Senators hear push to rework Medicaid

JEFFERSON CITY - Members of the healthcare community dissected a Senate Medicaid bill Tuesday, praising it for simplifying the healthcare system and criticizing it for increasing state oversight.

Some 20 witnesses, ranging from healthcare professionals and AARP representatives, to a former state Medicaid director and a mother of a disabled child, voiced their support and critiques of a bill that would help transform the state's Medicaid system into what Gov. Matt Blunt has called Missouri Health Net.

Supporters said Missouri Health Net seeks to reshape Medicaid, in part by enrolling all eligible customers into the program within five years. Opponents said the change is nothing but a fancy name.

Sen. Charlie Shields, R-St. Joseph, outlined his bill for the Senate's Health and Mental Health Committee.

Shields said the bill would focus on preventative care, and even reward Medicaid participants for making healthy lifestyle choices. Such choices would include quitting smoking and losing weight.

"I said it many times, under Medicaid, nobody gets paid until somebody gets sick," Shields said. "That was the old system of Medicaid."

Shields said the state should focus on preventing illnesses. Under his bill, the state would issue Medicaid participants health benefit cards, and award points to users for healthy behaviors. Participants could then use those points to buy healthcare products, including over-the-counter drugs.

But even some of the bill's supporters -- who outnumbered those opposed to the legislation Tuesday by about 5 to 1 -- said they were concerned about the points system.

Edward Duff, with the National Alliance on Mental Illness, said the system would prohibit some mentally ill patients from gaining points and thus better healthcare coverage. Some mentally ill patients, he said, take medications that prevent them from losing weight. The state should not penalize them, he said.

Rebecca Lakewood, Jackson County public administrator, praised the changes made under the bill, but, like Duff, said it didn't protect mentally ill patients, especially those with self-destructive habits.

"These people are not being properly addressed under your plan," Lakewood said.

Fortuna resident Pam Byars voiced a similar concern. Her 9-year-old daughter Jessica is disabled and uses Medicaid.

"Who determines what is a proper lifestyle and behavior for a person like my daughter?" Byars asked.

Under Shields' bill, the state would also link Medicaid participants with a healthcare advocate, who would help users navigate the complexities of the Medicaid system. The advocate, Shields said, would help participants make informed choices, including finding primary care doctors, coordinating referrals and finding specialty care physicians.

Healthcare participants would chose their own advocates.

"The healthcare advocate is a person," Shields said. "And it doesn't have to be a physician. It could be a physician. It could be a nurse, it could be a care manager, it could be a dentist, it could be a psychiatrist."

But some of those who spoke at the committee meeting questioned how the state would review each healthcare advocate's qualifications. Some also questioned who would train the advocates and hold them accountable.

"We'd really like to see an oversight process on the case managers," said Van Ellet, senior legislative representative for AARP Missouri.

Shields' bill calls for a phasing in of Medicaid participants. By July 2009, the state is to enroll the remaining parents and children not already enrolled into the Medicaid system. By July 2013, the state is to enroll all elderly, blind and disabled participants.

Shields' bill would also increase healthcare coverage for foster children. Under the bill, foster children would receive coverage until 21 years old, instead of the current limit of 18 years old.

"You have to think of this as a long-term transformation," Shields said.