JEFFERSON CITY — After a month of hearings, a state Senate committee narrowly voted Thursday to advance legislation that would revamp the way Medicaid is administered in Missouri to make it more like private insurance for many patients.
The legislation would shift more children and adults into managed-care Medicaid policies run by insurance companies while authorizing a new model of coordinated care for many seniors and disabled patients.
The proposal is based on the recommendations of a special Senate committee appointed last year to study changes to Missouri's Medicaid program, dubbed MO HealthNet, which serves about 840,000 people. The committee was led by Sen. Gary Romine, R-Farmington, who also is sponsoring the legislation.
"We've got a system that's taking care of our patients, but it's not well coordinated, so it's costing us money," Romine said while explaining his bill to colleagues earlier this month.
The Senate health committee endorsed the bill Thursday by a 6-4 vote, clearing it to move to the full Senate for debate. It was backed by three Republicans and all three Democrats on the committee but opposed by four other Republicans, meaning it could encounter some problems in the GOP-led chamber.
The legislation does not include a provision sought by Gov. Jay Nixon and his fellow Democrats to expand Medicaid eligibility to hundreds of thousands of low-income adults under the terms of President Barack Obama's health care. An eligibility expansion could draw down billions of additional federal Medicaid dollars. But it has repeatedly been rejected by Republican lawmakers wary of its long term costs and averse to doing anything that could be construed as supporting the federal health care law.
Some Republican senators also have expressed concern about the expansion of managed or coordinated care plans under Romine's bill.
Managed care insurance policies already are used by Medicaid to cover parents and children in about half of Missouri's counties in a swath stretching across the central part of the state from Kansas City to St. Louis. Elsewhere, the state Medicaid program pays a set fee to doctors and hospitals for each service they provide. The bill would require managed care to be expanded statewide for parents and children beginning in 2015.
Starting in 2018, the legislation also would require some senior and disabled Medicaid patients to be covered through "coordinated care organizations." Romine has estimated the provision will affect about 83,000 people.
The new organizations could consist of regional partnerships among hospitals, doctors and pharmacists that coordinate care for Medicaid patients. They would differ from managed care plans, in part, because they would not be run by insurers and, at least initially, would not entail the financial risks associated with the administration of managed care policies.
"We're moving the most vulnerable population — that I am very sensitive to — into a program that you're advocating for that has no track record with regard to Medicaid," Sen. Eric Schmitt, R-Glendale, said as the committee began considering the bill last month. "There's just a lot of unanswered questions."
Among its other provisions, the bill would increase the amount of assets people could have while still qualifying for Medicaid. That provision drew bipartisan support because the asset limit has not been changed in years. But the committee's chairman, Sen. Dan Brown, R-Rolla, raised concern about financial projections showing the change could cost tens of millions of additional dollars.