Senate keeps Medicaid bill alive

JEFFERSON CITY, Mo. -- With the House on the sidelines Thursday, the state Senate spent hours debating an expansion of the state's Medicaid program before finally agreeing to it.

Under a provision adopted 25-9 by the Senate, about 10,000 more poor, blind and disabled Missourians would become eligible for Medicaid's health-care and prescription drug benefits.

The Medicaid expansion was added to a highly touted bill that abolishes a prescription drug income tax credit and replaces it with a new insurance-like medicine benefit for lower-income seniors.

There are two versions of the legislation winding through the Legislature. Ultimately, senators and representatives are expected to meet in a conference committee to work out the differences.

A version passed Wednesday night by the House includes the Medicaid expansion. A separate version as amended Thursday by Sen. Sarah Steelman, R-Rolla, would phase in the Medicaid expansion over three years.

Either way, the income eligibility limits for Medicaid would rise to $716 monthly from the current $530.

Under Steelman's gradual approach, the estimated cost of the increase would be $3 million the first year, $4.2 million the second year and $5.1 million in the third year.

The Senate debated the change for four hours, with many lawmakers insisting that a Senate bill without any Medicaid expansion would provide better leverage for negotiations with the House.

At the beginning of the day, expanded eligibility was in the prescription drug bill, then was taken out, then voted back into the bill with Steelman's amendment.

Although the expanded Medicaid program would apply to people of all ages, the proposal for a new prescription drug benefit targets only those age 65 and older who have neither Medicaid nor private prescription coverage.

Under both versions, the state would pick up 60 percent of the prescription costs for seniors earning up to $17,000 annually and couples up to $23,000.

Individuals earning $12,000 or less and couples making $17,000 or less would pay a $25 enrollment fee and a $250 deductible. Those earning more would pay a $35 enrollment fee and a $500 deductible.

Benefits would be capped at $5,000 annually per participant.

But a new commission also could adjust fees and deductibles, or limit coverage to only the neediest, in order to stay within the amount appropriated for the program.

Legislative researchers have projected the prescription drug program to cost about $100 million during the fiscal year that begins July 1. Some lawmakers have disagreed, pointing to private consultants who have put the costs at half that much.

The cost is an issue because it is one of the reasons lawmakers want to repeal the prescription drug income tax credit.

The credit -- offering up to $200 annually to seniors -- cost $85 million last fiscal year. Some lawmakers have said it provides too little to seniors at too great of a cost to the state.

Senators adopted an amendment Thursday that would nullify the new program if the courts were to strike down the repeal of the tax credit as an unconstitutional tax increase.