Medicaid reform

House Republican Medicaid plan sponsor undeterred by Senate Republican comments

March 24, 2014 By Mike Lear

Work will continue on a House Republican proposal that would reform Medicaid and expand eligibility in Missouri, despite Senate Republicans reaffirming their opposition to Medicaid expansion. A House Committee will hold its third hearing on the proposal, HB 1901 sponsored by Representative Noel Torpey (R-Independence), early Tuesday in the basement of the Capitol.

“There is no path for Medicaid expansion to occur in Missouri this year,” said Brad Lager (R-Savannah) on Monday, one of five Republican Senators who said they would block any attempt to expand Medicaid eligibility this session.

“If we’re going to allow five people to run the state, that’s unfortunate,” says Torpey. He agrees that expansion by itself will not succeed in the Republican-controlled Missouri legislature.

“That was evident last year,” Torpey tells Missourinet, “but if people want reform and truly want reform, we’re going to have to do some type of eligibility changes, and so they’re linked together.”

Torpey says the Senators’ comments won’t cause him to do anything differently.

“Things can change in politics in a day, let alone eight weeks,” says Torpey.

House Speaker Tim Jones (R-Eureka) says the opposition to expansion is not limited to the Senate.

“The signals I’m receiving from the (House Republican) caucus and the signals I’m receiving from the Senate are that expansion is simply something that the legislature does not have much of an appetite for this year,” Jones says. “They’re very concerned about the long-term effects on the budget, and I share those concerns.”

Torpey thinks stripping out the expansion components of his legislation would not be successful either.

“I really think it’s a partnership,” says Torpey of reform and expansion of Medicaid. “We get both or nothing.”

The hearing Tuesday will focus on three aspects of Torpey’s bill, including increased eligibility in some populations.

Earlier stories:

Hearing highlights work requirement, premium in House Republican Medicaid plan

House Republican files Medicaid expansion, reform proposal

Hearings continue on proposed Medicaid reform, expansion plan

March 24, 2014 By Mike Lear

A House Committee will continue its hearings on a Republican proposal for reform and expansion of Medicaid Monday afternoon and Tuesday morning.

The Committee on Government Oversight and Accountability will hear Monday at 2 p.m. the portions of the legislation dealing with health care homes, managed care, and managed care requirements. In a hearing Tuesday beginning at 8 a.m. the committee will discuss the “Show-Me Healthy Babies program,” proposed to provide medical coverage to unborn children through the Children’s Health Insurance Program (CHIP), increases in eligibility, and coverage for high-cost Medicaid recipients with complex medical conditions who would fall under a new category of “medically frail.”

The hearings will take place in Hearing Room 3 in the basement of the State Capitol.

The proposal is HB 1901, sponsored by Representative Noel Torpey (R-Independence).

Earlier stories:

Hearing highlights work requirement, premium in House Republican Medicaid plan

House Republican files Medicaid expansion, reform proposal

Hearing highlights work requirement, premium in House Republican Medicaid plan

March 11, 2014 By Mike Lear

A House Committee has held the first hearing of a Republican proposal for reform and expansion of Medicaid.

Representative Noel Torpey (photo courtesy; Tim Bommel, Missouri House Communications)

The first of three planned hearings to pick apart the bill has focused on reform components. Drawing the most criticism on the day are the proposals of a requirement that Medicaid recipients have a job, be looking for one or be a student, and that participants pay a premium of 1-percent of their income.

Saint Louis University law professor Sidney Watson tells the committee those might not be legal, and says there is a question of whether the secretary of the U.S. Department of Health and Human Services has the authority to grant waivers to allow them to become policy.

“The Secretary has never approved a straight premium charge that results in ineligibility for nonpayment,” says Watson of the premium proposal, “because of concerns that people earning below or near the poverty line can in any given month have problems coming up with those payment charges.”

The bill is written so that if those waivers aren’t both granted, the legislation as a whole would fail. Joel Ferber with Legal Services of Eastern Missouri urges the committee to remove that contingency.

“It just seems like a very potentially not very productive endeavor. I think the key is to either modify these two provisions or to loosen up the waiver provision so if you get 99.9-percent of the waivers you want you can still go forward.”

Committee Chairman Jay Barnes (R-Jefferson City) says he isn’t convinced those provisions would not be approved for waivers, and says they are key to the bill.

“I think it’s only fair that we require an able-bodied person to actually work before they qualify for Medicaid,” Barnes says. “I think Missourians are willing to help those who are willing to help themselves.”

Barnes hopes to have the next hearing on the Monday after next week’s Spring Break, with a focus on more reform components.

The legislation is HB 1901.

See our earlier story on the legislation.

House Republican files medicaid expansion, reform proposal

February 19, 2014 By Mike Lear

A Republican plan for expansion and reform of Medicaid has been filed.

Representatives Jay Barnes (left) and Noel Torpey (right) were announced as the chairs of 2 House Interim Committees on Medicaid last summer by House Speaker Tim Jones (center). (photo courtesy; Tim Bommel, Missouri House Communications.

Representative Noel Torpey (R-Independence) has filed the bill after chairing one of two House interim committees on Medicaid last summer. Torpey’s proposal takes a different approach from past legislation in that it would require Medicaid recipients old enough to work to have jobs.

It would extend Medicaid coverage to adults with incomes below the federal poverty level and, Torpey says, it would help people making between the poverty level and 138 percent of the poverty level buy private insurance on the federal exchange.

“Why not help people who are trying to help themselves?” Torpey asks. “From a state’s perspective it’s fiscally responsible.”

Torpey says another key component of the bill is transparency for hospitals.

“We should know what non-life-threatening procedures cost … time after time after time, they don’t want to share that information and that’s unfortunate,” says Torpey. “I think that in itself will help some of the costs in healthcare.”

The lead co-sponsor on the bill is Representative Jay Barnes (R-Jefferson City), who chaired the other of those interim committees and has filed Medicaid reform legislation in the past.

He says another chief difference between those bills and this one is the requirement of at least one-percent of a recipient’s annual income to be paid in a premium for a coverage plan.

“We need recipients to take the responsibility to pay some of their own money for their health insurance,” says Barnes. “Because they make lower incomes that’s going to be a lower amount of money, but I think it’s important that they pay what they can into the system in order to get their own health insurance.”

Legislative staff are still preparing an estimate of the impact Torpey’s bill will have on state revenue, and he believes it will save the state money.
“I’m eager to see how positive it is,” Torpey tells Missourinet.

Torpey’s legislation is HB 1901.

Nixon meeting with legislative Medicaid committees canceled amid dispute

November 19, 2013 By Mike Lear

A meeting that had been planned for next week between Governor Jay Nixon and the members of the House and Senate interim committees on Medicaid reform has been canceled after disagreement arose on where and how it would be conducted.

Governor Jay Nixon

Governor Nixon issued an invitation to those legislators on November 5 to meet with him on the morning of November 26. Several legislators told Missourinet they planned to be there.

Tuesday morning before a hearing of the House Interim Committee on Medicaid Transformation, Chairman Jay Barnes (R-Jefferson City) released a letter he and the Chairman of the Senate Interim Committee on Medicaid Reform and Transformation, Gary Romine (R-Farmington) had issued to the Governor. In it they accepted his information and laid out how they wanted the meeting to be conducted.

They told the Governor it would be a joint session between the two committees that Barnes and Romine would co-chair. Nixon would be the only witness called and would be given time for an opening statement before questions could be asked by the committees’ members.

The chairmen agreed to the time and day but wanted the hearing to be held in the House Lounge in the State Capitol. Nixon’s invitation was for lawmakers to join him at the Governor’s Office Building, two blocks away.

Nixon responded with his own letter saying that Romine and Barnes had previously agreed to the meeting as well as its “form and content,” and accusing them of reneging on that agreement.

Nixon writes, “I can only conclude that this last-minute change of heart demonstrates that, as we saw last session, you and your leadership have chosen to give politics precedence over the substance of the discussion. And while I am always willing and eager to engage in a serious, thoughtful debate about Medicaid, in any setting, I am not interested in taking part in a political game at the expense of the Missourians we have sworn to serve.”

A spokesperson for Nixon, Channing Ansley, says the Governor will not be in either location Tuesday morning.

She writes, “The agreed-upon purpose of the meeting was to have a constructive dialogue between the Governor and members of the committees.”

Barnes was informed of the Governor’s letter during his committee’s hearing. He did not read it to its members but informed them the Governor would not be coming to the joint hearing he and Romine had laid out.

He accused the Governor of playing “political theater,” and said the hearing should be held in the Capitol because “legislative committees operate in the State Capitol.”

Barnes, asked whether a meeting between Nixon and the two committees was important enough to merit a legislative meeting outside the Capitol, said no.

“I’m not confident any meeting between the Governor and the two committees in November is going to make a tremendous difference for what happens in the General Assembly in April and May.”

Senate leader wants tort reform with Medicaid legislation

November 11, 2013 By Mike Lear

The Majority Leader in the Senate says he doesn’t think legislation that expands Medicaid will get anywhere in his chamber in 2014. Senator Ron Richard (R-Joplin) says if it does, he wants tort reform with it.

Senator Ron Richard

Richard tells Missourinet, “I don’t think there’s a lot of support for Medicaid expansion. At least, there’s nobody in the Senate calling me that we want to expand Medicaid. All I’m hearing is that if we get Medicaid expansion from the House they’re going to slow it down.” Richard continues, “I don’t know if there’s room for a compromise on this or not. All I’m saying … if there is a compromise I would like to see tort reform be a part of it.”

Representative Jay Barnes (R-Jefferson City) is the Chairman of the House Interim Committee on Medicaid Transformation. He just presented to that Committee his proposal for Medicaid reform that attempts to save the state money over the life of Medicaid expansion. He says tort reform faces its own challenges.

“There’s a problem with the constitutionality of some of the measures that have been proposed thus far,” Barnes says. He notes the Supreme Court last year threw out a 2005 tort reform law. “That ruling is still there, so that’s an obvious issue that supporters need to figure out.”

The legislature overturned Governor Jay Nixon’s vetoes of three pieces of tort legislation in September’s veto session.

Richard says he hasn’t started developing an approach to tort reform legislation for 2014. “The fact that the Supreme Court took off the limits and we almost had the same limits as Kansas and the Supreme Court upheld it, that’s putting outstate Missouri at a disadvantage,” says Richard. “We’ve got medical facilities being built right across the borders and putting hospitals at a disadvantage in Missouri.”

He says he isn’t only looking at medical issues. “Doctors and nurses aren’t the only ones that need some relief from frivolous lawsuits.”

The Senate Interim Committee on Medicaid Transformation and Reform will meet Wednesday. Barnes’ House Committee meets again November 19. Both committees have been asked to meet in a joint session with Governor Nixon November 26.

House members pleased with Nixon call for joint Medicaid hearing

November 5, 2013 By Mike Lear

Governor Jay Nixon wants to meet with the members of House and Senate committees digging into Medicaid expansion and reform.

Governor Jay Nixon

The Governor says as the House and Senate interim committees on Medicaid reform and expansion wrap up their hearings, he wants to discuss with their members how to proceed on those issues. He has sent those legislators a letter inviting them to a joint session November 26 at the Governor’s Office Building in Jefferson City.

Missourinet will cover that hearing.

Click here to see the Governor’s invitation (pdf)

The Chairman of the House Interim Committee on Medicaid Transformation, Jay Barnes (R-Jefferson City), says the invitation is a good idea and an encouraging step.

“I think he wants to talk about the whole gamut of issues that both committees have talked about … Medicaid transformation, ways to improve the delivery system for healthcare to Missourians at low income levels, I think he wants to talk about eligibility levels and he wants to talk about how we can save money for taxpayers.”

Representative Chris Kelly (D-Columbia) calls the meeting, “Absolutely critical. Whatever we pass, the Governor’s office … the administration … will have to implement, and they have a lot more specific information on all the technical aspects of this and on the economic and monetary aspects of this, so to be actively engaged with the governor on a discussion about what things to put in or how to structure them is essential.”

Kelly says he’s anxious to hear what the Governor has to say.

“We know his position over the last year. He’s been unequivocal about his support for the economic benefits of expansion, and I expect that he is not going to change on that … we already know that … but I’m mostly interested in the nuts and bolts stuff.”

Kelly doesn’t know whether the call for a joint session is any indication whether the Governor has shifted his position regarding Republican proposals to reform Medicaid that would require federal waivers to be enacted.

He tells Missourinet, “There’s one big question. That’s whether to expand (Medicaid eligibilty) to 138 percent (of the federal poverty level). Either you do or you don’t there. That’s not one where you can do something in the middle. Once you do that I think all the rest of it is negotiable.”

A Twitter account for Governor Jay Nixon on Tuesday (@GovJayNixon) tweeted: “Health care reform the Missouri way will mean better outcomes for patients & better returns for taxpayers.”

Meanwhile, Barnes’ committee will discuss the issue of eligibilty in a hearing beginning at 8:00 Wednesday in the basement of the Capitol. Its final hearing is slated for November 19. The Senate Interim Committee of Medicaid Transformation and Reform is next scheduled to meet November 13.

House Medicaid Committee discusses mental health care

October 15, 2013 By Mike Lear

A House Committee working to create a plan for Missouri to expand and reform Medicaid spent much of its latest hearing talking about mental health.

Chairman Jay Barnes (R-Jefferson City) says the testimony of mental health professionals shows the state can save money if more people can be kept out of prison by increasing coverage for mental health and substance abuse.

“A lot of other states are now including mental health treatment and substance abuse treatment in Medicaid, and the reason for that is simple. It saves states a lot of money in their departments of corrections to make sure that people with mental illnesses are getting the treatment they need to not commit violent crimes.”

Representative Jeanne Kirkton (D-Webster Groves) wants to see more discussion of expanding managed care from the corridor along I-70.

“People that live along there are well-served, but what do you do out in rural areas where there are fewer providers? Is that going to be a workable solution.”

The Committee has five more hearings scheduled between October 29 and November 19. Kirkton hopes the committee will have a proposal drafted sooner rather than later.

“Certainly if we have one out by December 1 it will give people more time to study it and really dig into it. We can’t do anything about it until we get back in session but at least we’ll be ahead of the game. I think we’d like to see it before January because it takes a long time to get things through committee and through one chamber or the next.”

December 1 is the first day legislation can be filed for the 2014 session.

Medicaid Committee Chairman: discussion has shifted to reform plus expansion

August 8, 2013 By Mike Lear

The larger of the two House Committees studying Medicaid expansion and reform has one hearing left.

Representative Noel Torpey (R-Independence) chairs the committee made of up citizens and legislators studying Medicaid eligibility and reform issues. He says the comments his committee is hearing tell him that the conversation has changed since the legislative session.

“People who have testified in person … I would say maybe even 95 percent of them … are for expansion with reforms. I felt like when we brought it up while in session it was really, for the most part, just talking about expansion or not expansion.”

Torpey says some witnesses have reminded lawmakers of significant needs for reform.

He says one example was raised on Wednesday, “Why does Medicaid pay for surgery but not pay for the rehab? Those are important points to bring out. Those are questions we need answered, because that doesn’t make sense.”

The Committee’s final hearing is Wednesday in Chesterfield, after which it will submit a report to another committee made up entirely of House members. 55 people have signed up to testify at that hearing. Torpey anticipates another 20 or more will show up that day to testify. He expects it to last until 6:00 that evening.

Lawmakers’ discussion of Medicaid could carry into legislative break

May 20, 2013 By Mike Lear

Representative Jay Barnes speaks on the House floor on SB 125 while it's Senate sponsor, Senator Jamilah Nasheed, looks on. Barnes handled her bill in the House. (photo courtesy; Tim Bommel, Missouri House Communications)

Representative Jay Barnes (foreground, on mic) and Senator Jamilah Nasheed carried proposals for a joint interim committee on Medicaid reform in their respective chambers. (photo courtesy; Tim Bommel, Missouri House Communications)

The discussion of the future of Medicaid in Missouri has likely not ended with the close of the legislative session. The General Assembly has approved legislation that would create at House-Senate Committee to study Medicaid reform in the interim.

The idea was proposed in the House by Representative Jay Barnes (R-Jefferson City), who told his fellows, “It’s now my hope that we can form a joint interim committee to work together with leaders on this issue from the Missouri Senate. I think that there’s an interest in there in exploring paths forward.”

The proposal was carried in the Senate by Senator Jamilah Nasheed (D-St. Louis), who criticized Republicans as opposing Medicaid expansion out of “hatred for President Obama.” She called the idea of an interim committee a “light at the end of the tunnel.”

She says, “Hopefully we can get this past the finish line next year.”

House Minority Leader Jake Hummel (D-St. Louis) says his caucus will participate in that committee, but says the Republican majority already knows what needs to be done.

“I think that’s just a way for them to kick the ball down the field. They’re just going to try and push it off ’til next session, but Missouri can’t wait for next session. We absolutely failed … it was the single most important issue of this session.”

The interim committee proposal was passed out of the legislature on Friday before the end of the session. Governor Jay Nixon (D) must now decide how to act on it.