Senators considering changes that would kick tens of thousands of people off the Medicaid program have heard allegations of questionable operations in a state Medicaid office. Doctor David Ingelking was a member of the Medical Review Teams that looked at applications for state medical assistance for people too disabled to continue with meaningful employment. He noticed early in his career that the Springfield office, which handles cases for western Missouri, was giving approvals at a rate of two to three-times the rate allowed by the Jefferson City office. He says he learned why when he became part of the Springfield review team. He says the Springfield office wrote its own guidelines for acceptance. And he charges the program coordinator there, who is not a doctor, has ignored the doctors doing medical revues. Ingelking has told a Senate committee the woman told team members to approve some things automically, or almost automatically. He says he complained to the State Supervisor of Medical Review Teams, then to the State Director of Family Support. He says his complaints led to his firing. The senior member of the committee has called for a legislative investigation of those practices.