JEFFERSON CITY — Advocates for the mentally and physically ill urged lawmakers to expand access to Medicaid as a Senate panel began taking public testimony Tuesday on ways to improve the government-funded health care program.
The plea to expand adult eligibility for Medicaid was a familiar one — embraced by Democratic Gov. Jay Nixon but repeatedly rejected by the Republican-led legislature during its annual session that ended in May.
Republicans on the Senate Interim Committee on Medicaid Transformation and Reform stressed Tuesday that they were looking for ways to make the Medicaid program better, not necessarily larger.
But some of those testifying ranked a Medicaid expansion among the most necessary improvements, because it would decrease the number of uninsured and thus could reduce the tendency of medical providers to shift costs to insured patients.
"By increasing access to preventative care for all Missourians, the end result should be lower costs for care across all sectors," said Todd Richardson, of the South Central Missouri Community Action Agency, which aids low-income families.
Committee Chairman Sen. Gary Romine, R-Farmington, cut off Richardson's testimony after he used up the allotted five minutes. But other witnesses testified much longer, as senators kept asking questions of them.
The Senate panel is one of three special committees looking into Medicaid changes that could be considered during the 2014 session. A committee composed of 36 citizens and 14 House members is to hold its first hearing Wednesday in Independence. A separate House committee is to meet later this year to consider the findings of the 50-person panel.
Under the federal Affordable Care Act, states can receive full federal funding through 2016 if they expand adult Medicaid eligibility to 138 percent of the poverty level, which equals more than $15,850 annually for an individual or about $32,500 for a family of four. Starting in 2017, states must pay a 5 percent share that gradually increases to 10 percent by 2020.
Missouri's Medicaid program currently covers custodial parents earning up to 19 percent of the poverty level, or about $4,475 annually, and doesn't cover adults without children in their homes. Missouri's Medicaid eligibility for children extends up to three times the poverty level, which equates to $70,650 annually for a family of four.
Erin Brower, of the Kansas City-based Partnership for Children, said tens of thousands of eligible children still do not have coverage. She said parents would be more likely to enroll them in Medicaid if the parents also qualified.
Representatives of the National Multiple Sclerosis Society and National Alliance on Mental Illness also urged senators to raise adult Medicaid eligibility to the threshold set by President Barack Obama's health care law. That law provides enhanced Medicaid funding only for working adults, not for the disabled, seniors or children on Medicaid.
But Joanie Gillam, of the Disabled Citizen Alliance for Independence in Viburnum, said Medicaid eligibility also should be expanded for disabled residents. She said Missouri's asset limits are so low that they prevent many disabled Medicaid recipients from keeping enough money in their bank accounts to make emergency repairs to their homes or vehicles.
Among the others testifying Tuesday were two psychologists from Springfield, who said their Medicaid reimbursement rates haven't been raised in a couple decades. The psychologists urged lawmakers to exempt mental health services from Medicaid's managed care plans, which they said add so much bureaucracy that some patients don't get the immediate care they need.