Hundreds of thousands of lower-income adults could regain Medicaid benefits cut a decade ago under a Missouri budget plan passed Friday that also boosts spending for public education.
The $26.4 billion budget includes numerous spending increases under the assumption that Missouri tax revenues will continue rebounding from the Great Recession, although they have been falling below expectations in recent month.
The budget now goes to Democratic Gov. Jay Nixon, who can cut or veto particular items but cannot add to the bottom line. It would take effect July 1.
The 2015 budget omits Nixon's proposed Medicaid eligibility expansion for an estimated 300,000 lower-income adults that would have been financed by billions of federal dollars available under President Barack Obama's health care law. Yet the budget represents a significant policy shift for the Republican legislative majority by restoring some of the sweeping Medicaid cuts the GOP enacted in 2005.
"We're trying to help the most vulnerable first," said House Budget Committee Chairman Rick Stream, R-Kirkwood.
Because of term limits, just 13 of the lawmakers who voted for the 2005 Medicaid cuts remain in the Legislature. Most of those voted Thursday for the Department of Social Services budget that includes $48 million to restore basic dental care and nearly $20 million to restore occupational, speech and physical therapies for adult Medicaid recipients.
"I think there's a little bit more of an understanding ... that if you ignore dental care, it leads to bigger, more expensive health problems," said Senate
President Pro Tem Tom Dempsey, a Republican from St. Charles who voted for the 2005 cuts as a House member and who voted for Thursday's budget.
A decade ago, Republicans said the Medicaid cuts were necessary to control a program that was growing beyond the state's ability to pay for it. At that time, Missouri was spending more than $5 billion annually to provide Medicaid health coverage to about 1 million people. Partly because of eligibility and benefit cuts in 2005, Missouri's Medicaid rolls have shrunk to 840,000, but the cost has continued to rise and amounts to $9.3 billion of federal and state funds in the 2015 budget.
Nixon campaigned for governor in 2008 by pledging to reverse the Republican Medicaid cuts but initially was stymied by GOP lawmakers.
Republican Rep. Sue Allen, a physical therapist from Town and Country who wasn't in office a decade ago, led the effort this year to restore the benefits, calling it a "significant Medicaid reform."
Republicans also touted the education funding in the budget. It includes a $115 million increase in the state's $3.1 billion of basic aid for public schools districts, which could rise to as much as a $278 million if revenues meet Nixon's more optimistic projections. The budget also includes additional money for school busing, safety initiatives and preschool programs; an average 5 percent increase in performance-based funding for public colleges and universities; and millions of dollars to expand the state's main financial-need and merit-based college scholarships.
Republican Rep. Mike Thomson, a former teacher from Maryville, encouraged colleagues "to go home and brag about how we have funded education."
Yet even with the increases, K-12 school funding would fall short of what is called for under a 2005 law, though no lawsuit has been filed challenging that. Higher education funding would remain shy of the amount that institutions were budgeted to receive in 2002, before a series of cuts began.
Democratic Rep. Margo McNeil, of Florissant, was one of about a dozen House members who voted against both the public school and higher education funding bills. She said the budget "is unnecessarily limiting" education spending.
The budget includes a 1 percent pay raise for state employees, with additional increases for some, such as foster care caseworkers and nurses in high-security mental health facilities. It also authorizes bonds for the construction of a new building at the Fulton State Hospital and includes money to open a new unit at the women's prison in Chillicothe.
Among other things, the budget boosts spending on tourism promotion, funds a new trade office in Israel and provides money to try to control the proliferation of Asian carp in Missouri's waterways.