Medicaid.1a

JEFFERSON CITY, Mo. -- Gov. Matt Blunt spoke of reforming Missouri's Medicaid system with "program and eligibility changes." Republican lawmakers stood and applauded during the new governor's first State of the State speech.

Left unspoken -- and perhaps unrealized by many listeners -- was what exactly Blunt meant.

Details that emerged Thursday revealed that 89,000 of the state's nearly 1 million Medicaid recipients would be dropped from the rolls, while about 370,000 would see services cut back.

The reforms proposed by Blunt would eliminate eye glasses, hearing aids and wheel chairs from many Medicaid recipients. They would require a single mother of three to live on about $4,700 annually -- less than $13 a day -- to qualify for health care. And they would eliminate the ability for many disabled people to get part-time jobs without losing their health care.

"This is going to lead to real tragedies in people's lives," said Karl Wilson, of St. Charles, a board member of the Missouri Association for Social Welfare.

Blunt stood by the proposed cuts Thursday, reaffirming his belief they are necessary to "reform the Medicaid program so that it is sustainable and affordable for Missouri taxpayers." Democrats in the legislature promised to fight the cuts, as they successfully did last year when proposed by GOP lawmakers.

But already, Medicaid recipients are worrying about whether they will be affected.

"It's really hard for me to pay my bills right now -- without Medicaid there is no way I'd be able to," said Linda Hartman, 52, of Maplewood, who is still recovering from severe burns that occurred about a decade ago.

Hartman does not work, so she likely would keep her basic Medicaid coverage under Blunt's proposal to lower income eligibility thresholds. But Hartman would lose her dental coverage, as would everyone who is not either pregnant, a child or blind.

Blunt argued during his Wednesday night speech that Medicaid, a federal-state program than provides health care for the poor, elderly and disabled, is taking up more of Missouri's budget every year. According to a report from the National Association of State Budget Officers, it consumed 30.7 percent of the state's total expenditures in the 2004 fiscal year-- more than every state except Tennessee.

"Clearly thousands of people on Medicaid today will no longer be on this form of social welfare," Blunt told reporters Thursday.

Part of the difficulty in determining how Blunt's proposals would affect people stems from the fact that he provided few details. He mentioned none of the specific cuts in his 44-minute speech, when he talked in terms of dollars saved -- $626 million -- and didn't mention the number of people affected.

His half-inch "budget book" also did not contain specifics about the Medicaid cuts.

The Department of Social Services, which oversees Medicaid, estimated that 89,046 people would lose coverage within a year and an additional 23,257 would face greater costs to qualify. An additional 370,000 would see a reduction in services through the elimination such things as dental, vision, podiatry and medical equipment coverage.

Most of the people losing coverage would be parents, whose income eligibility threshold would be lowered to 30 percent of the federal poverty level, compared to the current 75 percent. A family of three, for example, could earn no more than $4,701 annually -- instead of the current $11,752 -- for the parent to qualify for health care. The children still would be covered.

The proposals would make Missouri's parental income threshold the 12th lowest nationally, according to the California-based Kaiser Family Foundation, a nonprofit that focuses on health-care issues.

His plan also would cut in half the two-year transition period during which adults can continue receiving Medicaid after their incomes rise.

The proposed Medicaid cuts would also affect the disabled and elderly by reversing a three-year expansion of eligibility standards. As of this year, the disabled and elderly can earn up to federal poverty level -- $9,310 annually for a single person -- while qualifying for Medicaid. Blunt's plan would return that to the 2001 cutoff of around 75 percent of the poverty level.

His plan also would end Medicaid coverage for a few thousand medically unemployable adults. And it would cancel a program that allows disabled people between ages 16 and 64 to earn up to twice the poverty level -- $18,620 for a single person -- and still qualify for Medicaid.

"If our goal is to get economically self-sufficient, they're just adding one more disincentive to going back to work. It hurts people, and it hurts the economy of our state," said Kirsten Dunham, of Paraquad Inc., a St. Louis not-for-profit that provides independent living services.