A major battle in the upcoming Missouri legislative session will be over Medicaid.  Close to one in six state residents receive benefits from the federally subsidized program.

The state’s contribution to assist in financing it will spike by hundreds of millions of dollars in the upcoming fiscal year.

House Republican Justin Alferman of Herman

Key Republicans in the GOP dominated legislature have said major cost cutting measures need to be implemented.  Incoming House Budget Committee Vice Chairman Justin Alferman of Herman says Medicaid is starting to drain money out of other important programs.  “You start looking at some of the things that take up general revenue” said Alferman.  “If you keep pouring more and more money into the Medicaid system, that’s eventually going to start hurting public safety.  It’s going to start hurting education – both K-12 and higher education.”

Republicans are considering a number of plans they say would bring Medicaid costs under control.  One would require recipients to pay fees for services, while another would implement a work requirement to receive the benefits.

House Republican Scott Fitzpatrick

GOP House Budget Committee Chairman Scott Fitzpatrick of Shell Knob thinks both options would be fairly easy to do.  He says implementing a fee structure could be particularly effective.

“Creating incentives for folks to not seek the highest cost form of care possible every time they get sick would be a good start.” Said Fitzpatrick.  “I’m talking about emergency room co-pays, things like that to make the system run more like a private health insurance plan where there’s responsibility to basically get the consumer included in their own health care decisions.”

Fitzpatrick also thinks making adjustments to Medicaid eligibility may need to be done, although he admits it might be tougher to pass.  He claims to have heard from constituents who are parents wanting to switch their kids from Medicaid to private insurance, but are unable to because the threshold for Medicaid coverage of children is so high, 300 percent of poverty.

House Democrat Kip Kendrick of Columbia, who is also a member of the chamber’s Budget Committee, contends putting restrictions on eligibility would hurt the people who need it most.  “We’re at the federal threshold for adult Medicaid at 19 percent of the federal poverty level” said Kendrick.  “It seems at this point, if we’re going to make changes to eligibility, the only people we’d be kicking off are the most vulnerable, whether that’s individuals with disabilities, children or pregnant mothers.”

House Democrat Kip Kendrick

Kendrick wants to hear the proposals Republicans have for imposing work requirements or a fee structure on recipients before he decides if they would be effective or fair.

Democrats have a different perspective on the budget.  They generally contend special interest tax breaks have been a bigger burden on the state finances than Medicaid.

Republicans and Democrats also sharply differ over Medicaid expansion.  Republicans say the state can’t afford the extra cost it would bring while Democrats say it’s infused billions of dollars into state’s which have expanded the program.

With a new Republican administration under President-elect Donald Trump set to take over the White House, most members of both parties believe Medicaid will see massive changes.