Medicaid drug tests eliminated

Missouri legislators give up on the proposal to keep from losing federal funding.
Thursday, May 17, 2007 | 12:00 a.m. CDT; updated 6:54 p.m. CDT, Monday, July 21, 2008

JEFFERSON CITY — Missouri lawmakers have scrapped a proposal to conduct random drug tests on Medicaid recipients for fear it could have cost more than $4 billion, the full amount of Medicaid money the state gets from the federal government.

The drug testing language was overwhelmingly adopted last week by the House, which voted 123-24 to amend the requirement to legislation revamping the government health care program for the poor.

But a panel of five House and five Senate members negotiating a final version of the bill decided Tuesday night to drop the proposed drug tests after learning they could have violated federal policy and thus jeopardized federal funding for Missouri’s Medicaid program. That could have left the state to pick up the slack of $4.3 billion, the state Department of Social Services said.

The amendment had been sponsored by Rep. Will Kraus, R-Raytown, who said he understood why it had to go.

“We don’t have that kind of money in the budget,” Kraus said Wednesday.

Missouri’s Medicaid program serves about 823,000 low-income people, down significantly from the 1 million enrollment of two years ago, before the Republican-led legislature tightened eligibility and cut benefits to try to save money.

This year, the legislature is considering restoring a few of those services as part of a bill that would rename the program “Mo HealthNet,” place a greater emphasis on preventive health care and potentially increase the rates paid to medical providers who treat Medicaid patients.

The amendment sponsored by Kraus was brief. It stated: “Notwithstanding federal law and subject to appropriations, MO HealthNet participants shall submit to random testing for illegal drugs to remain eligible for MO HealthNet services.”

Mary Kahn, a spokeswoman for the federal Centers for Medicare and Medicaid Services, said Wednesday that there was “no reason I can think of that it would be legitimate ... certainly not as a condition of enrollment.”

The amendment contained no penalty for those who failed the drug tests. But Kraus said he hoped it would discourage some drug users from applying for Medicaid or encourage those already on Medicaid not to use illegal drugs.

“I’m in the military, and every month I go to drill I’m subject to have to take a random drug test,” said Kraus, who is in the Army Reserves and was deployed to Iraq in 2003-04. “Why would the people we’re giving benefits to in Missouri not have to be subject to the same requirement?”

Dan Viets, a Columbia attorney for the mid-Missouri chapter of the American Civil Liberties Union, said there is a key distinction. Military members give up some rights when they sign up and are responsible for the safety of others. That’s not the case for medical patients, Viets said.

The Fourth Amendment to the U.S. Constitution prohibits “unreasonable searches and seizures.” Federal courts have determined that drug tests qualify as searches and can be imposed randomly on public employees only if governments show a special need that outweighs privacy rights. Medicaid enrollees aren’t government employees but rather recipients of government services.

“I can guarantee you it would be challenged forthwith if it were enacted” for Medicaid recipients, Viets said. “It would never be allowed to go into effect.”

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