STATE MEDICAID WAIVER PLAN STILL ALIVE

JEFFERSON CITY -- An estimated 720,000 men, women and children in Missouri have no medical insurance, and unless the Missouri department of Social Services receives a Medicaid waiver from the federal government, there is little likelihood they will have benefits anytime soon.

Missouri's uninsured residents may be the fastest growing segment of the state's population, increasing at a rapid rate because of higher costs, corporate down-sizing and the growing number of employers that have terminated their group medical programs.

According to recent statistics provided by the U.S. Census Bureau and the U.S. Treasury Department, the number of uninsured in the state increased by 124,360 persons in the past 18 months.

Missouri's Medicaid waiver request to the U.S. Department of Health and Human Services, submitted earlier this year, was returned late in October with demands for answers to more than 200 questions posed by the federal agency's Health Care Financing Administration.

For the past 45 days, staff members in the Division of Medical Services have worked feverishly to answer the questions raised by U.S. officials.

Several deadlines have come and gone as staff members have worked extra hours and on weekends to respond to the numerous questions raised about the waiver proposal that seeks to extend Medicaid coverage to 46 percent of the state's uninsured citizens.

There is some confusion over the status of the Missouri waiver request, with some persons believing it already was rejected by Washington.

A somewhat similar waiver program submitted by Illinois was rejected by HHS, but Missouri's plan is still very much alive.

In addition to supplying more facts requested by Washington, state social services officials, including Director Gary Stangler, have been conferring with federal counterparts in Washington on the details of the program.

Basically, the Missouri waiver program calls for an extension of Medicaid services to 330,000 of the state's poorest citizens who fail to quality for coverage.

All are currently dependent on charitable services provided by both public and private medical and hospital providers.

The state plan, which would be fully implemented over five years, calls for the redirection of funding to primary care from state money already spent on the uninsured. The plan also calls for cost-sharing by patients able to pay all or part of their premiums.

The principal component of the Missouri plan is the state's ability to reduce administrative and delivery costs and use existing money for primary care for the uninsured.

Stangler says competitive bidding, managed care and strict quality standards should create financial incentives for providers to replace fragmented delivery with primary-care networks.

The waiver will offer a comprehensive, standard benefit package to all families and individuals in Missouri who lack access to private health insurance. Participants would pay according to their financial status.

Residents with income above 200 percent of the federal poverty level could join by paying the full cost of the waiver premiums.

Those with income between 100 and 200 percent of the poverty level would be able to buy into coverage on a sliding scale that corresponds to their income.

A family of four with a total monthly income of $1,300 would pay about $33 in monthly premiums, while those with incomes below 100 percent of the poverty level would receive full coverage without paying any premium.

Marilynn Knipp, associate director of the agency, confirmed the state's intention to submit its waiver program answers to Washington sometime next month.

HHS asked 27 questions about the Missouri waiver. The entire list of questions deals with sections on administration, behavioral health, benefits, data issues, disabled population, eligibility, outreach, costs, payments and quality assurance. Some questions raised included as many as five different queries on a subject.

If approved, some portions of the state program could go into effect next July 1.