Missouri Senate Medicaid panel splits over expansion

Three Democratic state senators walked out of a Medicaid committee work session Wednesday because Republican members refused to discuss expanding Medicaid eligibility.

The committee instead considered a slew of other recommendations.

When they returned with a list of their own recommendations to add to the committee’s final report, the committee rejected the additional language, which included acknowledging the majority of testimony supported expansion, expanding Medicaid saves the states money and tasking the Missouri General Assembly to consider waiver options that other states have developed.

“The bulk of the testimony was on Medicaid expansion and here in this report — which I am appalled by — we have no recommendations for expanding Medicaid,” said Sen. Jamilah Nasheed, D-St. Louis.

Committee chair Sen. Gary Romine, R-Farmington, said the move was not productive and made it more difficult for them to achieve their goals.

“I was very disappointed that they left, that was hard to take,” Romine said. “I was willing to accept their coming back and trying to work with them, but it created a wedge and a difficulty to go forward with what they were presenting.”

After the committee’s three minority members left the meeting to draft their own recommendations, the Republicans on the committee went through a list of 16 reforms to the current system. Romine and the report stressed the state needs to improve its current system before taking on thousands of new participants.

“The committee believes that before the state can consider expanding eligibility and increasing the number of participants to the program, transformation of the entire Medicaid program must occur,” according to the committee’s draft report.

The reforms included expanding groups currently covered by managed care plans statewide. Managed care plans, which currently cover some Medicaid participants in more than 50 counties along the Interstate 70 corridor, allow the state to contract with private companies responsible for developing provider networks to care for Medicaid participants. The contracts set rates based on the number of participants being covered and specific measures of health improvement.

“Managed care is the most efficient way of handling the Medicaid population,” Romine said. “They’ve got systems in place, they’ve got technology in place…. I realize that the free market is the best way to serve.”

Not all of the senators agreed that managed care plans were as effective at reducing costs as their proponents argue.

“Putting everyone on managed care gives me a bit of heartburn,” said Sen. Rob Schaaf, R-St. Joseph. “We don’t pay the providers enough now. I can’t imagine we can put all of these people on managed care, and provide the same service and still save money.”

Schaaf also said most of the witnesses who testified in favor of expanding managed care were representatives of managed care companies and stand to benefit financially from more responsibility.

Unlike his Democratic colleagues, Schaaf succeeded in adding a recommendation of his own to the committee’s list: tort reform. Tort reform caps the amount of damages doctors can be forced to pay if sued for malpractice.

“It’s a well known fact that defensive medicine contributes to a great percentage of the cost of health care,” Schaaf said, referring to expensive and often unnecessary tests doctors run to cover all of their bases.

Despite Romine’s objection that tort reform was outside their purview, the committee’s other Republicans approved of Schaaf’s recommendation.

“Talk about a waste of time, a complete waste of time,” said Sen. Paul LeVota, D-Independence. “Adding (tort reform) makes it the pet project committee.”

The Senate work session comes a week before a similar House committee plans to meet for the last time and two weeks before a meeting about Medicaid between members of both committees and Gov. Jay Nixon.

While Republican members on the House side have also expressed concerns with expanding the Medicaid population throughout their hearings, chair Rep. Jay Barnes, R-Jefferson City, presented budget projections to his colleagues that estimated the state would save more than $40 million in general revenue by 2021 if the state were to expand.

Keaveney said he was heartened by Barnes’ projections. “The most intriguing part of it was he challenged his colleagues (to offer alternative projections) … To date, I haven’t seen anyone disagree with his numbers,” he said.

The three Democrats were planning to meet and decide if they would develop a minority report to accompany the other recommendations, but none of them were willing to sign the report as it was discussed during the work session Wednesday.

Other recommendations in the report include:

• Expand programs designed to manage “super utilizers” like the Department of Mental Health health homes;

• Promote the use of technology and telehealth in the state;

• Strengthen investigations of participant abuse;

• Include dental services for adults and the disabled in plans;

• Reinvest savings into provider reimbursement rates.


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