Medicaid spending divides House, Senate

JEFFERSON CITY, Mo. -- Lawmakers negotiating a final version of next year's state budget worked all week to reach compromise on difficult issues but could not find common ground on one of the biggest: Medicaid, the health insurance program for the poor, elderly and disabled.

The negotiators -- five each from the House and Senate -- concurred on such items as a $106 million increase in basic state aid to school districts and a $20 million increase for higher education in the fiscal year that starts July 1.

Everything the conference committee approves still must pass the full House and Senate before advancing to Gov. Bob Holden. Lawmakers are constitutionally required to send Holden a budget by next Friday.

Of all the items in the proposed $18.8 billion budget, Medicaid is both the single biggest expense and the main sticking point.

Slowing the growth of the Medicaid program has been a centerpiece of the House Republican majority. About 985,000 Missourians were enrolled in Medicaid as of Jan. 31, the most recent figure available.

Earlier in the session, the House approved legislation that would force at least 48,000 people off Medicaid. The House measure would lower the eligibility threshold to 50 percent of the poverty level -- or $7,630 for a family of three -- from the current 77 percent, or $12,066 for a family of three.

The Senate, however, has resisted that change, preferring to maintain the existing rules on eligibility.

Senators have also been cool to another section of the House bill that would halt some Medicaid services altogether, such as optical and dental coverage for low-income adults.

As revised and pending in the Senate, the Medicaid legislation simply would require the state to annually review whether recipients are still eligible and to crack down on anyone hiding assets in long-term annuities.

Late Thursday, the negotiators studied a proposed compromise with three key elements: No change in the maximum income for poor adults to qualify for Medicaid; House acceptance of some other Senate changes in the bill; and Senate acceptance of eliminating medical benefits for people on the General Relief program.

General Relief provides medical coverage for people who earn just slightly more than Medicaid eligibility requirements. Last year, lawmakers ended the state's cash payments to General Relief recipients.

Negotiators are scheduled to resume their work Monday.

Over the course of the past week, the committee decided several other items:

Co-payments for some Medicaid services, which Gov. Bob Holden had proposed, won't be instituted. Lawmakers said patients would not make the co-payments, which would lead to lower income for doctors.

The state should pay 80 percent of health insurance costs for state employees' families, rather than the current 73 percent to 78 percent.

State health labs in Springfield and Poplar Bluff would stay open. Holden had proposed closing those labs and have samples tested at the remaining lab in Jefferson City.

The "alternatives to abortion" program would be funded, and may be able to draw down extra federal money. Holden had withheld funding for the program through the first 10 months of the current year until releasing it Friday.

Nursing homes would get a $26 million increase in reimbursements for treating Medicaid patients. A separate bill that would give nursing homes a $167 million increase over three years has passed the House and Senate and awaits Holden's signature.