JEFFERSON CITY - Three months after Missouri's governor won legislative approval for a controversial plan to provide Medicaid coverage for children of middle-income parents, the administration has yet to implement the proposal.
The measure formally took effect on Friday.
It had passed the legislature last May after months of debate. When it implemented, it will cover some children under the age of 19, who fall below 300 percent of the poverty level.
That would cover four-person families with incomes reaching almost $50,000 per year. But it may be a while before the program is actually implemented.
In Columbia, Brenda Wilson, the office manager of pediatrics at Boone Clinic, said little information has been given to her about the new program.
"We have been sent no information from the state on this, she said. "All I know is that it was in the works."
Sen. Ed Quick, D-Liberty, who proposed the program, said Friday was the day the bill was to go into effect, not the day it was going to be implemented.
"They're not using it yet," Quick said. "They're still working on having things lined up. It will be a couple of more months before people are actually receiving service from it.
"I don't think anybody thought it was going to go into operation by the date the bill went into effect. It's pretty much on schedule."
Quick said a system needs to be set up for the program and sufficient funds need to be set aside as well before services can be provided.
As for the number of children it would effect at the local clinic, Wilson said it would be an asset to those who have bad insurance.
"Children with no insurance, we probably get 3 or 4 a day," she said. "But people with bad insurance, we get a few more, those that have $1,000 deductibles."
The program is broken down into two areas. Children between 186 percent to 225 percent of the poverty level are covered under this program if they have been uninsured for 6 months. A $5 co-payment will be collected from people who fall in this group for each visit to the doctor.
Children who fall between 226 percent and 300 percent of the poverty level, are eligible for extended Medicaid only, if they can prove they do not have access to affordable health insurance. People in this group are responsible for premiums and co-payments equal to the state's consolidated health-care plan. The current premium is $65 per month. The current co-payments are $10 for doctor's visits and $5 for prescriptions. Families with total assets greater than $250,000 are not eligible for this expanded program.
Those requirements were stuck onto the law to ease opposition from GOP lawmakers who charged the proposal, a key plank in the governor's program, was a massive expansion of welfare.
There is a 30-day waiting period required to receive care, and families must wait six months before reentering the program if they miss their cost-sharing responsibilities.
Sen. Peter Kinder, R-Cape Girardeau, who opposed the bill, said he expects the issue to be an ongoing debate.
"I was contacted by two pediatric dentists who foresee a big problem," Kinder said. "They say the state doesn't know what it is going into."
Kinder said it is already difficult for Medicaid patients to find doctors.
"They only charge 30 cents on the dollar to Medicaid patients and they can only take in so many patients, or they are going to go out of business," he said. "They have to be able to pay their staff."
The state is currently in the process of making people aware of the program.
"We are in the process of publicizing the program. We are providing information to parents on how they can get coverage," said Chris Sifford, communications director for Gov. Mel Carnahan.
The program terminates in the year 2002.