Bill would give doctors tax break for seeing Medicaid patients

Sunday, December 28, 2008 | 7:52 p.m. CST; updated 8:03 p.m. CST, Sunday, December 28, 2008

CAPE GIRARDEAU — A state lawmaker is pushing legislation that would provide health care workers tax breaks as an incentive for them to see more Medicaid recipients.

State Sen. Jason Crowell, R-Cape Girardeau, said the bill would allow doctors, nurses and dentists to deduct Medicaid payments from their taxable income.

He said such a move would make up some of the gap between how much the taxpayer-funded program reimburses for health care and how much that care actually costs. The generally low payments have led many health care providers to avoid treating Medicaid patients, creating a bottleneck for those patients to find care.

In the fiscal year that ended June 30, Medicaid payments to health care providers totaled $206.7 million. Crowell estimates his bill would provide tax savings to those providers of about $12.4 million.

Ultimately, Crowell said he'd like to see the Medicaid payments closer to those of Medicare, a health program for the elderly that more closely matches actual costs.

"It is an acknowledgment that we are not at the Medicare reimbursement rate and we are not covering costs," Crowell said. "This is another way to hopefully prevent doctors, especially those providing specialist care, from refusing to see Medicaid patients."

This fall, Medicaid, or MO HealthNet, as it's called in Missouri, seemed to be a big target for the 2009 session of the General Assembly. Governor-elect Jay Nixon had centered his election campaign on restoring cuts made to the program in 2005.

But the collapsing economy has turned a $833 million state surplus to an expected $342 million deficit.

Crowell said the focus should now be on how to give the 700,000 state residents without insurance access to doctors and preventative health care.

"It is a new day in the state of Missouri, and tough economic times allow us to be more creative and reform-minded when you start trying to address health care issues in the state," he said. "The issue needs to be focused on access to health care in Missouri, not how many people we put on Medicaid rolls."

He pointed to the state of North Carolina, which pays doctors there the same rates for seeing Medicaid patients as for Medicare and where each Medicaid patient is assigned a general practitioner as a "health care home." MO HealthNet has such a structure available but no way to encourage physicians to sign up as health care homes.

North Carolina pays the physician $3 monthly per patient enrolled for a health care home. It's not much, Crowell acknowledged, but it does allow the doctor to counsel the patient about obesity, smoking and other conditions that could cause serious medical costs down the road.

"We won't pay $3 a month to help manage some kind of element of health, but boy, we will pay for an open-heart surgery," he said.

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