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Medicaid reform due by 2008, say Mo. officials

The main issue in the redesign is coverage for all Missouri children.
Thursday, November 30, 2006 | 12:00 a.m. CST; updated 2:52 p.m. CDT, Sunday, July 20, 2008

“First, do no harm.”

The axiom attributed to Hippocrates, known as the Greek founder of medicine, is one that Citizens for Missouri’s Children hope Gov. Matt Blunt and the state legislature will keep in mind next year as they redesign a Medicaid program that’s set to end in 2008.

Citizens for Missouri’s Children hosted members and child-welfare workers and advocates at its annual policy briefing Wednesday in Columbia. One of the advocacy group’s highlighted goals for the next year is to ensure health insurance for all of Missouri’s children.

“It’s universally accepted by anyone who thinks the world is round that people with health insurance get better health care,” said Joel Ferber, managing director for Legal Services of Eastern Missouri, who presented research findings on Missouri’s Medicaid program.

Ferber said Medicaid cuts enacted by the state in 2005 are a major obstacle between children and sufficient health care in Missouri. The cuts were included in a Senate bill, which Blunt signed into law, that imposed a “sunset clause” on Medicaid, eliminated some of its services and raised eligibility requirements, taking thousands of people off the Medicaid rolls.

The law targeted all optional spending in the Medicaid program, including pharmaceutical drugs, eyeglasses and power wheelchair batteries. Some of the programs that were cut were later reinstated at a cost to the insured. Those programs included First Steps, which provides care for developmentally disabled children younger than 3.

Ferber said this cost-sharing, which proponents say saves the state money, places undue financial pressure on low-income families.

Since the bill was signed into law 18 months ago, an estimated 90,000 Missouri children have either lost insurance or left the program because of the expense of new cost-sharing initiatives, said Beth Griffin, director of Citizens for Missouri’s Children. Ferber placed that number at about 70,000, but both estimated there are more than 190,000 children in Missouri who are uninsured.

“We are concerned about the losses in the last 18 months,” Griffin said. “It’s very difficult for low-income families to jump through the hoops put in front of them.”

The group’s goal is to use Medicaid, the State Children’s Health Insurance Plan and private insurance to ensure that all Missouri children are covered. The belief is that preventative care provided by a primary physician can prevent inappropriate use of emergency rooms, which is more prevalent among uninsured patients and is a financial drain on hospitals, Ferber said.

This assumption counters that of proponents of reform, who feel that Medicaid is an economic burden on the state.

Medicaid accounts for $6 billion of the state’s $21 billion budget, according to the Missouri Office of Administration. Only $1.4 billion of that money comes from the state’s general revenue fund. Another $1.3 billion comes from taxes on hospitals; the rest comes from federal matching money.

Ferber said that because the majority of money comes from the federal government, the state actually stands to lose money if the program is allowed to end. He doesn’t think that will happen, though, predicting the General Assembly will pass a plan that “sounds different” in the 2007 session.

Ferber said he doesn’t expect that Blunt or legislators will want Medicaid reform hanging over their heads during the 2008 election cycle.

“No one is really thinking there will be no Medicaid in Missouri,” Ferber said.

That’s why Citizens for Missouri’s Children wants to be involved in the Medicaid redesign.

Meanwhile, representatives of state executive agencies -- including the Department of Health and the Department of Social Services -- are preparing recommendations for a new Medicaid program that should be presented to Blunt in December. Blunt will then assess those proposals and submit a plan to the General Assembly in January, Blunt spokeswoman Jessica Robinson said.

Griffin invited a representative of the governor’s office to speak to the group Wednesday, but the invitation was declined.

“It’s too early to talk about policy,” Robinson said. “There will be ample opportunity for public input later.”


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