JEFFERSON CITY - Although Republican legislative leaders have issued statements attacking Medicaid expansion, one of their key committees has scheduled two days of hearings on a plan that would expand Medicaid as well as making fundamental changes to the Medicaid system -- suggesting the idea of Medicaid expansion is not yet dead in Missouri's Capitol.

So far this session, Republicans have defeated two Medicaid expansion bills pushed by Democratic lawmakers in committee. House Minority Floor Leader, Jake Hummel, D-St. Louis City, sponsored a bill that would expand Medicaid eligibility coverage to 138 percent of the federal poverty level. This expansion would have put Missouri's Medicaid program in accordance with the federal health care law. At a press conference earlier this session, Hummel said he believes Medicaid expansion is the most important issue in the state. Hummel's bill, however, was killed in the House Government Oversight and Accountability committee.

A similar bill, sponsored by Sen. Paul LeVota, D-Independence was defeated in the Senate Appropriations Committee by a vote of 8-3 along party lines. Sen. Jamilah Nasheed, D-St. Louis City, is sponsoring similar legislation but her bill has yet to be heard in committee.

Even though Republicans have defeated Democratic-backed measures twice so far, one Republican is sponsoring legislation that would address eligibility for the state's Medicaid program. Rep. Jay Barnes' bill would transform the Medicaid systems as well as expand it. In February, Barnes, R-Jefferson City, said he believes Medicaid expansion as prescribed by the federal law is not the way to go and transformation of the system is a better alternative.

Barnes' bill would cut a large number of children from the program and expand Medicaid eligibility, but not to the extent set by the federal law. His bill would also offer an annual cash incentive to encourage Medicaid recipients to keep their health care costs low.

Gov. Jay Nixon has been traveling around the state touting the importance of Medicaid expansion. Nixon has said the expansion would provide health care to an additional 300,000 people and add 24,000 jobs.

"Strengthening Medicaid will strengthen our economy," Nixon said during his annual State of the State address.

Whichever way Missouri lawmakers choose to address the state's Medicaid program, they are wading into an already complicated system. Missouri has had a Medicaid program since 1965 when it was enacted through an amendment to the Social Security Act. The program was designed to offer long-term care to low income citizens of the state.

According to the Department of Social Services, Missouri's current Medicaid program:

• Provides care to about 880,000 individuals.
• Missouri HealthNet coverage is available to recipients of nursing care, home and community-based services, supplemental aid to the blind, blind pension and adult supplemental payments.
• Eligibility for the program is determined by the Family Support Division.
• Some individuals receive the HealthNet benefits through a "fee for service arrangement" in which they have the freedom to choose any vendor of needed services that is enrolled to participate in the HealthNet vendor plan. Other individuals receive benefits through a managed care plan, in which they must obtain all needed medial services through a health plan, physician sponsor or other designated single source of total health care.
• Missouri HealthNet provides medical assistance such as inpatient hospital care; outpatient hospital services; nursing home services; physician's services; drugs and medicines prescribed by a physician, dentist or podiatrist; home health care services; family planning services; optometric services and eyeglasses; rehabilitative services; hospice services; case management services for pregnant women; community psychiatric rehabilitation services; substance treatment and rehabilitation; certified nurse practitioner services; and services such as immunizations and early periodic screening, diagnosis and treatment for Missouri's "Healthy Children and Youth" program.
• Missouri HealthNet will provide coverage for families with incomes that do not exceed certain income standards.

Income Limits:

• The program also provides health care coverage for children under the age of 19 whose family income falls within certain guidelines. For children not covered under the State Children's Health Insurance Program (SCHIP), coverage is provided if their net family income does not exceed the following: 

• Children with monthly family incomes above the income limits may be eligible under SCHIP if the family gross income is more than 150 percent of FPL and up to 300 percent of FPL, if they are uninsured for 6 months and have family assets with a net worth of less than $250,000. Children in families with gross income over 150 percent FPL cannot have access to affordable health insurance and the family must pay a  monthly premium, which is based on family size and income to insure that no family pays more than 5 percent of their income for coverage.
• Missouri HealthNet also provides coverage for the aged, blind and disabled. Among other qualifications, individuals may receive coverage if they are 65 years or older; 18 years or older and determined to be legally blind; have a net income of less than $814 per month or a couple with a net income of less than $1099 a month; blind and do not have a sighted spouse who can provide support; is not a resident of a public, private or endowed institution.