Missouri Medicaid to make major changes over the next two years

The Missouri Medicaid program will undergo an extensive overhaul in the next two years in an attempt to restrain growth in the taxpayer-funded health-care program.

Changes in the works include an emphasis on preventive care and a concerted effort to recover money from people who try to hide assets while receiving help from the program, Gary Sherman, director of the Missouri Department of Social Services, said during Friday during a visit to Cape Girardeau.

When state lawmakers passed $900 million in cuts to Medicaid last year, they also set a 2008 date to end the program, Sherman said. That date is a spur to dramatically change the program, which combines state and federal dollars to pay for health care for the poor.

Missouri lawmakers held a series of hearings around the state last year and issued their report last month, Sherman said. Gov. Matt Blunt has formed a working group of top state officials and health providers to plan his proposal, he said.

"It will be personalized and individual and look quite a bit different than it does today," he said.

Sherman made his remarks during a visit to Cross Trails Medical Center, a Cape Girardeau-based health-care provider. Cross Trails is a "federally qualified health center" that receives about 20 percent of its operating budget from a federal program designed to make health care affordable for the uninsured.

The emphasis on recovering money spent on care would mostly hit senior citizens who use Medicaid to pay for nursing home care. More than 70 percent of the annual increase in Medicaid funding goes for such care, Sherman said.

To be eligible for Medicaid to cover their expenses, seniors must either spend their life savings or, as many do, transfer the assets to other family members.

The issue has touched Sherman personally. A Missouri native who had worked in Wyoming for many years, his mother needed nursing home care, he faced a choice of how to provide long-term care for his mother.

"They told me to distribute the funds, which is legal," he said. "But the Medicaid program wasn't intended for that."

The costs of Medicaid, which are shared by state and federal taxpayers, are the largest single item in the Missouri state buget. Even with the changes imposed last year, the cost in the coming budget year will exceed $5 billion.

Cuts last year were a one-time fix that will not cut the rate of growth in spending unless the dramatic changes being contemplated take place, Sherman said.

"There is always that balance between helping people and what you can afford," Sherman said.

The visit to Cape Girardeau was part of a regional tour of the federally qualified clinics. Blunt asked state lawmakers to fund startup costs for four more such clinics across Missouri.

The $8.5 million proposed by Blunt would help clinics in Hannibal, Lynn and Sedalia, Sherman said.

The visit allows him to see what is provided at various clinics and also to visit with providers to understand their concerns, he siad. Sherman has been in his current job about 10 months.

"I haven't been able to get out of Jefferson City much," he said.

Federal grants that support Cross Trails make up about 20 percent of the center's budget, CEO Vicki Smith said. Cross Trails provides comprehensive medical services, dental services and has laboratory and X-ray services on-site at its offices on South Broadview Street.

And to keep costs down for specialty services, there's a small room where a video camera allows doctors at the University of Missouri Hospital and Clinics in Columbia, Mo., to work with patients. One common use, Smith said, is for a dermatologist to diagnose skin conditions and prescribe treatment.

Anyone is welcome at Cross-Trails, Smith said. People with no or limited health insurance who have lower incomes pay a fee scaled to their ability to pay; the clinic also accepts regular health insurance plans and Medicaid.

"When you walk into our clinic, we like to think we give a total approach to health care," Smith said.