JEFFERSON CITY — Witnesses pushed for a Missouri House panel to expand Medicaid as legislators heard from mental health providers, nurses and dentists in nearly five hours of testimony Tuesday.
The committee gathered for its second meeting this fall as it sets out to develop legislation to reform and expand Missouri's Medicaid program that can be introduced when the Missouri General Assembly convenes in January. A similar Missouri Senate committee has also been meeting and plans to begin work on draft legislation in November.
Mental health providers and experts at the hearing stressed the importance of serving at-risk patients at early stages of mental health illness in order to save money that is otherwise spent on more expensive back-end services such as serious rehabilitation and sometimes incarceration.
"Getting services on the front end really saves money on the backside," said Jim Wallis, vice president of public affairs at Preferred Family Healthcare, a nonprofit that provides mental health services. "Medicaid expansion could expand services to at-risk populations."
Witnesses said expanded Medicaid would allow providers across the state with more flexibility and the opportunity to provide more services to more patients.
Wallis said closing the coverage gap could help reduce the overall cost of treating mental health services because more patients would receive less costly forms of treatment at earlier stages.
He also said the Missouri Department of Mental Health currently serves 12,500 mental health patients, and expansion would bring in 4,200 additional patients. The department treats 21,000 people for substance abuse, and expansion could increase that number by 11,000.
He said the 10 percent spending match the state will eventually have to shoulder for the expanded population could be funded at the department's current budget levels.
Many people who suffer from mental health conditions fall through the cracks until they land in the hands of local law enforcement agencies, which bear substantial burdens dealing with indigent populations.
"We are the front line, we see these folks day in and day out,” said Kent Oberkrom, immediate past president of the Missouri Sheriffs' Associationc. "Now we let them fester until they commit a crime and show up at our doorsteps."
Rep. Chris Kelly, D-Columbia, said the state pays 100 percent of the incarceration costs for people that re-offend, even though it is clear that paying for mental health treatment can reduce recidivism rates.
"The dollars to the state of Missouri in this area are enormous," Kelly said.
Mental health counselors and a nurse practitioner asked the committee to provide more leeway to provide services to patients who don't have consistent access to physicians.
Michael Bleich, dean of the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, said advanced practice registered nurses are critical for family- and community-based care.
"We need to optimize all hands on deck," Bleich said. "We have the opportunity to uplift primary care providers."
He said nurses have experience practicing in different types of environments such as schools, parishes and homes, but Missouri still restricts the type of care nurses can provide more than other states.
"We need to look at our health care workforce and be where people are going to be," he said. "There is no reason to restrict and think about the role of the (nurse) in a limited way. ... Somehow we think no care is better than the care of an advanced practice nurse."
The committee continued to discuss a system that would focus on providing premium assistance for patients to be on private plans, some of which could be available through the new federally run health exchanges. A private-managed care option is also under discussion, but many of the witnesses said they would want their patients to be exempt from any managed care plan.
Because the legislators are determined to develop a plan that would be unique to Missouri, it would likely need approval from the Secretary of the Department of Health and Human Services — approval that will only come if Missouri expands eligibility to all adults under age 65 at or below 138 percent of the federal poverty line.
A 2012 MU study estimated more than 200,000 Missourians would be eligible under the new Medicaid requirements.
"It's a negotiation with (the Centers for Medicare and Medicaid Services), but I think the criteria are pretty squishy," said Joel Ferber with Eastern Missouri Legal Service of developing a Missouri-specific plan. "There is the option to do a more privatized plan for an expansion group."
Some legislators discussed the challenge of digesting the complexity of the Medicaid system before knowing how to reform it and what services to provide.
"We hear from department heads that it is very difficult to see the whole picture" at the department level all the way down to the single patient, said Rep. Sue Allen, R-Town and Country. "We have many challenges as far as communicating and seeing the whole picture."
The committee chair, Jay Barnes, R-Jefferson City, said he hopes Missouri can create a market-based system that shows other states how to provide services to Medicaid beneficiaries in the most efficient and effective manner possible.
"We are a misplaced decimal point nationwide when it comes to expanding Medicaid, which is why we should be able to serve as an experiment to show states like New York and California how to save massive amounts of money," Barnes said.
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