Hundreds testify on Medicaid

JEFFERSON CITY, Mo. -- State workers alleged abuses in the Medicaid system Monday while hundreds of people lined the Capitol halls for a turn to testify on Gov. Matt Blunt's proposal to trim Missouri's social services programs.

Legislation pending in a Senate committee would toughen the eligibility standards for Medicaid while eliminating some of the services it covers and requiring recipients to pay money toward their care.

The Republican governor and legislative leaders contend they must cut Medicaid to provide more money to public schools and avoid tax increases. But Democrats decry the human effect: About 89,000 of the state's nearly 1 million Medicaid recipients would be dropped, while about 370,000 would see services cut back.

Many of those cuts would be accomplished through legislation sponsored by Sen. Chuck Purgason, R-Caulfield, that received a daylong hearing before the Senate Pensions, Veterans' Affairs and General Laws Committee.

More than 160 people -- including many in wheelchairs and many families with children -- lined up in the halls before the start of the meeting because the roughly 80 seats in the room were already full. As one person left the room, doorkeepers let another one in.

But senators spent most of the day listening to witnesses they had arranged in support of and opposition to the bill. Among them were several Department of Social Services employees who described what they viewed as abuses in the Medicaid program. All stressed they were not testifying as official department representatives.

Melinda Sheppard, a supervisor in the St. Louis office of the Division of Family Services, said she recently reviewed between 400 and 450 cases in the Mc+ for Kids program, which provides health care to families earning up to three times the federal poverty level ($56,550 for a family of four). Of those, 258 families should not have been in the program because they had access to private insurance or earned too much to qualify, she said.

"Waste, fraud and abuse!" committee chairman Jason Crowell, R-Cape Girardeau, proclaimed while praising Sheppard as a "whistle-blower" and a "brave and honest citizen."

Blunt's proposal would not cut spending for children's health care, but it would require annual eligibility reviews of all Medicaid recipients, which could force families off the Mc+ for Kids program.

No consequences

Sheppard said that when the state determines families have wrongly received Medicaid, it sends a letter asking for repayment but has no way of enforcing it.

"We don't hold people responsible for Medicaid abuse," she said. Consequently, many "people do not report it because there is no consequence."

Sen. Pat Dougherty, D-St. Louis, estimated it would cost $6 million to hire hundreds of additional case workers to perform annual eligibility reviews for Missouri's 1 million Medicaid recipients -- something he supports.

But Dougherty accused Republicans of pushing "a morally bankrupt solution" by cutting people off health care while calling it "reform."

Among other things, the bill would eliminate a program that provides Medicaid coverage to more than 14,000 disabled people whose income levels might otherwise disqualify them but who perform at least a slight bit of paid work.

The bill also would end in-home services for some disabled people and place supervision of all those services under the Department of Health and Senior Services. Some in-home services now are provided through a Department of Elementary and Secondary Education program that has grown rapidly in recent years.

As of 1999, the program served 513 people -- with another 800 on a waiting list -- at a cost of $5 million, said Jeanne Loyd, assistant commissioner for the department's Vocational Rehabilitation Division. It now serves about 6,400 people at a cost of $74 million, she said.

Transferring the program from the education to the health department would heighten the state review process for approving services and allow them to be provided by for-profit businesses that already contract through the health department.

Bob Pund, 36, of Columbia, was among those who said he would lose some of the state-funded personal assistance he receives to eat, bathe and perform daily activities. Pund was paralyzed in a car accident and uses a wheelchair -- another item that Medicaid no longer would pay for under Blunt's proposal.

"These [cuts] are not numbers. These are things that are going to totally destroy people's lives," Pund told the committee.

The Medicaid bill is SB539.