Signs are mounting that the general assembly may fail to act on legislation to reform and expand Medicaid this session. While State Representative Jay Barnes (R-Jefferson City) has worked diligently to explain his Medicaid reform bill (HCS HB 700) to both House Republicans and Democrats, no similar bipartisan effort has taken place in the Missouri Senate. The Senate appears inclined to have an interim committee look into the issue over the summer after the session adjourns.
Delay would mean the state of Missouri forgoes receiving millions of new federal dollars to expand health coverage to the working poor. At present, Missouri only allows Medicaid health coverage for parents with incomes up to 19% of the Federal Poverty Level (FPL). The Medicaid expansion offered under the federal Affordable Care Act (ACA) would raise the eligibility to 138 percent of the FPL with the federal government covering 100 percent of the cost of the expansion for the first three years.
The Barnes bill proposes raising eligibility to 100 percent of FPL, a vast improvement over current Missouri law, though some legal experts argue the U.S. Department of Health and Human Services (HHS) will not grant the enhanced 100 percent federal funding if a state refuses to expand to 138 percent of FPL.
Further complicating the picture is an announcement this week by the Obama Administration to seek a one-year delay in cutting the payments hospitals receive for providing uncompensated care to indigent patients. One of the main arguments for expanding Medicaid has been that the Medicaid reimbursements are necessary to replace the lost payments to hospitals. The Obama Administration announcement may dissipate the push to immediately expand Medicaid. For more on the reaction of state legislators, see this St. Louis Post Dispatch article.
Meanwhile, Medicaid expansion without reform appears to be a non-starter in the general assembly. Reforms under discussion call for some cost-sharing (co-pays, etc.) by Medicaid recipients, encouraging more prudent use of emergency rooms and more competitive bidding in selecting managed care companies.
The Missouri Catholic Conference is supporting Representative Barnes’ bill as a step in the direction of expanding coverage to many of Missouri’s working poor.