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PrintJEFFERSON CITY — Inarguably, the biggest issue to face Missouri lawmakers when they begin their 2007 legislative session on Jan. 3 will be to restructure the state’s largest welfare program — Medicaid.
Last year, the Missouri General Assembly passed a June 30, 2008, sunset on Medicaid in an effort sponsors said was designed to force the state to look at restructuring the entire program. A sunset clause provides for the expiration of a program on a specific date unless it is purposefully renewed.
Despite the magnitude of the program that consumes more than $5 billion per year, the state administration’s efforts at putting together a new program have been kept under wraps and unannounced.
Various members of the governor’s Cabinet, executive department heads and other experts have been working together to recommend the new health care program, according to a spokeswoman for the governor. But neither the members of the group nor their meeting schedules have been announced.
“There’s not a group, and it hasn’t been the same group that has met all the time,” said the governor’s spokeswoman, Jessica Robinson. “The nature of it is that it is an ongoing discussion. They’ve pulled in different division directors and subject matter experts depending on what they were talking about.”
The executive directors, deputy directors and the legal councils of the departments of mental health, health and senior services and social services have consistently been involved in the meetings.
The proposal is scheduled to be finalized by the end of December — just days before lawmakers begin their session. The governor will review the proposal, and then present it to the General Assembly.
In addition to the governor’s group, a formal Medicaid Reform Commission drafted a plan last year for changing Medicaid.
The commission was created by the legislature in the same year it adopted the Medicaid termination date. The commission’s plan stressed preventive care efforts and modernizing medical information systems. The commission was created as part of the 2005 legislation that included the Medicaid termination date and cut more than 94,000 Missourians off the program.
Legislative leaders decided to postpone action on the recommendations until the 2007 session.
The one recommendation that was brought before the legislature died in a House-Senate standoff. It would have established a grant program to help health care providers modernize their information systems.
“I think the report serves as the basis for much of the recommendations for the administration,” said the commission’s chairman, Sen. Charlie Shields, R-St. Joseph.
Since the commission presented its plans, the top leaders for health and welfare programs in Missouri have left the administration. Resigned or departed are the directors of the Social Services Department, Health and Senior Services Department and the Mental Health Department, along with the director of the Medical Services Division that administers the Medicaid program.
Missouri was facing a $1.1 billion budget shortfall with a Medicaid system that was growing way out of control, said Ana Compain-Romero, spokeswoman for the Department of Social Services.
“If the system continued to grow in that manner, it would have single-handedly crippled the state’s economy,” she said. “The choice was either to increase taxes, and Missourians have consistently voted against that, or to make changes to the system.”
While the Blunt administration has been tight-lipped about its plans, last year’s commission adopted a lengthy, detailed report after hours of public meetings. The group recommended that the new program place more emphasis on prevention.
“We have a health care system focused on paying for disease and not paying for wellness,” Shields said. “We will pay to keep a diabetic in the hospital, but we won’t pay for a nutritionist to work with a diabetic patient to keep them out of the hospital. The biggest change in the new system will be more of a focus on wellness prevention.”
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