JEFFERSON CITY — Some Missouri Republicans have remained adamantly opposed to expanding Medicaid to hundreds of thousands of adults by tapping into billions of federal dollars available under President Barack Obama's health care law.
Yet support has been quietly growing among some of those same Republicans for a mini Medicaid expansion.
Some Republicans have teamed up with Democrats to back a proposal that would double the amount of assets people could have without being disqualified for Medicaid coverage. The change is projected to expand Medicaid to nearly 8,200 elderly and disabled residents at an eventual annual cost of around $160 million in combined federal and state funds.
"I think it will cross the finish line. I think we will change those asset limits," said Sen. Dan Brown, a Republican from Rolla who is chairman of the chamber's health committee.
Brown's support for the higher asset limits is notable because he's one of more than half of a dozen Republican senators who have vowed to block any attempt to enact the larger Medicaid expansion envisioned under Obama's health care law.
Under that federal law, states initially can receive full federal funding — but eventually must pay a 10 percent share — if they expand Medicaid eligibility to adults earning up to 138 percent of the poverty level, which is nearly $33,000 for a family of four.
About half of the states have adopted the expansion. Missouri could reap more than $2 billion annually from the federal government. But Missouri Republicans have repeatedly said "no." This past week, some GOP senators derailed debate on a Medicaid overhaul bill out of a fear that it could be amended to include Medicaid expansion.
One of the things tucked into that bill was the proposed increase in Medicaid asset limits. But none of the debate focused on that provision.
Under a 1968 law that remains in place today, senior and disabled residents cannot qualify for Medicaid if individuals have more than $1,000 of assets, or $2,000 for married couples. That calculation excludes the home they live in but not the money needed to repair the roof. A vehicle similarly would not count toward the limit, but the money needed to repair the transmission would.
A lot of other things have changed in the 46 years since those asset limits were last adjusted. If the limits had kept pace with inflation, they would now stand at more than $6,700 for an individual and nearly $13,500 for married couples.
Missouri's low limits mean the disabled and elderly must essentially drain their bank accounts in order for Medicaid to cover in-home care services that can help them remain self-sufficient and out of nursing homes, said Andrew Lackey, a public policy analyst for the Missouri Developmental Disabilities Council.
"You can't accrue savings to deal with unforeseen emergencies," Lackey said. "The rest of society is encouraged to save, but we have a system that discourages saving."
This past week, Lackey helped lead a disability rights rally at the Missouri Capitol. There wasn't much discussion of expanding Medicaid eligibility under Obama's health care law. Instead, participants were lobbying for higher asset limits and Medicaid coverage for adult dental care.
A bipartisan Senate health committee has twice endorsed bills this year that would raise the asset limits to $2,000 per individual and $4,000 per married couple. It included the provision in a larger Medicaid bill now stalled in the Senate. It also endorsed the change as a stand-alone bill.
Legislative researchers estimate the higher asset limits could cost a total of $125 million in 2015, with more than $30 million coming from state general revenues and the rest from federal and other sources. That total is projected to rise to $163 million by 2017, with nearly $40 million coming from state general revenues.
"I'd have concerns about the cost," said Senate Appropriations Committee Chairman Kurt Schaefer, R-Columbia, whose panel is to begin work Monday on the next state budget.
Sen. Rob Schaaf, an appropriations committee member, said he believes raising the asset limits ultimately could save the state money by helping to keep people out of nursing homes.
"I don't want to expand Medicaid," said Schaaf, R-St. Joseph. But he added: "I would support that" higher asset limit.
For Brown, the quest to raise the asset limits has become personal. His 84-year-old father has been paying out-of-pocket to reside in an assisted-living center for the past three years. Within the next six months, he's likely to run out of money and may have to apply for Medicaid, Brown said.
"I wish he could have a greater asset limit when it gets to that point," Brown said. "I personally would love to see it raised."