Medicaid funding likely to avoid ax

In recent weeks, Rep. Jo Ann Emerson, R-Cape Girardeau, has helped lead a charge against a move by President Bush that sought to change the way states fund Medicaid.

The proposal by Bush directed the federal Centers for Medicare and Medicaid services to restrict states' ability to tax health-care providers in its 2007 budget.

The change would mean a loss of $1.3 billion for Missouri's Medicaid program over five years, according to the Missouri Hospital Association. Missouri relies heavily on the tax, which is used by 32 other states.

After a House vote Friday, the changes will likely be significantly smaller than proposed and will be protected from further reductions. The Senate has not taken action on the bill.

Emerson said she was troubled by the proposal.

"The provider tax is literally a safety net for the Medicaid program. It has the potential to make up fully half of the funding for our state's program through taxes paid by providers and federal match," she said in a written statement.

For Missouri, "it would be very difficult to fill that hole. We were very concerned that a lot of people would be cut off Medicaid rolls, and hospitals, nursing homes, pharmacies would have to cut staff," she said in an interview.

Missouri health-care providers were particularly hostile to the idea.

"This would have a devastating impact to what is a system already in crisis," said Jon Dolan, executive director of the Missouri Health Care Association.

Dolan said representatives of his organization made multiple trips to Washington, D.C., and met with the state's representatives to voice displeasure with the proposal.

There are 35,684 residents of certified nursing homes in Missouri, according to a 2005 Kaiser Family Foundation study. Of those, 64 percent pay through Medicaid.

Dolan said caring for a long-term Medicaid patient in Missouri costs $130 per day, yet the state is only funded for $108 of that.

To recoup some of the difference, nursing homes pay a provider tax of $8.42 per Medicaid patient per day. That is matched by the federal government at a rate of 62 percent. The state then spends the tax and the match on Medicaid.

Compromise figure

The provider tax is currently allowed at a rate of 6 percent of total Medicaid costs for Missouri's nursing homes, hospitals etc. The Bush proposal sought to shrink the cap to 3 percent.

The compromise caps the tax at 5.5 percent. It also prevents the president from changing it in the future by codifying the percentage for the first time.

"We just want to be positive this holiday season and do our best to give quality care to those who need it," Dolan said, adding that "a cut like this could change staffing levels. It could change food and meal quality or even the amount of therapy" given to a nursing home patient.

Gov. Matt Blunt was also involved in fighting the proposal. He sent letters to Senate and Health and Human Services leaders and worked with fellow governors and elected officials to voice opposition to Bush.

Blunt is expected to unveil a plan to reform Missouri Medicaid early next year, a prospect that would be more difficult if funding is cut.

"If you were playing a football game and rules changed halfway through, then no one ends up winning because you don't know the rules," said Blunt spokeswoman Jessica Robinson.

"This would have had a significant and really crippling impact to programs across the board," Robinson said.

Emerson said she was not surprised by the Bush administration's move, which came in a transition period when a new congressional class is coming to Capitol Hill.

"It doesn't matter which administration, whether it was under Clinton or this one. We always have these kinds of issues," Emerson said.

tgreaney@semissourian.com

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