GOP senators offer plan to revamp Medicaid

JEFFERSON CITY, Mo. -- Republican Senate leaders offered a plan Thursday to gradually reshape Missouri's health care program for the poor by focusing more on preventative care and rewarding people who try to stay healthy.

The long-waited legislation reflects Gov. Matt Blunt's plan for "Mo HealthNet" -- a renamed and retooled version of Medicaid, which serves about 825,000 low-income Missourians.

The legislation would start shifting people to a new health-care management format in July 2008, with all enrollees to be covered by the new system by July 2013.

But it would not restore coverage to most of the people who were dropped from the Medicaid rolls since Blunt and the Republican-led Legislature made budget cuts to the program two years ago. Because of that, some Senate Democrats said the new program was little more than a public relations event with a catchy name.

Under the legislation, all recipients would have the option of choosing a "health care advocate" -- likely a doctor, nurse or some other medical professional who help would coordinate their health care.

The basic services covered under Medicaid would remain the same. But recipients could earn credits to be spent on additional health-care costs by "participating in healthy practices" and "making responsible lifestyle choices."

If a person kept doctor's appointments, tried to lose weight, ate healthy food or tried to quit smoking, for example, he would receive credit on electronic debit cards that could be used to buy over-the-counter drugs or receive dental care not covered on the basic plan.

A person who uses the emergency room too often for unnecessary reasons could be asked to make a higher co-payment, said Senate Majority Leader Charlie Shields.

"The goal would be to move a system that is focused almost primarily on paying for disease to a system that pays for outcomes and pays for health," said Shields, R-St. Joseph, the bill's sponsor.

"We have a system right now that, for the most part, somebody has to get sick before somebody can get paid," he said. "This system would hope to pay somebody to keep somebody from getting sick."

Blunt, whose staff worked with Shields to develop the legislation, said the bill moves Missouri toward "a completely new program to guarantee every MO HealthNet participant has access to primary and preventative care."

But Democratic Rep. Joan Bray, of St. Louis, called the legislation "an attempt to gloss over the past while restoring health care to a very small percentage of the people who desperately need it."

Missouri's Medicaid enrollment fell by 178,131 people -- a drop of nearly 18 percent -- from its peak in March 2005 through the end of last year, according to Department of Social Services statistics.

Some Medicaid recipients along the Interstate 70 corridor from Kansas City to St. Louis already are enrolled in a managed care plan. Most residents elsewhere are on a fee-for-service plan, under which medical professionals are paid set amounts by the state for each time they treat a Medicaid recipient. A few thousand people with chronic illnesses are enrolled in a special health care management program.

The legislation would increase the coordination in the existing managed care model and also introduce some health care coordination into the basic plan in which the state makes per-service payments to health care providers.

Health care providers could see their payments reduced if they don't meet savings and quality targets set by the Department of Social Services.

Children and parents not already enrolled in a managed care plan are to be phased into the revamped program beginning July 1, 2008. One year later, the department is to begin enrolling half of the elderly, blind and disabled on Medicaid in the new program -- with full enrollment in the revamped program to be complete by July 1, 2013.

Another prong of the legislation would offer government subsidies to help offset premiums for private health insurance for small business employees. That part is intended to tie into a separate bill introduced in the House that would create a quasi-governmental agency to serve as an insurance clearinghouse for small businesses.

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Health care bill is SB277.

On the Net:

Legislature: http://www.moga.mo.gov