Missouri doctors get more, Medicaid patients don't

JEFFERSON CITY, Mo. -- Doctors, dentists and other health-care providers will be getting more money from Missouri's Medicaid program. But the adult patients they treat won't be getting greater benefits.

House and Senate budget negotiators agreed Wednesday to increase the Medicaid payment rates for doctors' visits and other medical services. The higher payments will cost at least $62 million in state tax dollars, plus a greater amount of federal money.

But lawmakers chose not to restore adult dental and eye coverage that had been cut from Medicaid in 2005. Budget negotiators also rejected a Democratic House amendment that would have funded therapeutical services for Medicaid patients.

The restoration of adult dental and expanded optical coverage had been recommended by Republican Gov. Matt Blunt, who endorsed their elimination three years ago. It would have cost $24.6 million in state and federal money to restore the services.

Occupational, physical and speech therapies for adult Medicaid recipients would have cost an additional $6.1 million in state and federal funds.

Senate Appropriations Committee chairman Gary Nodler said that while the state could perhaps afford to expand programs now -- thanks to money set aside from previous years -- it probably couldn't afford to sustain those expanded programs in future years.

That caution wasn't just limited to health-care benefits for the poor. Nodler made similar assertions throughout the budget negotiations, often using an agricultural analogy.

"When you put too many cows on the land, they're going to starve if the forage is not sufficient to sustain them," said Nodler, R-Joplin. "We can't feed all these cows."

Nodler expressed concern that the state's tax revenues have been trailing off. As of last week, annualized revenues were 5.4 percent higher than the previous year. But by Tuesday, that growth rate had dropped to 3.2 percent and by Wednesday it had fallen to 2.4 percent, Nodler said.

Blunt's budget director said officials were trying to determine whether there was simply a blip in tax payments or a real downward trend.

The budget crafted by House and Senate negotiators includes a 3 percent pay raise for state employees. Mental health and foster care providers would receive a similar 3 percent increase in their state payments.

But some medical professionals would get more.

Medicaid spending for physician payments would rise by more than 7 percent and payments to dentists and nursing homes would go up by 5 percent.

Missouri's Medicaid program for the poor currently pays doctors at least 55 percent of what they would receive for providing the same services under the federal Medicare program for the elderly. During the budget year that starts July 1, physicians would be paid at least 62.5 percent of the Medicare rate, said Jennifer Tidball, the budget director for the Department of Social Services.

Dentists, whose Medicaid payments currently amount to about 33 percent of the usual private insurance rate, would get a state increase to about 38 percent of the private rates under the negotiated budget, Tidball said.

The funding increase for nursing homes would bring their average payment to $126 a day per patient instead of the current rate of $120 a day, she said.

The budget still needs to receive final House and Senate approval before the May 9 deadline for passing it.

Also Wednesday, the House voted 146-1 to reject an amendment increasing state income taxes on those earning more than $50,000 per year. Republicans said the measure would have raised about $300 million and could be used to restore the 2005 Medicaid cuts. The measure was offered by Rep. Steve Hunter, R-Joplin, to force Democrats to vote for a tax increase or against extra money for Medicaid.

Republicans shouted angrily, accusing House Democrats of being excessively critical of Blunt and GOP lawmakers for enacting the cuts. Republicans said the Democrats complain about not putting enough spending in the budget but don't offer suggestions for where to find the money.

Rep. Jeanette Mott Oxford, who has filed legislation to raise taxes for those with higher incomes while dropping it for those who make less, said she was offended by the debate.

"The Medicaid cuts have created pain and misery and real death throughout our state," said Oxford, D-St. Louis, who briefly started crying while recounting the death of a friend who lost Medicaid coverage and couldn't afford health care. "And rather than having a strong discussion about restoring health care for our friends and neighbors, we are playing a trick."