Missouri Senate budget writers endorse $146 million health care expansion

Thursday, April 2, 2009 | 4:15 p.m. CDT; updated 11:26 a.m. CDT, Thursday, September 3, 2009

JEFFERSON CITY — House Republicans had rejected it, but Senate budget writers agreed Thursday to provide nearly $146 million for an expansion of government-funded health care to low-income parents.

The proposal, backed by Gov. Jay Nixon, would be financed with special hospital tax revenues and federal dollars — a key selling point for some senators opposed to committing general state tax revenues to the program.

As a result of Republican-led budget cuts in 2005, Missouri's Medicaid program currently covers parents earning no more than about $292 a month for a family of three. That equals about 19 percent of the federal poverty level and is the minimum amount allowed by the federal government.

The planned expansion would cover about 35,000 custodial parents earning up to 50 percent of the federal poverty level, or $763 monthly for a family of three.

House Republicans rejected the Medicaid expansion last month because of concerns the program would grow in the future, eventually eating into general revenues and forcing budget cuts.

For accounting purposes, the Senate committee separated the proposed health care expansion from the state's existing Medicaid and government health care programs. It also designated that it can be funded only with federal dollars, hospital taxes and money that otherwise would be paid to hospitals for treating the uninsured.

"That's a sound, conservative, Republican principal called efficiency," said Senate Appropriations Committee Chairman Gary Nodler, R-Joplin.

The committee's ranking Democratic member applauded the move.

"It is a sane, rational, compassionate thing to do, and I'm delighted they see the value of 35,000 adults getting health care at no additional cost for the state," said Sen. Joan Bray, D-St. Louis.

The Senate committee vote came a day after the full Senate chamber endorsed legislation authorizing the proposed health care expansion.

Nixon had proposed a straight Medicaid enlargement. The bill by Sen. Tom Dempsey, R-St. Charles, would enroll people in a Medicaid-like program called "Show-Me Health Coverage," which would be paid for by the state but provide some different benefits than Medicaid.

For example, Dempsey's proposal would not cover nonemergency transportation to doctor's visits, as Medicaid does, but would go further than Medicaid in covering some therapies. It would limit people's participation to three years, with an extension of up to two more years if they are enrolled in educational courses.

The money inserted into the budget by senators could be used to fund either Nixon's proposed Medicaid expansion or Dempsey's alternative, if it becomes law.

Nixon said Thursday that he's optimistic health care coverage will be extended to more low-income parents.

"There will be some disagreements about how exactly that gets done, but I think that's a significant step by the Missouri Senate ... to embrace that we need to move forward in this area," Nixon said.

Dempsey's legislation, which needs another vote to move to the House, also includes provisions that could provide government-subsidized insurance to people earning up to 225 percent of the poverty level, or $41,198 for a family of three. But that only would occur if legislators provide funding. It is not included in the proposed budget for next year.


Associated Press writer Lee Logan contributed to this report.

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