State budgeting

Missouri Gov. Matt Blunt has proposed a $20.93 billion budget for the fiscal year that starts July 1. It is likely that legislators will come close to appropriating that much spending -- up from the current $19.39 billion budget -- because the state's economy has improved and state revenue is higher than expected. However, the specific programs to be included in the final budget will be those that survive the legislative process and the governor's veto pen.

The budget is divided into 13 appropriations bills. These bills will get hearings in six appropriations committees in the House before being sent to the House Budget Committee. This process involves just about every legislator. Then the appropriations bills will be subject to floor debate and conference committees to work out any significant differences between House and Senate actions.

While the governor proposes the budget, it is up to nearly 200 legislators and hundreds of staff members to work out all the details of this complex process that both charts the course of state government and pays for it.

Last year, when Missouri's economy wasn't quite so strong, both the governor and a majority of legislators took steps to keep the state solvent under tremendous revenue constraints. A great deal of attention was focused on changes in eligibility requirements for Medicaid assistance. While fewer Missourians qualified under the new system, more money was spent on Medicaid overall.

And since the end of the last year's legislative session, a special committee has been seeking updated solutions to the state's Medicaid program and health-care issues in general.

Governor Blunt devoted significant portions of his State of the State address last week to both Medicaid and health topics:

In-home health care: "Most seniors and disabled adults would like to remain in their own homes. In-home health care is more cost effective, and it allows them to do so. Last year, working together, we increased funding for in-home health-care services. To continue encouraging home care as an option, this year's budget calls for a $10.9 million general revenue increase to improve the quality and availability of in-home health care."

Medicaid reform: "I recognize the importance of health care to every Missouri family, and I believe we have an obligation to provide assistance to those truly in need of help. Last year, we took important steps to save Medicaid for our neediest citizens and began a process of reform. What few Missourians have heard is that we spent more money on Medicaid last year than we did the year before. If left unchecked the old program would literally bankrupt state government with a matter of years. Missourians know that simply throwing money at the problem without any other changes would not have solved the problem. Had we not taken action last year, today it would cost taxpayers an additional $935 million to fund the old program. For those who continue to clamor for a return to the old way, I ask that you be candid. Be honest with the people of Missouri and tell them what programs you would cut or what taxes you would raise. Do not pretend that we can spend money in a vacuum with no resulting harm to schools or Missouri taxpayers."

Additional spending: "My administration remains committed to providing meaningful assistance to our neediest citizens. Medicaid is an important state program. This is why my budget asks for $275 million additional state dollars to sustain its current commitments. This significant increase will allow us to continue providing health care for 16 percent of our fellow citizens. It also means that this important program will receive 29 percent of the entire budget."

Medicaid fraud: "Fraud, whether by dishonest providers or ineligible recipients, comes at the direct expense of people who truly cannot provide for themselves. In the past, we had a lackadaisical approach to fraud. Rooting it out was not a priority, but since January 2005, it has been one of my chief objectives. Since I assumed office, $138 million of Medicaid waste and fraud has been identified and corrected."

Finding the best balance for state spending is a process that has to stay within the bounds of available revenue. That's the task Missouri's senators and representatives face before the legislature adjourns in a few months.