Medicaid Archives - Missourinet

Medicaid expansion supporters optimistic despite recent rejections

March 26, 2014 By Mike Lear

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.

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

March 25, 2014 By Mike Lear

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)

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

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.

Nixon renews call for Missouri to expand Medicaid eligibility

December 31, 2013 By Mike Lear

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

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

November 20, 2013 By Mike Lear

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)

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

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.”

Legislative Medicaid Committee Chairmen respond to Nixon invitation to joint session

November 19, 2013 By Mike Lear

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.

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.

Subject of expansion divides Senate panel on Medicaid reform

November 14, 2013 By Mike Lear

The work of the Senate Interim Committee on Medicaid Reform and Expansion has ended with its minority members breaking away to write their own report on its findings. This comes after the Republican majority led a vote to reject recommendations regarding eligibility expansion over Democrat objections.

The Committee discussed a draft report with 16 bullet point recommendations. Senator Jamilah Nasheed (D-St. Louis) asked Committee Chairman Gary Romine (R-Farmington) why expansion was not among them.

He told her, “Because it was not under the purview or the auspices of this committee’s responsibility.”

Romine elaborated, telling Nasheed the committee was charged with looking for ways to make Medicaid more efficient before expansion can advance. “If we get this accomplished, then any other legislation that’s presented will have a better fighting chance … but until we reform and transform the current Medicaid program, no one’s in a position that they feel confident expanding anything to any additional eligibility.”

Democrats objected, noting that a great deal of testimony taken by the Committee dealt with expansion. Romine notes that testimony is included in the report, but Nasheed and her fellow Democrats were not satisfied. They pushed for the Committee to discuss expansion issues first, and when it did not, they walked out.

“I’ll come back when we’re ready to deal with Medicaid expansion,” she told Romine, and walked out joined by Senators Paul LeVota (D-Kansas City) and Joseph Keaveny (D-St. Louis).

The three returned with their own recommendations and asked the committee to vote to include them. Those included stating that “the majority of testimony” to the committee said that the state should expand Medicaid and accept federal money for doing so, that the General Assembly should consider waiver options for expansion, acknowledging Office of Budget and Planning estimates that the state would realize General Revenue savings under expansion and the findings of a Kaiser Commission report that says states not expanding Medicaid expect a larger increase in their state budget portions going to Medicaid compared to those moving forward with expansion.

Those recommendations were rejected.

Senator Rob Schaaf (R-St. Joseph) then recommended the committee include tort reform in the report.

“One of the big drivers of healthcare is defensive medicine,” Schaaf said. “It’s been estimated that as much as twenty percent of the cost of healthcare is as a result of lawsuits, so I would ask that tort reform be included in the report to lower the cost of healthcare overall.”

Schaaf’s proposal earned derision from LeVota.

“Based on our charge and based on the fact that we just rejected the biggest cost-saving thing is ridiculous,” LeVota said. “The integrity of this committee, which I think is already gone because we’re not dealing with the number one thing, but adding this in there would be … talk about a waste of time.”

The Democrats on the Committee said they would write their own minority report that will include recommendations regarding eligibility expansion.

Asked whether he thought the impasse in the committee was a sign of things to come if Medicaid expansion reaches the Senate floor in the 2014 session, LeVota expressed optimism.

“I’m going to continue to have hope that the common sense of this will be overwhelming and we’ll be on the path to do what other states did and look at this opportunity, and create it our own way.”

Recommendations the committee did put in its report to transform Medicaid include putting low-income parents, children and pregnant women on Medicaid into private managed care plans. It estimates managed care could save the state between $14 million and $15 million dollars annually.

It also recommends raising the asset limit for the elderly and disabled from $999 for a single person and $2000 for a couple to $2000 for a single person and $3000 for a couple, adding dental care for adults and encouraging health savings accounts to be used for deductibles and copays.

The Senate Committee will join its House counterpart on November 26 in a joint session with Governor Jay Nixon.

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.