Missouri lawmakers could haggle over Medicaid in next regular session

The Missouri legislature’s annual “veto session” takes place this week.  Two state lawmakers are facing harsh criticism for controversial comments they posted on Facebook.  It’s an eventful stretch of time on the Missouri political landscape.

Missouri capitol

But some members of the General Assembly are already focused on the next regular session, which starts in January.

During a visit to Missourinet Moberly affiliate KWIX radio, House Republican Cheri Toalson Reisch of Hallsville, sounds a familiar GOP battle cry when speaking about Medicaid.

“So much of the Missouri tax dollars are going to Medicaid, and we need to see what we can do about that,” said Toalson Reisch.  “By getting people back to work with good paying jobs, providing for their own families.  The government isn’t there to do all and be all for everything.”

There’s little argument that Medicaid is expensive. At $8.2 billion, it accounts for almost one-third of the state’s nearly $28 billion budget.  By some calculations, the price tag for the federal program is even higher.

According to Politifact, the number rises to roughly $10 billion when all the supplemental appropriations under Medicaid are figured in.  The fact-checking organization gave Republican state Senator Caleb Rowden of Columbia a “mostly true” judgement when he said “this would be the first year, if everything holds true, we will spend over $10 billion of our state budget on Medicaid” at a legislative breakfast in January.

It’s also true that taxpayer money through the general revenue fund accounts for only 17% of Medicaid funding.  The federal government contribution covers about 50% of the program’s costs, while provider fees (hospitals, nursing facilities, pharmacies, etc.) and other state funds pick up the rest of the tab.

Professor Sidney Watson, a health law specialist at St. Louis University, says Medicaid is the only option available to some low-income segments of the state’s population. “Medicaid is the safety net” says Watson.  “If Medicaid is not there for poor children and seniors and people with disabilities, there is no alternative.  People are going to go without care.”

For her part, Representative Toalson Reisch thinks it’s important for healthy people to work, and not have to rely on the state to cover their medical bills.  “It’s imperative that we get people off the Medicaid rolls that are able bodied persons.  We need to get them jobs that they could provide for their families without government assistance.”

According MO HealthNet, the state department that administers Medicaid in Missouri, certain qualifications must be met to be eligible for the service.  A single person must be “either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in (the) household with a disability“.

Watson describes the conditions more directly.  “I don’t care how poor you are.  In Missouri, if you’re between 18 and 64, to qualify for Medicaid, you have to be permanently and totally disabled, unable to work, or a parent caring for minor children.”

In addition to the conditions required under MO HealthNet, a single person would have to have an income of $15,800 or less to qualify for Medicaid, while a family of four could not have an income exceeding $32,319.

State Representative Scott Fitzpatrick of Shell Knob chairs the House Budget Committee.  He’s thinks the cost of Medicaid places a heavy burden on the state.  Fitzpatrick says the program’s high level of coverage for children actually creates problems for families.

“I’ve had multiple people contact me, basically saying that they went to the exchange, purchased insurance and wanted to have insurance for their kids, but because Missouri’s eligibility levels are so high, they were forced to put their children on Medicaid,” says Fitzpatrick.

He thinks lowering eligibility levels for children could be one way to lessen the state’s financial burden from Medicaid costs.  Fitzpatrick would also want to look at creating a fee structure, which he thinks would create an incentive for recipients to not seek the highest cost form of healthcare possible every time they’re sick.

Others argue that Missouri has the most stringent requirements overall.  According to calculations by the left-leaning Missouri Budget Project, eligibility for Medicaid assistance for low-income parents ends at 19% of the federal poverty level, at an income of $301 per month for a family of three. The organization notes it’s the lowest eligibility level in the nation, tied with Texas and Alabama.

Watson of St. Louis University says Medicaid in the state is already running as lean as possible.  “The idea that there is some place that we can cut a large number of people off of Medicaid in Missouri is fanciful.”

It remains to be seen if Medicaid becomes a front burner issue for lawmakers when they start the next regular session in Jefferson City in January.

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