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State Medicaid commission encouraging healthy behavior

Thursday, November 10, 2005 | 12:00 a.m. CST; updated 12:24 p.m. CDT, Tuesday, July 22, 2008

JEFFERSON CITY — The commission charged with reforming the state health care system switched its discussion Wednesday from changing coverage to changing behavior.

In less than two years, Missouri Medicaid is slated to be replaced, and the Medicaid Reform Commission is developing ways to renovate the state’s welfare program. But philosophical debates about personal responsibility for healthy behavior have dominated the commission’s work sessions.

Suggestions include requiring tobacco cessation for Medicaid recipients who smoke and dietary counseling for those who are obese.

The commission’s debates have not been limited to adult behavior, however. Commission member Sen. Pat Dougherty, D-St. Louis, recommended Wednesday that schools be required to form an “action plan” to address nutrition, physical education and obesity as a condition of receiving state funding.

Sen. Chuck Purgason, R-Caulfield, said such a requirement would encourage parents to turn over their responsibilities into the school system.

“There are things that education needs to do and that’s basically reading, writing and arithmetic. Do I want schools teaching my child things like what to eat? What if the teacher is a vegetarian?” said Purgason, a cattleman.

“It’s just another issue that parents allow schools to take over. I don’t want to go down that road,” he said.

Dougherty said he supports making state-funded schools offer healthier food in vending machines and cafeterias.

Medicaid Reform Commission chairman Sen. Charlie Shields, R-St. Joseph, supports the drive to focus on health management and education.

“If the state is willing to pay money for the disease state, the recipient should be willing to invest the time on the education side,” Shields said.

“To this point we’ve been focused on the disease state and not on preventing disease,” he said, “and I think if we’re going to change the way our nation looks at health, the way our state looks at health, we have to change that mind-set.”

Reduced co-payments were introduced as a potential incentive for Medicaid recipients to practice healthy lifestyles.

But Shields also recommended that Medicaid require co-pays and deductibles across the board. Giving recipients a financial stake would increase patient compliance, he said.

The group of state legislators and state department leaders also discussed incentives for businesses to offer employee health coverage, as a way to reduce the burden on Medicaid and the number of uninsured Missourians. The group was divided over whether employers should be encouraged or required to offer insurance coverage for workers.

The commission’s final recommendations are due in a report to the governor in January. Its final scheduled work session is today, but Shields said after reviewing its progress he will decide whether to plan more meetings.


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