Bill would restore benefits, increase compensation

JEFFERSON CITY, Mo. -- Hundreds of thousands of Medicaid recipients could regain coverage of services eliminated two years ago, while thousands of doctors could be rewarded with more money for treating them under legislation endorsed Tuesday by a House committee.

The Medicaid overhaul legislation crafted by the House panel could be debated by the full chamber by the end of this week. But it would have to be reconciled with a significantly different Senate version before the legislative session ends May 18.

The legislation contains Gov. Matt Blunt's proposal to rename the government health care program for some 825,000 low-income Missourians "Mo HealthNet," placing a greater emphasis on preventive health care.

But the House version focuses more on expanding health care coverage than the Senate version does. It also does more to ensure higher payments to physicians and other medical providers, some of whom are reluctant to participate in the current Medicaid program because it pays significantly less than private insurers and the federal Medicare program for seniors.

Supporters of higher payments hope to entice more medical providers to the Medicaid program, thus making it easier for participants to get their health problems treated.

"The No. 1 problem is access," said Republican Rep. Rob Schaaf, a St. Joseph physician who is handling the House version and is chairman of the House Healthcare Facilities Committee. "Raising provider reimbursement is the most important thing to do in reform."

Schaaf's legislation would raise Medicaid payment rates to at least the Medicare levels over the next several years. He estimates it would cost $40 million in state funds, plus additional federal money, in the 2009 fiscal year and $80 million in the 2010 fiscal year.

The Senate version would direct an 18-member committee to come up with guidelines for a new incentive payment system for medical providers -- for example, reimbursing surgeons more if their patients have quicker recoveries.

The House version would implement the incentive system only when basic Medicaid payment rates have at least matched the Medicare rates and the federal Medicare program also has implemented a pay-for-performance program.

Some of the new costs in the House version would be offset by expected savings. Schaaf projects the net cost of his legislation to be around $55 million next year. Legislative and executive branch staff also are developing their own cost estimate.

Two years ago, Blunt and Republican legislative leaders said they were taking a first step toward Medicaid reform when they cut certain benefits for many adult Medicaid recipients and tightened the eligibility standards in a budget-cutting move that eliminated coverage for many. Medicaid enrollment at the time was about 1 million.

Assuming money is appropriated in the budget, the House legislation would restore coverage for dental, podiatry, optometry, orthopedic and therapy services for adults. Schaaf estimates that would cost about $15 million next year in state funds, plus additional federal money, and about $30 million in state funds each of the following two years.

"Getting these services that people need is true reform," Schaaf said. "What good is the program if you can't get people the care they need?"

But some Democrats said the bill doesn't go far enough. They want to restore all of the eligibility cuts made in 2005.

Rep. Mike Talboy, the only committee member to vote against the bill Tuesday, called it unfair and "unchristian" not to reverse the "bloodletting of 2005."

"They have basically chilled the voice of a lot of people who have been denied access to health care," said Talboy, D-Kansas City. "We're taunting all these people we cut off health care by saying we have this surplus and we're just saving it."