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Missouri House committee moves forward on Medicaid expansion proposals

Thursday, September 26, 2013 | 7:57 p.m. CDT
Correction: Twenty-four states and the District of Columbia are currently moving forward with Medicaid expansion. Twenty-one states are not moving forward with Medicaid expansion at this time, and five states are debating Medicaid expansion at this time. A previous version of the story incorrectly stated these totals.

A Missouri House committee evaluated proposed legislation Wednesday that would expand Medicaid to more low-income residents. Rep. Jay Barnes, R-Jefferson City, who chaired the committee, said he would file the legislation in December.

Formal debate in the Missouri House over Medicaid expansion would not begin until the spring. That's when members will debate whether to seek a federal waiver to help offset the cost of expansion.

JEFFERSON CITY — A Missouri House committee aims to land a federal waiver that could help subsidize private health insurance premiums for low-income Missourians. 

The House Interim Committee on Medicaid Transformation decided Thursday to begin drafting legislation during the next several weeks proposing changes to the state Medicaid program.

Upcoming Medicaid hearings

The Missouri House Interim Committee on Medicaid Transformation will hold several topic-specific hearings in the next few weeks to collect expert opinions about what a potential Medicaid expansion bill should include. All are open to the public. 

The tentative dates, times and topics are:

Tuesday, Oct. 15, 1 p.m. — How to prevent Medicaid fraud; what services should be added to Medicaid coverage.

Tuesday, Oct. 29, 1 p.m. — Accountable care organizations

Wednesday, Oct. 30, 8 a.m. — Cost-sharing; debit card models like U.S. Rep. Paul Ryan's proposed alternative to the Affordable Care Act

Tuesday, Nov. 5, 1 p.m. — Strategies to discourage Missourians from using the emergency room in a non-emergency.

Wednesday, Nov. 6, 8 a.m. — Eligibility levels.

Tuesday, Nov. 19, 1 p.m. — Wrap-up.



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Under the Affordable Care Act, states can apply for waivers that allow them to customize their Medicaid model and receive high levels of federal funding — if they expand coverage to adults with income up to 138 percent of the federal poverty level.

According to a House report, that means a family of four that earns up to $32,500 would be covered.

In a hearing Thursday, the committee reviewed four proposed Medicaid expansion models: one from Iowa, Indiana and Arkansas, as well as a plan U.S. Rep. Paul Ryan proposed as an alternative to the Affordable Care Act. 

Committee chairman Rep. Jay Barnes, R-Jefferson City, chose the plans because they would allow those who were added to the Medicaid program to be covered by private insurance companies.

“I see at least two similarities (among the plans)," said Rep. Chris Kelly, D-Columbia, a member of the committee. "One, they go beyond 138 percent. The other one is they all contemplate some kind of financial subsidy to encourage people to participate.”

The plans differed in their methods of covering childless adults between 19 and 65, a population Medicaid doesn't currently cover. Missouri opted out of the Medicaid expansion provision of the Affordable Care Act, but this waiver could give the state access to federal funds on its own terms.

Iowa's proposal, which has not yet been approved, would allow the newly covered to pay no premium and only a small co-pay as long as certain wellness criteria were met. That model could encourage recipients who now avoid the doctor to attend their annual checkups, said Sidney Watson, a St. Louis University law professor who was the sole expert witness at the hearing.

"Monthly premiums cause barriers to care ... (When) there's another expense — the gas bill goes up — they don't get the premium paid," Watson said.

Indiana's system, instituted by Gov. Mitch Daniels in 2007,  provided participants with a high-deductible health plan attached to a health savings account. The savings account allows recipients to let money roll over, potentially discouraging them from unnecessary use of expensive emergency room services.

The House committee includes two members of the Boone County delegation: Kelly and Rep. Stephen Webber, D-Columbia.

Kelly was vocal during the hearing, so much so that members joked he should take a seat at the front of the room next to the expert providing testimony. He was especially adamant that the potential legislation work to reduce misuse of the system, both from healthcare providers and recipients.

"We've got to cut down the fraud, including the patients who behave really, really badly," Kelly said.

The committee will meet several times in October and November to hear expert testimony about concerns they raised in Thursday's hearing. Barnes' goal is to file legislation in December for consideration by the General Assembly in 2014.

Committee vice chairman Rep. Noel Torpey, R-Independence, said Missouri should take the other models into account, but above all consider its own priorities in the legislation it eventually drafts.

"We need to think outside the box," Torpey said. "We should push the envelope a little bit. I think sometimes it's good to be unique and come up with our own ideas for Missouri."


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