The Missouri Medicaid Oversight Committee is facing the tall order of trying to keep ever increasing costs under control in a state with limited resources.

Photo courtesy of the Centers for Medicare and Medicaid Services

The 18-member panel held a periodic meeting in Jefferson City Tuesday.  The panel was created by the legislature in 2007 and is charged with evaluating Medicaid – known as MO HealthNet in the state – and its implementation.

Committee Chairman and Washington University Health Economist Timothy McBride noted state revenue gains this year of $300 million are equal to Medicaid cost increases.

He told Missourinet that a cut to the federal healthcare program is most likely coming.  “Healthcare costs are just going up at a faster rate than the economy is,” said McBride.  “And our enrollment is growing, and our aged population is growing.  These are just dynamics that our state is going to have to deal with.”

Missouri’s Republican Governor Eric Greitens signed a budget for the current fiscal year that included about $50 million in cuts to Medicaid, covered mostly be reimbursement reductions to providers and the elimination of vacant administrative jobs.

McBride says there are no good options for lawmakers to address the program’s cost increases at this point. “The only options are raising taxes, which they don’t really want to do, or (further) cutting provider payment rates, pushing more of the costs onto patients, which they can’t really do in the Medicaid population, or cutting eligibility.”

The legislature narrowed eligibility to Medicaid programs for senior nursing care and prescription drugs in order to save roughly $50 million dollars this year.  Lawmakers have been haggling ever since over how to restore the funding.

Jennifer Tidball is the Acting Director of Medicaid in Missouri, as well as the Deputy Director for the Department of Social Services.  She thinks the Oversight Committee’s biggest challenge is figuring out how to properly provide care to aged, blind and disabled recipients.

“When you look at our program, that group makes up about 20 percent of the participants in Medicaid, but their cost is between 65%-and-70% of the program,” said Tidball.  “And as we all know, the aging population continues to grow.”

Medicaid expenditures, which according to slide presentation at the committee meeting were $6.7 Billion in 2011, have continued to balloon over the years.

Tidball acknowledged they account for a third of the state’s general revenue budget of $9.4 billion.  She said the committee is considering numerous plans from outside groups to address soaring costs before moving forward.

“We’re listening a lot to groups that have ideas around curbing the costs, and thinking about how to potentially move forward with pilot (programs) related to those ideas, and figure out what best practices are before we make a decision that affects our entire population.”

Numerous presentations were made during to four-hour Medicaid Oversight Committee meeting.  Among the topics discussed was managed care delivery of the health care program, which went statewide this year.

Full benefit coverage of treatment for Hepatitis C, which the state had withheld until recently, was examined during the gathering.  There was also attention given to the Children’s Health Insurance Program (CHIP), and a program to let medical school graduates help fill vacancies by allowing them to practice as doctors before completing their residency.

Washington University Health Economist Abigail Barker, a colleague of Chairman McBride, gave a visualization presentation on the price drivers in Medicaid.  She concluded that controlling utilization of services is the only way to curb costs, not restricting eligibility to the program.

“Even if you can do a little bit more, you’re not going to affect the upward slope of what this thing looks like,” said Barker.  “The only thing that you can really do to really control costs in the long term, is to figure out how to control utilization.”

Barker contends the best way to control utilization costs is to implement measures that promote preventive care.

Chairman McBride thinks expanding Medicaid would solve a lot of problems because it would bring an infusion of $2 billion in federal money to the state.  He dismisses claims by many Republican lawmakers that expanding the program would be a further drain on the state budget.

“The thing they worry about is the $100 million, or so, that the state would have to pay,” McBride said.  “But the matching rate is such that the state would probably save at least that much, if not more.”

McBride does concede that there is not much appetite in the GOP dominated legislature to expand Medicaid in Missouri.