State passes $18.9 billion budget

JEFFERSON CITY, Mo. -- Missouri's multi-billion-dollar Medicaid program would be spared all but the smallest of cuts under a compromise state budget given final approval late Thursday night.

Passage of the nearly $18.9 billion budget came after House and Senate negotiators broke a several-day standoff over funding for the government-run health-care program.

House Republicans generally backed off their demands to pare Medicaid rolls through tighter eligibility standards, yet claimed a symbolic victory in the push for "Medicaid reform" by eliminating health-care coverage for an estimated 324 low-income adults.

988,000 Missourians

The Medicaid program currently covers about 988,000 poor, elderly and disabled Missourians. The original House plan would have squeezed more than 40,000 off the program.

Legislators voted to send Gov. Bob Holden the last of the 12 operating budget bills -- funding government for the fiscal year starting July 1 -- with less than 20 hours remaining before the 6 p.m. Friday deadline set by the state constitution.

But the final vote came only after Republican senators turned back an attempt by Democrats to send the Medicaid bill back for more negotiations because of the remaining cuts.

Earlier this week, legislators gave final approval to the first five budget bills -- assuring funding for debt repayment, education and transportation, among other things.

The Medicaid portion of the budget is expected to total nearly $5 billion in state and federal funds -- the largest single state program.

Medicaid now covers nearly one in five Missourians, and enrollment rose 5.6 percent from March 2003 through March 2004. The Department of Social Services says more than half of the enrollees are children, but most of the costs come from elderly and disabled participants.

Yet House Republicans had primarily targeted low-income adults with their proposed cuts, seeking to lower their current eligibility threshold of 77 percent of the federal poverty level, or $12,066 for a family of three.

That threshold already had been lowered from 100 percent of the poverty level on July 1, 2002.

Ultimately, budget negotiators agreed to inch the threshold down to 75 percent of the poverty level -- a move the Department of Social Services said would save $408,000 in state and federal funds while making 324 current participants ineligible.

"Two percent is basically symbolic," acknowledged House Budget Committee Chairman Carl Bearden, R-St. Charles. "But it's a very important principle, because we're starting down that road" to slowing the growth in the Medicaid program.

Some House and Senate Democrats expressed outrage at the deal, saying majority Republicans were taking health care away from several hundred people solely to save face on giving up on all of their other proposed cuts.

Sens. Pat Dougherty and Wayne Goode, both D-St. Louis, who were negotiators, protested by refusing to sign the committee's report for the bill funding the Department of Social Services.

"We saved almost every Medicaid cut the House proposed," Dougherty said. "But we had no good reason to cut 324 working women and men off -- it didn't need to be done."

Senate Minority Leader Ken Jacob, D-Columbia, also criticized the small Medicaid cut.

It "makes no sense to me when it's not a financial matter. The money is there to pay for those people," Jacob said.

House Minority Leader Rick Johnson, D-High Ridge, declared: "Cutting anybody off health care -- not only is it morally wrong, it's fiscally wrong."

But House Majority Floor Leader Jason Crowell, R-Cape Girardeau, countered by reading the names of 13 Democrats still in the House who voted to reduce the poverty threshold two years ago. None voted for the current budget bill, containing a much smaller reduction.

Also as part of the agreement, the state wouldn't follow a law scheduled to raise the Medicaid eligibility threshold for the elderly and disabled to 100 percent of the poverty level -- $9,310 a year for a single person. Instead, the budget would set that threshold at 95 percent of the poverty level, still up from the current 90 percent.

In another deal Thursday, negotiators compromised on a pay raise plan for the Missouri State Highway Patrol.

Nearly all other state employees are to receive a $1,200 annual pay raise under the budget, but patrol officers would receive raises about three times larger.

The patrol says it is losing officers to city police departments and federal law enforcement agencies because the state pays too little to retain experienced officers. More than 10 percent of the patrol's positions are vacant, said Capt. Kemp Shoun, the patrol's budget director.

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Budget bills are HBs1001-1012

On the Net:

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