Budget scrutiny to begin

Mo. legislature must act quickly on Medicaid-dominated budget
Tuesday, February 22, 2005 | 12:00 a.m. CST; updated 7:29 a.m. CDT, Tuesday, July 22, 2008

JEFFERSON CITY — The General Assembly is in the early innings of this year’s budget season, and politicians are swinging away.

While Gov. Matt Blunt is batting a thousand for his young career — the Springfield Republican has never lost an election — the 34-year-old rookie governor faces a new test in his first budget.

Blunt, who ran on a platform of no new taxes, has proposed slashing state spending by $1.1 billion. The centerpiece of the cuts is a reduction in Medicaid eligibility that would remove nearly 90,000 Missourians from state-subsidized health care.

Blunt’s plan, however, still must make it through House and Senate committees and win approval in both chambers before it slides safely back onto his desk. While there’s little reason to think he’s going to strike out — both the House and Senate are firmly in Republican control — Blunt might not get the pitch he’s looking for.

The Senate gutted a less severe Medicaid cut last year. Republicans from rural areas, where more than half of Medicaid recipients live, might be reluctant to sign on.

“I don’t think ever in time there has been a governor’s budget that came out exactly like it started,” said Rep. Jodi Stefanik, R-Ballwin, who chairs an appropriations committee on social services. “He said this is a starting point.”

Thanks to terms limits, legislators today are less experienced in budgeting than their long-serving predecessors. At a Monday meeting of Stefanik’s committee, a representative of the Department of Social Services spent more than two hours walking lawmakers through the procedure for enforcing Medicaid eligibility requirements.

Rep. Margaret Donnelly, D-St. Louis, thinks the lack of familiarity with the system makes it harder to sort out something as complex as Medicaid.

“I believe that (Blunt) has used an ax to make very arbitrary decisions about who we should cut,” Donnelly said. “It’s difficult if you have not been repeatedly looking at budgets to know how you might look at it differently.”

After watching more than a month go by before holding their first hearings, House members might now have to scramble to get the budget out before the General Assembly adjourns in May.

“We took way too long to get going at the beginning,” Donnelly said. “As a result, we’re going to find ourselves maybe making hasty decisions we’ll regret later.”

Medicaid uses a combination of state and federal money to provide health care assistance to Missourians with low incomes or disabilities. Throughout the 1990s, Missouri’s Medicaid rolls swelled. When Gov. Mel Carnahan took office in January 1993, just more than 510,000 Missourians were enrolled. The latest estimates say nearly 1 million are covered today.

The program’s $4.8 billion price tag accounts for more than 28 percent of Missouri’s budget.

In an effort to trim a program he called “financially unsustainable,” Blunt proposed slashing Medicaid rolls and eliminating a number of smaller programs. Blunt’s proposed 2005 budget would reduce the income threshold from 75 percent of the federal poverty level to 30 percent. The income cap for a family of four on Medicaid would drop from $14,137 per year to $5,655. All totaled, the cuts would drop 89,046 people from the program.

“If we don’t get after the eligibility, then certainly the program is doomed,” Stefanik said. “We need to do the reform to save the program for the neediest.”

Tennessee is the only state that spends a higher percentage of its budget on Medicaid than Missouri, according to the National Association of State Budget Officers. There, Democratic Gov. Phil Bredesen is fighting for massive cuts. His original proposal called for dropping 323,000 adults from the system, but compromises may force that number down.

And in Washington last week, President Bush issued his new federal budget. It calls for $60 billion in Medicaid cuts over the next 10 years, a measure that could force more states to consider eligibility rollbacks.

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