[Nfbmo] FW: [Education and Welfare] SB700 Hearing

[Shelia Wright]

Below is a message from Chris Gray on his perspective on yesterday's hearing
HB 700. I thought you all would be interested in reading this. 
Shelia

  

From: EW [mailto:ew-bounces at moblind.org] On Behalf Of Christopher Gray
Sent: Tuesday, March 26, 2013 12:41 PM
To: Education and Welfare Committee
Subject: [Education and Welfare] SB700 Hearing

Good Morning to All:

Despite the occasionally treacherous road conditions yesterday, I was able
to attend the House Government Oversight and Accountability committee
hearing on
HB700 which began at 9:30 sharp yesterday morning. Chairman Barnes expressed
some regret at not being able to postpone the meeting because of the
weather, but indicated the importance of moving forward with this bill given
the House schedule and the remaining time in this session of the General
Assembly.

The first 90 minutes or so were spent reviewing the proposed bill as amended
and distributed at the start of the meeting.  HB700 represents a major
overhaul of MIssouri's Medicaid system and is long, complex and
comprehensive.  In his presentation of the bill, Rep. Barnes divided the
presentation into a discussion of additions and incentives added to the
Medicaid system, exclusions/decreases, and contingencies.

It is in the area of exclusions and decreases in which we are most
concerned. 
The current language covering blindness in 208.151 is entirely removed.
Blind people will be eligible to receive Medicaid only if they are at or
below 100% of the poverty level.  Blind pension recipients are not exempted
from this in the new legislation as they are today.

The legislation is currently based on several contingencies.  The only one
of significance is that the bill only covers people up to 100% of the
poverty level.  The Affordable Care Act funding that would pay Missouri's
Medicaid expansion costs in full in 2014-2016 and then provide a 90-10
Federal match going forward requires coverage for people up to 138% of the
poverty level. 
Representative Barnes floated a theory that HHS might provide the equivalent
funding minus the coverage difference from 138% to 100%.  Nobody who
testified later in the hearing agreed with this theory and two attorneys
testifying as expert witnesses provided some pretty compelling evidence that
this partial raising of Federal spending for Medicaid in Missouri will not
happen.  It was also stated that the Secretary of HHS has already indicated
that no partial raising of Medicaid levels that are below 138% will qualify
a state for the
90-10 matching grant or initial 100% Federal support.If any of the
contingencies mentioned are not met, no provisions of this bill would go
into effect.  I'm not listing the other contingencies here because there was
general agreement that all could be met.

In my testimony before the committee, I made the following points on behalf
of
MCB:

1.  MCB has taken a position that we support the governor's proposal and so
we favor coverage of 138% of the poverty level.  We do not believe it is
wise to base health care on speculative ideas of what the Federal government
may or may not do.

2.  There are compelling reasons why blind pension recipients receive the
consideration they currently have in MIssouri law.  These reasons include
the high costs of the disability of blindness, and the high incidence of
multiple disabilities in the blind community.

3.  The citizens of Missouri created the blind pension as a means of
providing much needed support for the blind community.  Removing Medicaid
benefits for many recipients turns this benefit into a disincentive to work
and makes the blind pension potentially a burden rather than a benefit.

4.  In describing incentives provided in this legislation, Rep. Barnes
mentioned on several occasions a desire to do away with the Medicaid Cliff
and provide means for people to advance themselves without being unduly
penalized by losing their health insurance via Medicaid.  Without the
Medicaid exception for the blind, many recipients of the blind pension would
most likely have to stop working and being productive citizens of Missouri.

5.  MCB favors restoration of the current provisions set forth in Missouri
Statute 208.151 regarding blind recipients of Medicaid.  Failing that, the
committee has alternatives that we sincerely hope will be considered.  Some
alternatives might be:  grandfathering current recipients of the blind
pension such that their benefits remain unchanged and applying new
provisions to new recipients; excluding blind pension income from the
Medicaid eligibility standard used; allowing the blind full access to other
provisions in this legislation such as a section defining care centers or
provisions for the "medically feeble" described earlier by Representative
Barnes.

When I was done, Barnes pursued the idea of excluding blind pension income
from income calculation for Medicaid and "wrap arounds" he recalled being
put in place for the blind in 2005.  Based on that, I feel that we were at
least heard in part.  Also, I approached him after the hearing to follow up
and he indicated he would investigate these two matters further.  He
indicated he would not be interested in pursuing reinstatement of blindness
provisions in 208.151.  He simply believes that the creation of a national
health exchange in 2014 provides the benefits necessary to any individual at
an affordable cost.

The meeting was actually finished by 3:30 or so and everybody seemed pretty
surprised about this.  In the next week, the committee is invited to submit
amendments to HB700 and these and the overall bill will be discussed in
executive session some time next week.

Finally, in my testimony I did not say whether MCB supported or opposed
HB700. 
I felt the focus should be on what needs changing and that a statement of
nonsupport would not further that end.  However, we will have to decide in
the near future exactly what we wish to say about support or nonsupport.
I'm assuming we cannot support this bill as written today.  But I also
believe it is best not to say this explicitly until after the bill has been
finally amended.

My thinking now is to contact each member of the committee and see if we can
find somebody willing to introduce language for us from 208.151.  Barnes has
already declined to do this yesterday, but I have contacted nobody else yet.

All the best,

Chris

----------------------------------------
Christopher Gray, Executive Director
Missouri Council of the Blind

5453 Chippewa
St. Louis, MO 63109
Phone:     (314) 832-7172
Toll-free: (800) 342-5632
Fax:       (314) 832-7796

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