New Medicaid plan attracts suggestions and concerns

JEFFERSON CITY, Mo. -- Concerns and suggestions were plentiful Tuesday as a Republican plan to revamp government health care for the poor made its debut in a Senate committee.

The plan backed by Gov. Matt Blunt and legislative leaders would rename Medicaid "Mo HealthNet," while placing a greater emphasis on managed care, rewarding people for healthy habits and paying some medical providers based on their performance.

People stood in line -- some for more than an hour -- to testify about the legislation before the Senate Health and Mental Health Committee.

Some low-income and disabled people expressed concerns about the healthy living incentives that would provide extra health benefits only to people who met certain criteria.

Health-care experts urged either that the state move more quickly or more cautiously in adopting a managed care structure for the elderly, blind and disabled.

And while some praised the greater coordination that would come by assigning everyone a health-care adviser, others worried a greater emphasis on personal responsibility simply wouldn't work for some people.

Senate Majority Leader Charlie Shields, R-St. Joseph, the lead sponsor of the bill, said the hearing provided good suggestions, some of which could be incorporated into a revised bill the committee could consider within the next several weeks.

The state and federally funded Medicaid program covers about 825,000 low-income Missourians, down about 175,000 from its high point two years ago when Blunt and Republican lawmakers eliminated and reduced benefits for some recipients.

Under Shields' bill, all recipients would have the option of choosing a "health care advocate," likely a doctor, nurse or some other medical professional, who help would coordinate their health care.

The basic services covered under Medicaid would remain the same. But recipients could earn credits to be spent on additional health-care costs by "participating in healthy practices" and "making responsible lifestyle choices."

People who kept doctor's appointments, tried to lose weight, ate healthy food or tried to quit smoking, for example, would receive credit on electronic debit cards that could be used to buy over-the-counter drugs or join a health club.

Among those opposed to that concept was Shelley Shetley of Kansas City, who uses a motorized wheelchair and a service dog and is a member of the Missouri Planning Council for Development Disabilities.

"People should not have to earn health care," Shetley said. That "seems contradictory to the spirit of preventative health care," which the legislation emphasizes.

Others also voiced the need for the incentives to be tailored to the individual, particularly those with disabilities.

Jackson County Public Administrator Rebbecca Lake Wood, whose office assists about 1,000 indigent and often disabled people, told lawmakers of two mentally disabled women in their 30s who weigh more than 400 pounds and have no ability to understand their medical needs.

"They cannot be educated to engage in better health care habits, and neither can the other hundreds and hundreds of Missouri citizens who are just like them," she said. "These people are not properly addressed under your plan."

Most Medicaid recipients likely would fall under one of two options in the legislation -- a managed care model and a plan in which the state makes per-service payments to health care providers.

Children and parents not already enrolled in a managed care plan are to be phased into the revamped program beginning July 1, 2008. One year later, the department is to begin enrolling half of the elderly, blind and disabled on Medicaid in the new program -- full enrollment in the revamped program is to be complete July 1, 2013.

Donna Checkett, a former Missouri Medicaid director who now is a vice president at the health care management firm Schaller Anderson Inc., urged lawmakers to consider accelerating the phase-in of managed care for the disabled.

"We will have improved access to care, we will have improved case management," she said.

But Van Ellet, from the AARP in Washington, D.C., urged just the opposite -- that Missouri move cautiously in using managed care for the disabled and elderly.

"We are most interested in making sure that the needs and best wishes of the consumers are being met," Ellet said.

Shields said that was also his goal.

Among those supporting the bill was Joseph Pierle, executive director of the Missouri Primary Care Association. He particularly praised the aspect of matching health care coordinators to recipients.

This bill "will flip Medicaid on its head -- transitioning Medicaid from a system that just merely pays claims to a system that can be used to improve the health of individuals," he said.