Medicaid overhaul tops agenda at close of legislature

Friday, May 18, 2007 | 10:23 a.m. CDT; updated 11:04 a.m. CDT, Saturday, July 19, 2008

JEFFERSON CITY, Mo. (AP) - On their final day of work, Missouri lawmakers were still wrestling with the biggest issue of their session: an overhaul of the Medicaid health care program for the poor sought by Gov. Matt Blunt.

A compromise reached Friday by House and Senate negotiators would place a greater emphasis on preventive health care in a renamed "MO HealthNet" program and restore certain health benefits to some whose services were cut two years ago.

The Senate passed the health care legislation 26-7 Friday afternoon, shifting debate to the House, which had to pass the bill by its 6 p.m. adjournment for it to go to Blunt.

"I am just praying that both chambers will manage to get this bill down by the end of today," said lead House negotiator Rob Schaaf, a Republican physician from St. Joseph. "I feel like we've taken a giant step in really transforming the Medicaid program."

Republican senators on the last day also used their majority power to shut off Democratic debate on two contentious issues. They sent Blunt a bill subjecting some abortion clinics to greater state oversight, allowing abstinence-only sex education classes and prohibiting those affiliated with abortion providers from teaching sex education.

They also passed a proposed constitutional amendment making English the language of official government proceedings, but that measure needed a final House vote to go on Missouri's statewide ballot in 2008.

The Medicaid legislation would implement health risk assessments for the state's roughly 825,000 enrollees — part of an effort to better coordinate their care and catch budding health problems before they become serious.

The Department of Social Services, in conjunction with an 18-member oversight committee, would come up with several health plans, with varying levels of coordinated care. Everyone would be enrolled in one of those options, dubbed health improvement plans, by 2011.

"We are moving away from the old fee-for-service Medicaid system, which pays for sickness, to a system that encourages wellness and prevention and rewards good health outcomes," said Senate Majority Leader Charlie Shields, a Republican hospital executive from St. Joseph who is the bill's lead sponsor.

Dental and eye care benefits would be restored to thousands of adults whose coverage was cut two years ago as part of a budget-saving move by Blunt and the Republican-led Legislature. But the compromise bill would not mandate that they again receive podiatry or orthopedic services, as a previous House version would have done.

Medicaid coverage also would be restored or improved for a few thousand working disabled residents whose benefits were cut in 2005. Coverage would be expanded to several thousand children of lower-income parents. And an estimated 82,500 lower-income women age 18 and older, without employer-sponsored health insurance, could receive government-paid pelvic exams, cancer screenings and family planning services.

Democrats noted that Missouri's $6.5 billion Medicaid program serves about 175,000 fewer people than it did before the 2005 eligibility cuts. While praising some portions of this year's bill, they bemoaned that it didn't reverse more of those cuts.

"You could have a really darn good looking Cadillac sitting in your driveway, but if you don't have any gas in it, you're not going anywhere," said Sen. Wes Shoemyer, D-Clarence. "We've got programs without eligibility, without making that restoration."

Several members of the West Side Baptist Church in St. Louis paced the halls outside the legislative chambers to protest the Medicaid bill for not reversing more past cuts.

"It seems mean-spirited at best and really not considerate of the people," said deacon Alvin Purnell, 51, carrying a sign declaring "NO MORE Medicaid cuts."

The bill would let whistle-blowers get a 10 percent cut for reporting Medicaid provider fraud to the state attorney general's office, if their tips lead in successful cases.

It also would direct the Department of Social Services to come up with a four-year plan by July 2008 to increase the basic Medicaid rates paid to medical providers. Certain health care providers could get even more money if they have good patient outcomes, a key point pushed by Blunt, and the Senate that the House reluctantly accepted.

Negotiators dropped from the final bill a Senate proposal that also would have rewarded patients who kept doctors' appointments and tried to live healthy lifestyles with debit card points that could have been used for such things as medical co-payments, over-the-counter drugs or health club dues. But Shields and Schaaf said the department and legislative oversight committee still could include the patient incentives as they develop details of the health plans.

A plan to offset part of the private health insurance premiums of previously uninsured small business employees would be set up as a pilot project in an urban and a rural area, instead of being implemented statewide as originally sought by Blunt and the Senate.

Blunt made the Medicaid overhaul a top goal for the 2007 session, along with enactment of tax breaks and passage of a higher education plan that creates new scholarships, limits tuition increases and takes $350 million from Missouri's student loan agency to finance college buildings.

The higher education legislation and an income tax cut for Social Security benefits both received final legislative approval last week.

So did a massive economic development bill, with tax breaks for numerous businesses and causes, that included several troublesome provisions lawmakers still were trying to reverse on the session's final day.

—The Medicaid bill is SB577

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