Healthier habits would reduce the strain on Missouri’s Medicaid budget, but how to motivate recipients to improve their health is a matter of debate for the Medicaid Reform Commission. Some on the Commission lean toward the carrot, others prefer the stick. Medicaid Reform Commission Chairman Charlie Shields, a Republican senator from St. Joseph, says incentives could be built into Medicaid to encourage the obese to undergo nutrition counseling and smokers to take cessation classes. Shields hears a different approach from Representative David Sater (R-Cassville), who argues that if taxpayers pay the bills, they should be able to mandate that Medicaid recipients take courses to improve their health. Representative Allen Icet (R-Wildwood) says pregnant mothers on Medicaid should take prenatal classes. Shields advocates incentives to get recipients to take nutrition counseling or smoking cessation classes. Such incentives could be cheaper co-pays or even tickets to events and theme parks. State Health Director Julie Eckstein says Medicaid recipients should be given a health risk assessment as the first step toward improving their health habits. Representative Margaret Donnelly (D-St. Louis) questions the value of mandates, arguing that they would be impossible to enforce.Senator Pat Dougherty (D-St. Louis) questions the fiscal benefit of such a tactic. He points out Medicaid’s largest population consists of the elderly and the disabled and improved health habits wouldn’t affect that many Medicaid recipients.
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