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Missouri Medicaid Director Richardson to present budget this week (AUDIO)

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The state’s Medicaid director will present his budget to the Missouri House Budget Committee Tuesday morning in Jefferson City.

Former Missouri House Speaker Todd Richardson opens a special session on June 11, 2018. Richardson is now the state’s Medicaid director (file photo courtesy of Tim Bommel at House Communications)

The hearing is set for 8:15.

During his January State of the State Address, Governor Mike Parson (R) credited former House Speaker and current Medicaid director Todd Richardson for finding $84 million in savings, in the Medicaid system.

“While some in the press are eager to criticize this improved efficiency – or outright misrepresent it – the truth is that this system has been broken for many years and unproductively serving every Missourian who is paying for it,” Governor Parson told a joint session of the Legislature on January 15, in Jefferson City.

Richardson says that savings is important.

“Across the program, you know with both big chunks and small chunks we’ve been working to identify those efficiencies that allow us to deliver a better program,” Richardson says.

Medicaid is a federal and state program that assists with medical costs for residents with limited incomes. Missouri’s Medicaid budget is about $10 billion, accounting for more than one-third of the state’s $30 billion operating budget.

Governor Mike Parson criticized Medicaid expansion during his State of the State Address on January 15, 2020 in Jefferson City (photo courtesy of Tim Bommel at House Communications)

Governor Parson and Richardson say that savings is important to protect citizens who need Medicaid services the most. Director Richardson says there’s more work to do.

“We’ve got to work together to build a best-in-class Medicaid program that provides for the needs of Missouri’s most vulnerable, but does so in a way that’s financially sustainable,” says Richardson.

Richardson was appointed to his post by Governor Parson, and has been in the position since November 2018.

Statistics provided by the state Department of Social Services (DSS) show the number of Missourians on Medicaid has decreased from 953,000 in August 2018 to 846,000 now. Richardson will likely face some questions on Tuesday from lawmakers about thousands of children who have recently been removed from Medicaid.

The “Springfield News-Leader” reported this weekend that State Rep. David Wood, R-Versailles, says thousands of children removed from the Medicaid rolls were likely still eligible for coverage. The newspaper quotes Wood as saying that paperwork for the parents is horrendous, and that the state could do a better job of helping people through the process.

Wood is the House Budget Committee’s vice chairman.

Another issue that could come up during the hearing is Medicaid expansion. Governor Parson opposes it, as does Richardson. Director Richardson tells Missourinet he’s focused on reforming Medicaid, not expanding it.

“There will be a tremendous cost to Medicaid expansion and costs that frankly the state doesn’t have,” Richardson says.

Richardson’s focus is on operating a better program that produces better outcomes, in a financially sustainable way.

House Speaker Elijah Haahr, R-Springfield, and House Budget Committee Chairman Cody Smith, R-Carthage, also oppose Medicaid expansion. They say it would take dollars out of the classroom, noting it requires a ten percent match for the 90 percent draw down.

Speaker Haahr has warned that it would blow a hole in the general revenue budget.

But Democrats like House Minority Leader Crystal Quade, D-Springfield, and State Rep. Deb Lavender, D-Kirkwood, support Medicaid expansion. They have said 100,000 children have lost their Medicaid coverage and that it’s an emergency.

The organization “Healthcare for Missouri” also backs Medicaid expansion, citing a recent report from the Missouri Hospital Association and nine other healthcare organizations.

“This new research (the new report) only adds to the growing body of fact-based evidence that Medicaid expansion will not just save lives but could also save taxpayers money. The recent examples of Arkansas, Indiana, and Ohio show three states that have used Medicaid-derived savings to cut income taxes, increase government efficiency and improve worker productivity,” Healthcare for Missouri campaign spokesman Jack Cardetti’s statement reads, in part.

Medicaid expansion supporters also note that eight rural Missouri hospitals have closed in recent years.

Click here to listen to the full interview between Missourinet’s Brian Hauswirth and State Medicaid Director Todd Richardson, which was recorded on January 15, 2020 at the Statehouse in Jefferson City:

Copyright © 2020 · Missourinet

Former Missouri hospital executive pleads guilty to $114 million billing scheme

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A former executive of a northern Missouri hospital pleaded guilty in federal court in Florida Wednesday to a $114 million pass-through billing scheme.

The Justice Department in Washington says former Putnam County Memorial Hospital chief executive officer David Lane Byrns pleaded guilty to a one-count information charging him with conspiracy to commit health care fraud. Byrns pleaded guilty before U.S. Magistrate Judge James Klindt, of the Middle District of Florida.

The criminal count was originally filed in Missouri and was transferred to Florida, where Byrns now lives. The complex case was investigated by the FBI in Kansas City, Jefferson City and in Jacksonville, Florida. The Justice Department in Washington has been involved, as has the U.S. Department of Labor and the offices of two Missouri statewide officials.

The Justice Department says Byrns used the Unionville hospital to submit fraudulent claims for blood testing and toxicology, causing the Missouri Medicaid program and multiple insurance companies to pay more than $100 million in claims.

The Medicaid program is health care for low-income residents. Unionville is in far north-central Missouri, just south of the Iowa border.

Federal prosecutors in Missouri and Florida say billing companies and labs were also involved in the scheme, describing them as “co-conspirators.”

Missouri Auditor Nicole Galloway’s (D) scathing 2017 audit of Putnam County Memorial Hospital uncovered $90 million in inappropriate lab billings, and prompted calls for the federal investigation.

The Justice Department is acknowledging Galloway’s office for assistance, along with Missouri Attorney General Eric Schmitt’s (R) Medicaid Fraud Control Unit.

Copyright © 2019 · Missourinet

Medicaid expansion supporters optimistic despite recent rejections

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Supporters of Medicaid Expansion aren’t giving up, even as the majority Republican party continues to assert its position against expanded eligibility.

Michelle Trupiano points to more than 2000 witness forms in support of Medicaid expansion submitted at a Tuesday morning hearing on a House Republican Medicaid bill as evidence of Missourians' support for Medicaid expansion.

Michelle Trupiano points to more than 2000 witness forms in support of Medicaid expansion submitted at a Tuesday morning hearing on a House Republican Medicaid bill as evidence of Missourians’ support for Medicaid expansion. 

The House on Tuesday twice rejected amendments to its proposed budget for Fiscal Year 2015 that would have included federal money for expansion. The day before, five Senate Republicans said they would block any attempt at expansion that would reach floor debate in their chamber.

Proponents say Missouri should accept expansion under the provisions of federal healthcare reform and the money from the federal government that would come with it.

Still, the Director of the Missouri Medicaid Coalition Michelle Trupiano says she remains optimistic.

“I’m feeling positive that with all the support from Missourians across the state saying, ‘Let’s figure out a way to do this,'” Trupiano tells Missourinet. “Whether it’s in Joplin or whether it’s in southeast Missouri or whether it’s in northwest Missouri, everybody’s saying we have to get this done this year … that we can’t afford another $2-billion passing us by.”

Among the various legislation that has been filed, Trupiano doesn’t know what the path to expansion is at this point.

“I think that there are several different possibilities, so we’re going to keep working on both the House and the Senate and find opportunities where they are to try to move expansion.”

Legislative Majority Republicans say the federal government doesn’t have enough money to support Medicaid expansion and say for Missouri to accept expansion would only add to the national debt, while applying more money to a broken system. Some Republican leaders say they prefer Medicaid reform over expansion of eligibility.

A House Republican proposal to expand and reform Medicaid is still moving in committee.

Trupiano says she thinks the expansion debate has advanced a lot since last year.

“Last year if you mentioned the words ‘Medicaid expansion,’ everyone just turned up their nose and said, ‘no,'” says Trupiano. “I think people are very open to it on both sides … to come to the table, to look at that compromise, to look at reforms that include also increasing the eligibility limits.”

She says she still believes Medicaid expansion can pass this year.

“Eight weeks are still a long time until session ends and a lot can happen during that time.”

House gives initial approval to proposed FY15 budget

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The state House has given initial approval to a proposed spending plan for the fiscal year that begins July 1.

House Budget Committee Chairman Rick Stream (photo courtesy; Tim Bommel, Missouri House Communications)

House Budget Committee Chairman Rick Stream (photo courtesy; Tim Bommel, Missouri House Communications)

The Republican Majority twice rejected amendments that would have built federal money to expand eligibility for Medicaid into the budget. Both efforts were offered by Representative Jill Schupp (D-Creve Coeur).

“Ladies and gentlemen when rural hospitals close, actions here today will be remembered,” Schupp told the House before reading a list of groups that support Medicaid expansion. “There is only one group that is opposing it, and that group is right here in the Missouri legislature. It’s time to move forward.”

Schupp says Missouri’s failure to expand Medicaid means federal tax dollars coming from this state are going to other states. Representative Keith Frederick (R-Rolla) says he’s “kinda tired” of hearing that argument.

“That would be to imply that if we expand Medicaid we will deprive other states of the funds necessary for them to expand their Medicaid program and nothing could be further from the truth,” says Frederick. He argues that the federal government is creating further debt for the U.S. by offering to pay for Medicaid expansion in states.

The budget proposal uses a two-tiered approach 

The House also approved two amendments that would pull funding from the Department of Elementary and Secondary Education for common core standards, and the Republican Majority rejected an amendment to strip $6-million from the budget for a possible state takeover of the Ozark National Scenic Riverways.

The House is expected to send the full budget to the Senate later this week.

View the House budget bills

Hearings continue on proposed Medicaid reform, expansion plan

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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

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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)

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.

Nixon renews call for Missouri to expand Medicaid eligibility

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Governor Jay Nixon has stressed some of the ideas Republicans have pushed for reforming Medicaid in renewing his call for expansion of the program’s eligibility using federal money.

Governor Jay Nixon

Governor Jay Nixon

Nixon says 4.4 million Americans with jobs but no health insurance coverage will have that coverage beginning today, but says “the legislature’s inaction” means nothing has changed in Missouri.

“Missouri’s Medicaid system will operate as it has for years without additional needed reforms, protections for taxpayers or new measures to promote personal responsibility, many of which are being granted for the first time in states that are moving forward.”

He says Republicans and Democrats in states like Arkansas, Illinois, Iowa and Kentucky advanced, “common sense, market-based approaches to helping low-income working families afford the basic health care services they need to live healthy lives,” and he called on lawmakers to resolve to pass a bill to “strengthen and reform Medicaid the Missouri way.”

See Nixon’s prepared remarks here

Nixon, who began calling for Medicaid eligibility expansion at the end of November 2012, didn’t use the word “expansion” in his address to reporters on Tuesday, instead referring to “strengthening and reforming” the program.

He also said he supports some of the ideas that have been discussed by Republican lawmakers for reform including accountability language that would give recipients some “skin in the game,” a term often used by Representative Jay Barnes (R-Jefferson City). Barnes authored a Medicaid reform bill in 2013 and is expected to introduce a 2014 bill, after chairing one of two House interim committees on the topic.

Nixon noted ideas including requiring copays, allowing premiums to be charged and demanding personal responsibility.

“Folks shouldn’t show up at an emergency room with a stuffy nose,” says Nixon.

One idea he did not express support for is eliminating coverage for children of low- to middle-income families whose incomes make them eligible to buy federally subsidized insurance policies.

“It’s really hard to tell a 5-year-old to go get their lunch bucket and get to work and make some money so that they can pay health premiums,” Nixon says. “I will look very carefully at anything that deals with children.”

Some lawmakers on Barnes’ committee including Republicans were also cool on that idea but some Senate Democrats say they would not rule it out.

Work begins on draft report from House interim Medicaid committee

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A House Medicaid Committee will meet again once a draft of its report for the legislature is ready.

Representative Gail McCann-Beatty (foreground) and Chairman Jay Barnes listen to testimony in a hearing of the House Interim Committee on Medicaid Transformation. (Missouri House Communications)

Representative Gail McCann-Beatty (foreground) and Chairman Jay Barnes listen to testimony in a hearing of the House Interim Committee on Medicaid Transformation. (Missouri House Communications)

Unlike most committees, Chairman Jay Barnes (R-Jefferson City) says the report the House Interim Committee on Medicaid Transformation will issue won’t have recommendations. Rather, it will be more of a summary of testimony heard during the committee’s hearings since September.

He says there isn’t enough consensus for recommendations.

“I don’t think there’s a single topic I could come up with a recommendation on that we would have entire agreement,” Barnes tells Missourinet.  “Once you make a recommendation that’s the firm, solid way forward, and I think there are still some issues to be worked out.”

Instead he wants to create a report that summarizes the work of the committee and the testimony it heard that will prepare lawmakers to make a decision if legislation reaches a vote in the House.

No recommendations means the report won’t recommend that the state expand Medicaid eligibility as supported by Democrats including Governor Jay Nixon. The ranking Democrat on the committee, House Assistant Minority Leader Gail McCann-Beatty (Kansas City), says she would prefer to see that recommendation made but she understands Barnes’ position.

“There is still a lot of conversation going on and I don’t know that there was really a consensus, and so I can appreciate that the report is simply going to give a summary of what happened.”

McCann-Beatty says Democrats on the committee will keep their options open, however. She says one she sees a draft her caucus could seek to add things to it, or to draft its own report as the Democrats on the Senate Interim Committee on Medicaid Transformation and Reform are doing.

In a hearing Tuesday Barnes reiterated that he is comfortable if he is the only person advocating reducing Medicaid eligibility for some low- and middle-income children to save some of the projected cost of expanding eligibility elsewhere. His concept would be to lower eligibility from 300 percent of the federal poverty level to half that level for families who can get a subsidized insurance policy from the federal exchange that would cover those children.

McCann-Beatty says she needs to see more about how that would shake out.

“The conversations I’ve had with other members of my caucus is we really want to see what impact if some of those families are shifted to the exchange, can they, in fact, save money?” she says. “I think until we get those numbers we can’t really say whether that’s something that we can support.”

Barnes tells the committee that even if that eligibility isn’t lowered in statute, he still projects some savings in that program as families currently using it switch to exchange plans. He says if a quarter of those families switch it would save the state $3,325,000.

Barnes says he doesn’t know when the draft report will be ready.

Nixon meeting with legislative Medicaid committees canceled amid dispute

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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 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.”

Legislative Medicaid Committee Chairmen respond to Nixon invitation to joint session

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The Chairman of House and Senate interim committees dealing with Medicaid reform say they will take Governor Jay Nixon up on his invitation to meet with them next week, but they want to do it on their own terms.

The letter from Representative Jay Barnes and Senator Gary Romine to Governor Jay Nixon.

The letter from Representative Jay Barnes and Senator Gary Romine to Governor Jay Nixon.

Representative Jay Barnes (R-Jefferson City), before a hearing by the House Interim Committee on Medicaid Transformation which he chairs, passed out a letter signed by he and Senator Gary Romine (R-Farmington), the chairman of the Senate Interim Committee on Medicaid Reform and Transformation.

The letter thanks Nixon for his offer and say such a public meeting between the executive and legislative branches is “rare,” then outlines the procedures the two chairmen want to follow.

They tell Nixon the meeting will operate as a joint hearing of the two committees to be conducted under guidelines and laws governing such hearings, Barnes and Romine will preside as co-chairmen, Nixon would be the only witness called to testify and would begin the hearing with his opening address to the committee and public to be followed by questions and discussion from committee members, and the hearing would take place in the House Lounge at 10:30 on Tuesday, November 26.

Nixon’s invitation to members of the committees on November 5 asked them to join him on the same day at the same time, but at the Governor’s Office Buildings two blocks from the Capitol and across the street from the Governor’s Mansion.

A request of Nixon’s office for a response to the letter from the chairman has not been responded to by the time this story was posted.