Cuts to Medicaid top Nixon's withholdings

Thursday, October 29, 2009 | 12:01 a.m. CDT; updated 10:18 a.m. CST, Tuesday, December 8, 2009

JEFFERSON CITY — Medicaid and other health care expenditures topped Gov. Jay Nixon's list as he announced $204 million in budget cuts Wednesday.

Under Nixon's plan, Medicaid programs face a loss of more than $32 million, mental health programs will lose $3 million, and MU Health Care-affiliated hospitals and clinics around the state will lose $3 million.

Despite these cuts, Nixon said services will not be drastically affected. Health care advocates, however, said there would be an impact on health care.

The cuts will manifest themselves in a number of ways.

Increases in Medicaid reimbursement rates will be stalled — not cut — until the legislature can come up with the money to fund it, State Budget Director Linda Luebbering said.

The reimbursement plan originally passed through the legislature as a three-year plan.

"What was supposed to be a three-year plan is becoming a five-year plan," Rep. Chris Kelly, D-Columbia, said.

But that could have effects on the willingness of doctors to take Medicaid patients, said Bob Quinn, executive director for the Missouri Association for Social Welfare.

"When the reimbursement rate isn't high enough, if you as a practitioner take that patient, you're losing money on that. If you've paid your medical school debts, own the building you work in, maybe then you can take a few patients you're losing money on," Quinn said.

A major change will also come to the Medicaid billing formula, encompassing more than 16,000 billing codes for various procedures and services. The state is now opting to decrease the amount reimbursed for certain services that are being reimbursed at higher Medicare levels rather than the standard Medicaid rate. This includes services such as X-rays, midwife services, optical services and audiology services.

For people being served by both Medicaid and Medicare, the state will no longer cover some procedures through Medicaid, but will shift the burden to Medicare, which is entirely federally funded.

Because of the $3 million in cuts to the Mental Health Department, its programs will no longer be able to accept new people seeking help for alcohol or drugs, psychiatric issues and developmental disabilities.

"Folks that want to participate in one of those services will be put on a waiting list," said Bob Bax, a spokesman for the Mental Health Department.

"We would still accept those at community mental health centers, typically in emergency situations," Bax later said, by sending those people to emergency rooms for care.

The $3 million cut from MU hospitals and clinics represents a 25 percent decrease in funds supplied by the state. Additionally, the state will be withholding about $200,000 from MU's telemedicine program that allows doctors to diagnose at a distance and almost $1 million from the Missouri Kidney Program, which does much of its research at  MU. The MU School of Medicine will lose more than $400,000 for its Institute of Mental Health.

The governor is constitutionally required to keep a balanced budget, and Nixon said part of the blame for unfunded health care rests with the legislature.

"I should also note that all of the issues around Medicaid here would have been much easier had the legislature adopted what was a very, very solid proposal last year to not use one penny of state dollars," said Nixon. "If we had that 150 million dollars in the state till, all of this process would've been much easier."

The cuts by Nixon and Luebbering have garnered both support and criticism from health and welfare advocacy associations.

"Missouri is facing significant critical problems with revenue structure, and we've spent the last 10 years responding to this by cutting services over and over again," said Amy Blouin, executive director of the Missouri Budget Project. "It's like hitting your head against the wall and expecting a different result each time you do it. It's crazy."

Quinn said the budget cuts are a result of years of not generating enough revenue to cover programs.

"She (Luebbering) is a top-notch budget director," Quinn said. "She can't control what she has to work with. She must look at the most intelligent way she can spend this money. We all know we don't have enough money in there, and they have to say, we don't have the money to do that. But the people most vulnerable are the ones bearing the brunt of this, and that's the most unfortunate part of this."

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