Last year's Medicaid cutbacks reviewed

JEFFERSON CITY, Mo. -- Some legislators denounced waste, fraud and abuse last year as they repealed a Medicaid health-care program for the working disabled.

Now it appears lawmakers are poised to re-enact a trimmed-down version of that program in 2006 -- an acknowledgment, essentially, that last year's cuts went too far.

When lawmakers convene Wednesday, a new Medicaid plan for the working disabled will rank among the priorities in the House. And it will carry the endorsement of a joint House and Senate committee created to recommend reforms to the Medicaid program.

"There could be a lot of people saying we're backtracking or 'See, you were wrong,"' said House Speaker Rod Jetton, R-Marble Hill. But "you don't always know the consequences of any bill you pass until it actually goes into place. As we hear the feedback and as your budget situation improves, you look to see what you can do" -- or in this case, restore.

Jetton is backing a bill by Rep. Chuck Portwood, R-Ballwin, that would start a new version of the repealed program called Medical Assistance for Workers with Disabilities, or MAWD. Portwood says more than 40 legislators already have signed on as sponsors, and he predicts the bill could pass the House within the first 30 days of the session.

The momentum for the reversal appears to come partly from the 7,250 mentally disabled Missourians employed in 93 sheltered workshops around the state. They are paid below minimum wage to perform basic tasks such as shredding documents or packaging products for other companies. And many depend on Medicaid for their health care.

A 2004 sampling by the Department of Social Services estimated that nearly 10 percent of the roughly 17,000 people on the MAWD program were employed in sheltered workshops. The MAWD program allowed the disabled with incomes more than 2.5 times the normal cutoff to nonetheless enroll in Medicaid, so long as they worked at least a minimal amount each month.

Legislators heard testimony about some people who worked only one hour a month and still qualified for the program. But the employees at sheltered workshops often work about 30 hours a week.

When legislators eliminated the MAWD program, they also lowered the income eligibility threshold to qualify for traditional Medicaid, and they did away with Medicaid coverage for dental exams and eyeglasses for most adults.

The result was a triple hit on sheltered workshop employees such as Susan Buckley, 49, of Blue Springs. She works 9 a.m. to 3:30 p.m., Monday through Friday, at IBS Industries in her hometown. And she depends on Medicaid for medicines for her heart, thyroid, depression, glaucoma and diabetes.

Before last year's cuts, Buckley's Medicaid coverage was free. Now she must spend $211 a month on health care expenses -- more than half of what she earns at work -- before Medicaid will kick in. Even then, Medicaid won't cover her much-desired dental visit.

"I barely have enough food. It's a struggle to find money to put gas in may car," she said. "I don't have any money for clothes or extras or entertainment -- that's out of the question. What really hurts is the dental part."

Michael and Theresa Hill, of Jackson, are in a similar predicament. Both spouses work at the VIP Industries sheltered workshop, and their pretax income is about $1,580 a month -- two-thirds of that from Social Security, one-third from their wages. Both received free Medicaid coverage through the MAWD program, which paid for an in-home care provider and their van rides to work.

But after the cuts took effect Sept. 1, the Hills now must spend $482 monthly on health care expenses before their Medicaid coverage kicks in. That equals about one-third of their after-tax income.

So the Hills, based on the advice of their employer, have dropped their cable television, reduced their phone service and grocery bills and cut back on their visits to his parents in Arizona.

"We can't go on vacations; we can't do nothing," said Theresa Hill.

Ginger Williams, manager of the MCII Inc. sheltered workshop in Farmington, wrote in an October letter to fellow workshop administrators that she believes the attempted suicide of one of her employees was a "direct reflection" of the Medicaid cuts.

At the request of Gov. Matt Blunt's office, the Department of Elementary and Secondary Education sent an e-mail to sheltered workshops in December to survey the effects of the Medicaid cuts.

Thirty-six workshops responded, accounting for 3,185 employees. Of those, 18 employees had quit working because of the Medicaid cuts and 13 were working fewer hours so they could qualify for traditional Medicaid at lower income levels, said Larry Young, the sheltered workshop director for the education department.

"It really hadn't affected the workshops as a whole as drastically as we had first anticipated," Young said.

But Jetton cites the effect on sheltered workshop employees as one of the main reasons to restore Medicaid coverage for the working disabled.

They "are making sometimes 60 cents or $1 an hour for small jobs," Jetton said, "but they live for that job, they wake up in the morning with a purpose in life."

Blunt said he is willing to work with legislators who want to restore health care programs, but he insists the new versions must be affordable in the long run.

When created in 2001, the MAWD program was projected to cover 441 people at a cost of $7 million in state and federal funds. In the 2005 fiscal year, it covered 16,987 people at a cost of about $250 million, according to the Department of Social Services.

Portwood said the slimmed-down program in his legislation should cost less than $10 million. It would set a lower income cutoff to qualify and charge all participants premiums and application fees.

Blunt said lawmakers should carefully consider the costs before undoing last year's cuts.

"We don't want to dig ourselves into the situation we're coming out of," Blunt said.

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On the Net

* Sheltered Workshops: www.moworkshops.org