Changes to Medicaid leave some people with questions

If they had to pay for all of it, Leemon and Elaine Priest would have to spend about $600 a month for the parade of pills for Leemon's encephalitis and Elaine's Parkinson's disease.

"We'd never be able to come up with that," said Leemon, who works 20 hours a week as an administrative assistant despite the nearly constant pain in his legs. "All we get is a small disability check and the little bit I make. We've already cut back all we can cut."

But thanks to Medicaid's so-called "spend-down" provision, the disabled Cape Girardeau couple have only had to pay a more manageable $70 a month for the medication.

That program allows the elderly and disabled with incomes above the normal Medicaid limit to receive benefits anyway if their medical expenses reduce their available income to 74 percent of the federal poverty level -- $6,562 annually for an individual.

But with recent changes to the program -- the most recent one coming Friday from Gov. Bob Holden's office -- Leemon Priest said he has a lot of questions.

"I've heard a lot of different things," Leemon said. "But if I have to spend $600 a month on strictly medication out of my own pocket, I'm not going to have a whole lot left. I really don't know what's going to happen."

Leemon probably echoes the sentiment of others in similar situations.

It started when, under pressure by the federal government, Missouri agreed to change its spend-down provisions starting Oct. 1 so that people must pay -- not just incur -- their initial medical expenses, much like an insurance premium. After that, Medicaid will pay any additional costs.

Raising income cutoff

Under current policy, if people incur enough medical costs in one day to qualify, then the Medicaid program pays their full bill. The federal government, which had paid 60 percent of those "spending-down" costs, had said it would cut off those payments if the state didn't require recipients to pay their own medical costs before they become eligible.

On Friday, Holden announced the state was raising Medicaid's income cutoff for the disabled, blind and elderly from 74 percent to 80 percent of the federal poverty level -- about $7,094 annually for an individual, or $591 a month.

The state's budgeting director, Linda Luebbering, said that will help almost half of the roughly 25,000 people who receive Medicaid coverage under the spend-down program. That means that 4,600 participants in the spend-down program will be totally covered now and others will not have to spend as much to reach the qualifying amount.

"The governor wanted to assist those who might be seeing some difficulty with the federally mandated changes," Luebbering said. "So he thought raising the poverty level would ease the transition. The governor could have gone up higher, but we can't afford to do that."

She said Holden can raise the cutoff to 90 percent in 2003 and 100 percent of the federal poverty level after that.

Of those who participate in the spend-down program, a third pay their full share, a third split the cost of the "spend-down" amount and the state pays all of the rest.

Luebbering said the cost of going to 80 percent will be about $3.5 million. But since the state won't be paying any of the "spend-down" costs anymore, it will save $16 million.

'Good first step'

Miki Gudermuth, executive director for SEMO Alliance for Disability Independence Inc., said that the change will help make sure that some people don't fall through the cracks.

"It's a good first step, but the federal poverty level is what needs to be raised," she said. "Medicine costs are going to keep going up, not to mention what it costs to live. If you don't adjust the national poverty level, you're not helping those who live on fixed incomes and are not getting raises every year."

Gudermuth said there are 77 disabled people in their system who participate in the "spend-down" program. She estimated that raising the poverty level to 80 percent will probably help half of those.

"You're still going to have the other half who will not see any improvement because they make more than the poverty level," she said. "But any forward motion is good motion."

Vicki Smith of Cross Trails Medical Center called Holden's move a short-term solution.

"It's only really affecting 4,600 people," she said. "It's a move in the right direction, but hopefully next year he'll raise it some more and keep raising it until it's 100 percent of the federal level. Because what we're really talking about is access to health care."

smoyers@semissourian.com

335-6611, extension 137