THE SHOW ME STATE SHOWS THEIR OLD MEDICAID PROGRAM THE DOOR
Volume 28, Issue 494 June 25, 2007
Matthew Gever
In 2005, Missouri’s lawmakers decided that it was time to reform their Medicaid program, which was consuming nearly one in four state dollars. On May 18, 2007, the General Assembly passed SB 577.
Based in part on recommendations from a commission headed by Senator Charles Shields, the bill, which is expected to be signed by Governor Matt Blunt, changes the name of the Medicaid program to MO HealthNet as a symbol of the changes that are being made.
“The former Medicaid program was innovative when it was introduced in the 1960s, but grew over the years into a bloated, bureaucratic nightmare that failed to meet the needs of those it was designed to serve,” said Senator Delbert Scott.
MO HealthNet’s most innovative feature calls for enrolling members in “health improvement plans,” which will provide medical homes and coordinate care. With the help of an enrollment broker, beneficiaries will be able to choose from among three types of plans: risk-bearing managed-care organizations; entities that will provide only administrative services; or state administered point-of-service plans. (Aged or disabled beneficiaries will not be required to enroll in managed-care plans.) The state’s contracts with the managed-care and administrative services plans must include financial penalties for failure to meet specific quality improvement targets.
The bill also restores some of the cuts made by the General Assembly in 2005, including coverage of dental and vision services (subject to annual appropriations). A program that extends Medicaid coverage to people with disabilities who work and meet income and asset guidelines also will be reinstated. The State Children’s Health Insurance Program will be expanded to include 20,000 more children, largely through a revision of the rules that define what constitutes “affordable health insurance.”
The legislation also:
- Provides coverage of preventive benefits, such as breast and cervical cancer screenings, to some 90,000 low-income women who are not eligible for MO HealthNet;
- Extends MO HealthNet coverage to foster care children ages 18 to 21 who would otherwise have “aged out” of coverage; and
- Allows persons who buy long-term care insurance to deduct the cost of their premiums from state taxes.
In an effort to entice more providers to serve MO HealthNet enrollees, the legislation calls for development of a four-year plan to bring the program’s reimbursement rates for physicians up to Medicare’s. “We know the most significant problem facing participants now is low provider access,” said Representative Rob Schaaf.
Some think that the new program does not do enough to restore or expand benefits. “We still have more children uninsured under this bill that we did before the cuts in 2005,” said Senator Wes Shoemyer.
Senator Chuck Purgason said the legislation won’t sufficiently control costs. For example, restoration of dental and eye care coverage could cost the state upwards of $17 million per year. He also was concerned that the bill won’t change the basic structure of the health-care system. “It will take more of a cultural shift to move people toward providing for their own health-care and health-care needs rather than depending on the government-run health-care system,” said Senator Purgason.
But others say the revisions are at the very least, a good start. “The old Medicaid system did not focus on wellness, prevention and personal responsibility,” said Senator Bill Stouffer. This legislation, he said, does just that.
© Copyright 2007, State Health Notes
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