Missouri lawmakers are considering a proposal to ask the federal government to allow changes in the way Medicaid is delivered.

Missouri capitol

The measure calls for the state to apply for a “global waiver” from the federal government.  The proposal’s sponsor, Senator David Sater (R-Cassville) claims the global waiver would give the state greater flexibility to establish “a patient-centered, sustainable, and cost-effective market-based health care system”.

The proposal targets recipients to meet certain conditions such as work requirements.  It could subject them to co-pay and premium payment stipulations as well as accountability and transparency standards.

Recipients could also be required to maintain a health savings account.  Sater says the global waiver would promote personal responsibility.

“We have high utilizers that visit the emergency room many, many times” said Sater.  “The emergency room, if they’re non-profit, they have to accept those patients if there’s a legitimate reason.  And then they use multiple physicians, multiple pharmacies.  We need to do a better in correcting that behavior.”

At a committee hearing on the proposal Wednesday, St. Louis University Law Professor Sidney Watson questioned Sater’s facts.  She told Missourinet that there’s a misperception that global waivers give the states more flexibility to do things they can’t do through the normal Medicaid arrangement.

“My point is global waivers don’t give the state more flexibility.  They just cap costs” said Watson.

She says provisions to change certain requirements can be handled through the current arrangement, and acquiring a global waiver would place unnecessary burdens on the state.  “I think it puts the state at unnecessary financial risk.  We can do the same thing and be able to have a guarantee of more generous federal funding.”

Senator Sater is chairman of the committee (Seniors, Families and Children) which is reviewing his proposal.  He plans to have members vote on it next Wednesday.

It appears there’s a sharp divide between Republicans and Democrats over the proposal.  Senator Jill Schupp of St. Louis County thinks, if implemented, the plan could leave some people with little or no medical coverage.

“Let’s be clear” said Schupp.  “This is about not going by a per-person, what is needed to help support the people when they become sick in the state of Missouri.  This has a cut-off amount.”

Under this measure, the Department of Social Services would apply to the federal Centers for Medicare and Medicaid Services for the global waiver.  But the department would first submit the application to the state’s Joint Committee on Public Assistance, which would have the final say on it.  The Joint Committee on Public Assistance is comprised solely of state lawmakers.