Experts concerned about Medicaid work rules

As a House committee began work on a Medicaid reform bill raising eligibility requirements to win significant federal funds, legal experts said tying eligibility to a work requirement would not pass muster with federal officials.

The bill, introduced by Rep. Noel Torpey, R-Independence, and co-sponsored by Rep. Jay Barnes, R-Jefferson City, includes a variety of reform provisions that aim to reduce health care costs and encourage Medicaid recipients participate more in their own health decisions and care.

But most of the reforms are contingent on receiving a waiver from the Department of Health and Human Services to implement a Medicaid plan that doesn’t conform to federal laws. St. Louis University law professor Sydney Watson and lawyer Joel Ferber of Legal Services of Eastern Missouri said the provision requiring a beneficiary work or look for work was likely a non-starter with federal officials.

“The problem is that this

language is an additional eligibility requirement,” Watson told the committee. “The more productive avenue may be instead of tying workforce participation to eligibility, to seek a waiver to incentivize work.” She suggested notifying beneficiaries of work training programs they qualified for.

Another provision would require recipients pay one percent of their income as a premium for the Medicaid services. Torpey said the cost-sharing requirement was critical, because “it’s important to have ownership. … It helps folks moving forward to say I pay my share, I participated.”

Barnes acknowledged the work provision was a step further than other states gone in receiving waivers. But he said it was fair to ask people work or looking for work if they want to receive Medicaid coverage.

“I think its only fair that we require an able-bodied person to actually work before they qualify for Medicaid,” Barnes said. “Missourians are willing to help those who are willing to help themselves, but are not willing to help people who can work but choose not to out of laziness or whatever reason it is.”

Republicans on the panel also took the opportunity to knock the Obama administration for waiving or delaying other provisions of the Affordable Care Act.

“The nice thing about these waiver discussions is the Obama administration has made it clear if there is any way to interpret a statute any way, they will do it,” Barnes said.

Another provision of the law would require health providers, such as hospitals and private practice doctors, supply patients with a cost estimate of potential procedures if requested.

Daniel Landon of the Missouri Hospital Association asked the committee to put more of the onus on providing cost information on insurance companies, which are already required to give a patient information about cost-sharing, and know more about the actual cost to the patient.

“Is there any other facet of our economy where pricing is so opaque?” Barnes asked the bill’s sponsor.

Other provisions discussed at the hearing would allow school districts to establish health clinics for students, teachers, staff and members of the community; force the Missouri Department if Social Services subsidize private plans for Medicaid participants if it would be more cost-effective; and allow hospitals to establish urgent care facilities to divert “frequent-flyers” away from unnecessasry emergency room care.

“We share your effort to encourage patients to receive the right care at the right time at the right place,” said Randy Jotte, a St. Louis emergency room physician. He discussed a program at Barnes-Jewish Hospital that used teams of doctors, social workers and others who worked to coordinate care for patients that relied on the emergency room for all types of care but said it required additional funding.

Other Republican-sponsored bills have been introduced in the Senate and House but don’t include the expanded eligibility of Torpey’s bill. In multiple votes on the Senate side, all Republicans have rejected attempts to attach expansion amendments to various pieces of legislation.

Gov. Jay Nixon has made expanding eligibility a priority this year, and has signaled he would not support Medicaid reforms if they were not tied to expanding eligibility.

Barnes, the committee chair, said he plans to hold two more hearings after the legislative spring break. He said the next hearing will focus on health care delivery models, and the final hearing will look at eligibility levels.

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