Republicans seek to tighten Medicaid plan for children

The Associated PressJEFFERSON CITY, Mo. -- A House Republican proposal to require more families to pay Medicaid premiums could lead to 20,000 children losing health care coverage, the Department of Social Services has estimated.

The predicted loss of enrollment in the MC+ for Kids program is in addition to 48,000 children and adults who would lose coverage under the traditional Medicaid program for the poor and disabled under the Republican budget plan.

The Medicaid budget was debated Monday by a House appropriations panel, the first step before going to the full House Budget Committee and then the House and Senate.

About 89,000 children are now covered by MC+ For Kids, which is intended for families that earn too much to qualify for traditional Medicaid but cannot afford private insurance. A family of four, for example, qualifies if its income is less than three times the federal poverty level, or $56,500 annually.

Currently, enrolled families earning between 225 percent and 300 percent of the poverty level pay a monthly premium ranging from $59 to $225 per month, plus a $10 copayment.

Republicans, in their proposed budget, would require that families earning 185 percent to 225 percent of the poverty level pay premiums along with the $5 copayment they already pay. Families with annual incomes of 151 percent to 185 percent of the federal poverty line would pay premiums as well but no copayment.

Brian Kinkade, budget director for the Department of Social Services, estimates that 20,000 children would be dropped from the rolls because their families would choose not to pay the premiums.

Some Republicans say that without cutting some people out of Medicaid, total spending on the program would spiral out of control. But many parts of their plan also require changes to state laws, which would need approval from the House, Senate and Democratic Gov. Bob Holden.

Republicans say their total Medicaid revisions, including the proposed rule changes in MC+ for Kids, would yield $218 million in savings in the first year.

Even with those savings, Republicans say they are still planning to increase Medicaid spending by about $335 million, mostly to meet the rising price of ongoing costs.

Lawmakers have tried to end funding for Medicaid services such as dental and optical coverage for adults for the past two years, but the moves have failed either in the courts or the Legislature. Medicaid costs estimated when the current budget was approved last May have turned out significantly higher, and spending in areas including nursing homes, doctors' visits and in-home care have all gone up.

On top of that, more people are drawing Medicaid benefits. In the budget year that starts July 1, the state is expected to add 31,400 Medicaid participants, at a cost of $140 million. In addition, the Medicaid pharmacy plan is expected to cost an extra $127 million next year, assuming 12 percent inflation.

About 950,000 Missourians currently are covered by Medicaid, a $4.5 billion program funded with federal and state money.

------Medicaid spending bill is HB1011.

On the Net:

Missouri Legislature: http://www.moga.state.mo.us