Medicaid again this year might be a topic that causes Missouri residents and lawmakers to meet at loggerheads.
At the head of the debate could be the fight over how much the state chooses to reimburse skilled nursing facilities for care of patients who use Medicaid, said John Kotovsky, CEO of Lutheran Senior Services, a major provider of senior services in Missouri and Illinois.
Under Missouri's formula, the state should reimburse skilled nursing facilities $178 per patient per day. Instead, it pays only about $154 per patient per day.
The $24 gap is significant, Kotovsky said. It could mean the difference between a small nursing home continuing to provide adequate service and going out of business, he said.
"Our state is aging faster than a lot of other states," Kotovsky said. "More and more, people are going to need these kinds of services. When you have facilities closing, that's a recipe for disaster."
Lutheran Senior Services provided data that show, of the money the state reimburses skilled nursing facilities, $78.44 comes from federal funding, $30.76 from patient support (paid from patients' Social Security benefits), $21.53 from provider taxes (taxes paid by nursing homes on a per-bed basis), $15.26 from the Missouri General Revenue Fund and $7.82 from other sources.
Missouri's Republican-led General Assembly has resisted Medicaid funding for years.
In 2014, concerns over reductions for poor Missourians sparked numerous debates and marches. A May 6, 2014, protest led to the arrests of 24 religious leaders, whom Cole County Prosecutor Mark Richardson charged with misdemeanor trespassing. The men and women were convicted of trespassing in the state Senate's visitors' gallery. Sixteen of the leaders accepted pardons from then-Gov. Jay Nixon. The others were placed on probation.
Data that show Missouri — on average — pays about one-third toward Medicaid that surrounding states pay (about $48.22) further concerns skilled nursing facilities, Kotovsky said.
As a member of the Missouri House of Representatives Budget Committee, state Rep. Sara Walsh, R-Ashland, said she already is hearing about the Medicaid shortfall.
"This is the issue of a pay gap in funding," she said. "On the Budget Committee, that is a concern."
But lawmakers are far from coming up with final budgets, she said.
"I want to make sure that those who are most vulnerable will continue to receive funding," Walsh said. She added advocacy groups will have opportunities to make their best cases for where funding should go.
Unfortunately, the skilled nursing industry has been "pretty silent" on funding and accepted what legislatures have provided, Kotovsky said. This year, he said, things are different. Health care providers, staff members, patients and their families are writing to as many state legislators as possible.
They are focusing on Ways and Means, Appropriations and other committees with responsibility for purse strings.
The Missouri General Assembly passed a budget last year that included no changes to reimbursements from the previous year, Kotovsky said. But Gov. Eric Greitens vetoed the budget and instead signed a budget that provided $5 less per patient per day for Medicaid payments.
Greitens' office has not responded to a News Tribune request for comment concerning the payments.
Obviously, the state has to have a balanced budget, Walsh said.
Lawmakers are listening to concerned residents and making notes about things not working the way they should, she said.
"We're looking at re-allocating things from areas where they're not working," Walsh said. "We really want to protect the people who are the most vulnerable. I want people to know that this is something we're taking seriously."
Kotovsky is also, much like a politician, going where he can talk to people. He said he has attended town hall meetings, in which people expressed their fears for their loved ones.
"We've never spoken out about political issues," Kotovsky said. "A lady came up and said this is not a political issue — it's a moral issue."
Have a question about this article? Have something to add? Email reporter Joe Gamm at email@example.com.