and the Associated Press
JEFFERSON CITY - Several thousand adults and children could lose health care coverage under legislation approved by the House as a way to slow the growth of Missouri's multibillion-dollar Medicaid program.
In a marathon session lasting well past 11 p.m. Wednesday, the House voted along party lines to give final approval to a bill tightening the restrictions on who is eligible for Medicaid services.
The plan would make it more difficult for some people to qualify for Medicaid and impose new co-payments on participants each time they visit a doctor.
House Republicans support the measure, calling it a way to bring Medicaid eligibility "in line with where it should be."
"Those than can afford to should be expected to pay," said Rep. Kevin Wilson, R-Neosho. "The government should be the backup system, not the go-to system to begin with."
The legislation also would authorize the elimination of some Medicaid services not required by the federal government, such as dental and optical care for low-income adults.
Rep. Bryan Stevenson, R-Webb City, said the legislature should be able to examine such programs every year and decide whether the resources are available to fund them.
"When you have mandated programs that eat up large portions of the budget, it removes the flexibility we have to make decisions," Stevenson said.
While certain Medicaid provisions in Missouri are technically "optional" under federal guidelines, Stevenson said Missouri law does not include language making those programs "subject to appropriation" by the legislature. As a result, several courts have ruled the programs are mandates -- and must be funded every year.
The bill would make the requisite changes in state law to change that -- and to accommodate some of the Medicaid funding cuts proposed in the annual state budget that takes effect July 1.
That budget plan, pending in a House committee, would shave about $110 million in state and federal money from the $4.2 billion Medicaid program, which covers about 950,000 poor, elderly and disabled Missourians.
Wilson said about 140 new Medicaid recipients are enrolled each day, and that the program had grown beyond its original intent.
"Eligibility should be for those who need it most," Wilson said.
Rep. Jodi Stefanick, sponsor of the authorizing legislation, said Medicaid has grown from 4 percent of the state budget in 1968 to 23 percent of the budget now.
"This program has grown so much that today, just about one in five Missourians are on Medicaid," said Stefanick, R-Ballwin. She said her proposal "works to protect our highest priorities, such as education, by containing welfare spending."
But House and Senate Democrats said the cuts would force low-income, working families to seek medical care in hospital emergency rooms if they are no longer on Medicaid. Ultimately, that could cost the state more, they said.
"Republican leaders are choking to death every social program created in the last 50 years," Senate Minority Leader Ken Jacob of Columbia said at a news conference with Democratic colleagues.
During House debate, Rep. Sue Schoemehl, D-St. Louis, read a letter from Catholic bishops to lawmakers urging them not to cut health care for the poor. Immediately afterward, Republicans voted to shut off debate and then gave the bill initial approval.
Some of the bill's measures were recommended by Democratic Gov. Bob Holden, including the 50 cent-to-$3 co-payment for Medicaid recipients' doctor visits. That is projected to save $22 million in federal and state funds.
Holden also recommended another provision in the bill: a $25,000 asset limit, excluding such things as homes and vehicles, for participants in the MC+ for Kids program. That program provides health care to children whose families lack private insurance but don't qualify for traditional Medicaid. It currently covers people with a net worth of $250,000.
The change is expected to save $800,000 in federal and state money, resulting in a loss of coverage to about 880 children.
The bill also authorizes monthly premiums to a greater number of MC+ for Kids participants, which Holden did not recommend and which the Department of Social Services says could cause the parents of 20,000 children to drop out of the program. The premiums are expected to save $5.7 million.
Other Medicaid changes authorized by the Republican-backed bill would impose a $1,000 asset limit, excluding such things as homes and vehicles, for low-income parents to qualify for Medicaid. That could save $3.6 million and end coverage to about 1,600 people.
The bill also authorizes budget writers to stop funding Medicaid services not required by the federal government. House Budget Chairman Carl Bearden, R-St. Charles, said he plans to cut funding for dental and eye care for 409,000 adults, resulting in a savings of $17.8 million.
Similar budget cuts have been tried in previous years but rejected by courts because lawmakers had not changed the state law requiring the services.
A separate budget proposal - not needing legislative authorization - would reduce Medicaid's income eligibility threshold for low-income parents, saving $48 million while phasing out coverage for 39,000 people.