Dueling Medicaid Bills Take Center Stage

A Missouri House committee this week rejected legislation (HB 627) that would have expanded Medicaid along the lines set out in the federal Affordable Care Act (ACA). Meanwhile, State Representative Jay Barnes (R-Jefferson City) introduced his own “Market-based Medicaid” proposal (HB 700).

The Barnes proposal is expected to be more popular with House members, but House Speaker Tim Jones (R-Eureka) said the bill is not likely to pass this year. The speaker said the House will look at the Medicaid issue but passing any legislation is at least a two-year project. Meanwhile, there has been little attention given to Medicaid expansion in the Missouri Senate.

Because of a U.S. Supreme Court decision last summer, states have the option of accepting or rejecting the federal dollars to expand Medicaid as proposed in the ACA. A number of states are seeking waivers from the federal government in order to enact their own version of the Medicaid expansion. The Barnes’ bill would require several federal waivers in order to be implemented in Missouri.

The ACA would expand Medicaid to 138 percent of the Federal Poverty Level (FPL) for childless adults and parents. Currently no Medicaid health coverage is available for childless adults and, in Missouri, parents are only eligible with incomes up to 19 percent of FPL. The Barnes plan would provide coverage up to 100 percent of FPL, or $23,550 annually for a family of four.

The legislation would also eliminate health coverage for about 44,000 children now covered under the Children’s Health Insurance Program (CHIP), which provides coverage for children not eligible for Medicaid who have household incomes between 100-300 percent of FPL.

The elimination of the CHIP coverage would only go into effect if and when these children became eligible for coverage through the newly created health insurance exchanges. Parents would receive a federal subsidy to help pay for the insurance premium. Under the existing CHIP programs parents with incomes between 100-150 percent of FPL are not required to pay a premium.

The Barnes bill also reduces Medicaid coverage for pregnant women from its current level of 185 percent of FPL to 133 percent of FPL. A bill (HB 716) filed by State Representative Jeff Grisamore (R-Lee’s Summit) would offer health coverage to unborn children up to 300 percent of FPL through a separate CHIP program.

The MCC has not taken a position on any of the Medicaid related bills, but issued a statement setting out some broad recommendations for legislators to consider.

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