Senate gives initial passage to Medicaid reform bill

JEFFERSON CITY - The third consecutive day of Senate debate on Medicaid organization ended Wednesday with the initial passage, by voice vote, of a bill to restructure Medicaid and call it HealthNet.

The new plan would retool Medicaid to place more of a focus on preventative care through coordinators for Medicaid recipients and incentives to lead a healthy lifestyle.

The proposal, pushed by Gov. Matt Blunt is designed to reduce the growth of the Medicaid budget that provides health care coverage for nearly one million lower income Missourians. The bill also includes tax incentives to encourage private health insurance coverage by employers.

For Medicaid recipients, the bill would create three different health improvement plans dependent on geographic and population. The plans would be implemented in three stages beginning in July of 2008 with parents and children, followed by seniors and people with disabilities in July of 2009 and the remaining Medicaid-eligible Missourians in July of 2013.

The bill would reduce the number of recipients under the "fee for service" coverage in which recipients can go to any health care provider that accepts Medicaid reimbursement. In the new system, a recipient's access to medical care providers would be controlled by a coordinator, called a health care home, who would be expected to encourage preventive care.

The bill would also provide for a premium offset program, which would allow the low-income and uninsured to apply for assistance to pay insurance premiums. Those whose employers do not contribute to the payment for insurance premiums would also be able to apply.

Debate opened Monday on the bill, which faced significant opposition on the part of Sen. Jason Crowell, R-Cape Girardeau who said that the only good thing about the bill was the premium offset program.

He placed particular emphasis on a part of the bill that would reward doctors with higher reimbursement rates for providing quality care. He said that the state should have confidence in the free-market system to take care of the health care system.

A provision for Medicaid fraud was added to the bill during Wednesday's debate after Sen. Victor Callahan, D-Jackson County proposed an amendment to include it. Citing concern that the House would reject the entire bill because of the provision, similar to what happened to the Medicaid fraud bill last session, Sen. Luann Ridgeway submitted a Medicaid fraud bill already passed by the House this session, sponsored by Rep. Robert Schaaf, R-St. Joseph, to replace Callahan's amendment.

Callahan said that the bill was weaker than the one he proposed, but ultimately did not want to "belabor the point" because he was more concerned that some provision for Medicaid fraud prevention be included in the bill.

"I want something done about Medicaid," he said. "It is outrageous that two years ago when we were talking about cutting 100,000 people off Medicaid that this body did nothing about Medicaid fraud. That is outrageous."

Sen. Chris Koster, R-Harrisonville, who proposed last year's Medicaid fraud bill, agreed the provisions were not the toughest, but better than nothing. "It's not the full monte, but it's not a bad show."

The Senate rejected efforts by Democratic legislators to restore coverage for the approximately 100,000 who were cut from Medicaid in 2005. The Senate rejected an effort to expand Medicaid to cover physical rehabilitation services and free transportation for pregnant women.

The Senate did, however, agree to add to the bill coverage for hospice care.

The bill faces a final Senate vote before being sent to the House.