[Nfbmo] FW: House Republican plan could raise fees for Medicaid recipients

McMahon, Cory J cory.j.mcmahon at gmail.com
Mon Feb 25 16:39:45 UTC 2013


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Subject: House Republican plan could raise fees for Medicaid recipients

House Republican plan could raise fees for Medicaid recipients

4 HOURS AGO  •  BY VIRGINIA YOUNG VYOUNG at POST-DISPATCH.COM > 573-635-6178 JEFFERSON CITY • State House Republicans say the plans they are readying to reshape Missouri’s Medicaid program would require patients to assume more “personal responsibility” for their health care.
Their proposal aims to take advantage of proposed changes in federal policy that would let states charge premiums, deductibles and co-payments that are higher than the nominal costs that Medicaid beneficiaries incur now.
“It is reasonable to expect a recipient to have some ‘skin in the game,’ ” said Rep. Chris Molendorp, R-Belton. He is a member of small group of GOP legislators drafting an overhaul of Missouri’s $9 billion health care program for the poor.
After weeks of percolating, the Medicaid debate will surface in the Legislature on several fronts this week.
The House Government Oversight and Accountability Committee will hold a hearing today on a Democratic proposal backed by Gov. Jay Nixon. It would expand eligibility in the public insurance program to adults making 138 percent of the federal poverty level, or about $32,499 for a family of four. The federal government would pay the full tab for the new recipients for the first three years, phasing down to 90 percent after that. The state would make up the difference.
Republican legislative leaders have said they will not pass the expansion plan because it is not financially sustainable.
On Tuesday, Reps. Molendorp and Jay Barnes, R-Jefferson City, will announce their alternative. It is expected to combine an overhaul of the system with a partial expansion, perhaps covering people up to 100 percent of the federal poverty level.
“There’s great interest in transforming Missouri’s Medicaid system into the most free-market system in the history of our country, one that saves costs for taxpayers and ensures access to care for those that need it most,” Barnes said.
However, if the alternative doesn’t increase eligibility to the 138 percent threshold, federal officials have said states cannot receive the enhanced matching funds provided under the Affordable Care Act.
Even so, Florida’s receipt last week of federal waivers to allow private companies to run that state’s Medicaid program has encouraged Missouri legislators, who say they are looking for innovative solutions to lower costs and improve care.
Rep. Sue Allen, who chairs the House social services appropriations committee, said she would present her own Medicaid transformation plan today. Allen, R-Town and Country, said her proposal would broaden the use of managed care for Medicaid recipients.
Medicaid currently covers low-income seniors, people with disabilities, pregnant women and some families with children. The federal Affordable Care Act passed by Congress extended the program to include millions of childless adults and others nationwide, but the U.S. Supreme Court made that provision optional for states.
After months of silence on the issue, Nixon proposed that Missouri accept the expansion. His proposed state budget for next year counts on about $900 million in extra federal funds to extend Medicaid to
260,000 adults.
Leaders of the Republican-controlled Legislature dismissed the idea, and House Budget Committee Chairman Rick Stream, R-Kirkwood, removed the expansion from the budget bills he filed.
“Most of us believe it’s a broken system,” Stream said. “It’s just not functioning properly. We would like to transform the system into one that’s working.” Republican legislators say a system of carrots and sticks could be part of the solution. To encourage patients to make more cost-effective use of medical services, the GOP’s plan is likely to use new federal authority — still in the pipeline — that would allow higher co-payments and premiums.
The federal government has tightly limited such “cost-sharing,” with co-payments usually capped at a few dollars and allowed only for certain services. Some groups have been exempted from any co-payments.
Also, services generally cannot be withheld for failure to pay.
But now, to make Medicaid expansion more attractive to states, the administration of President Barack Obama is moving to give states more flexibility. For example, under a proposal released last month, adults could be charged for the “non-emergency use” of emergency rooms.
Co-pays for lower-cost, generic drugs could range up to $4 while higher-cost drugs could spur a co-pay of up to $8.
Molendorp said: “The question is, can you encourage the recipient to take better control of their health care and make better health care decisions by requiring a reasonable deductible and co-pay? And what is too much?” Health-care providers say the problem is that often, the patient doesn’t have the money. In that case, “it really becomes a bad debt, or charitable care,” said David Winton, a lobbyist who represents BJC Health Care Systems, Coxhealth of Springfield and the Missouri Association of Rural Health Clinics.
But a sliding fee scale based on income can work, legislators say.
They point to a model already in place for the uninsured — at the network of federally qualified health centers that provide primary care in underserved areas. Family Care Health Centers in south St.
Louis is an example.
“On average, to get in the door they’ll pay a $20 fee,” said Joe Pierle, who lobbies for the centers as head of the Missouri Primary Care Association. “At the end of the day, we absorb a lot of that.
Some of them pay it. We make every attempt we can to recoup it.
“We think it’s important for our patients to have a financial stake in their own health care because they take greater responsibility over their own health care when they are asked to pay something,” Pierle said.
Another way of emphasizing “proactive” preventive care would be to expand managed care, said Allen, who heads the committee that oversees the social services budget.
While there are different versions of managed care, in general, insurers are paid a pre-set amount each month for each person who is covered. That way, managed care supporters say, the insurer has an incentive to keep people healthy.
Missouri’s Medicaid program currently uses managed care only for low-income parents and children in the metropolitan areas and in mid-Missouri, an area dubbed the I-70 corridor.
“I’m looking for a wider paintbrush for managed care throughout the state,” Allen said. She said her proposal would include pilot programs as well as system-wide changes. Allen said her proposal also would help the state go after waste, fraud and abuse in the system.
Democrats on her committee responded that the state already had a solid fraud-prevention program.
“Waste, fraud and abuse is a very popular term, but I think the department (of social services) has done an excellent job in keeping a lid on that,” said Rep. Jeanne Kirkton, D-Webster Groves.
The governor contends that the state would actually reap $46 million in savings next year from expanding Medicaid because some health care costs could be shifted to the federal government’s tab and additional state tax revenue would be generated from new jobs in the medical field.
Republican legislators respond that they don’t trust the federal government to pay what it promises and that the state’s eventual share of the cost would take money needed for education and other services.

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