage.
Barnes said a line could be added into the provision to address this concern.
Maximizing Private CoverageSome people who qualify for Medicaid, but choose private insurance, would be able to get a subsidy from Medicaid, but only if the Department of Social Services says that it is more cost effective.
Avoiding Emergency Room Misuse
The Department of Social Services would be required to create incentive programs to encourage urgent care clinics to work outside normal business hours.
The department would also be required to develop a new model among health care providers to reduce misuse of emergency rooms by Medicaid users.
Gerard Grimaldi from Truman Medical Center presented a team based approach to solve the misuse of emergency rooms.
His approach includes a team of people identifying the physical and socioeconomic barriers of a patient. Then the team would work with the patient and their family to help manage the patient’s health care.
The committee took no immediate action on the measure. Instead, more meetings were announced to review the measure.
The bill is among several ideas proposed by Republican legislators to toughen provisions in the state's Medicaid program.
The bill heard by the House committee would expand eligibility for Medicaid coverage to the 138 percent of federal poverty level proposed by the governor, but only if the federal government agreed to the state Medicaid changes. The Medicaid expansion proposal was defeated by the Senate earlier this year.