MEDICAID SPEND-DOWN CHANGE NEEDED

ORAN, Mo. -- After suffering with clinical depression since 1966 and learning that faith in God, medical compliance and support yielded my husband and me and our families a healthy quality of life, God led me to become a mental health volunteer and advocate.

I am the founder in 1986 and still active member of the Depressive and Manic-Depressive Association of Southeast Missouri, an educational, support and advocacy organization. I was a consumer advocate for three years each with the regional and state advisory councils of the Missouri Department of Mental Health, where consumers' experiences and opinions are heard. I also have been an infrequent patient of psychiatric units. Thus, I have had every opportunity to experience, observe and realize the suffering, trials and problems of the mentally disabled.

A recent disappointment and grave concern materialized for caring and hard-working advocates when a bill, the result or real bipartisan effort by our legislators which would have eliminated the Medicaid spend-down at 85 percent of the poverty level, was pulled amid discussion close to the end of the legislative session in May. This canceled the opportunity for a final vote in the General Assembly.

Under the spend-down requirement for Medicaid eligibility, people who meet the Supplemental Security Income criteria for Medicaid but have income over the SSI level lose Medicaid every quarter until they spend down the difference. This affects people who are over 65 years old, the legally disabled and the blind. How many of us are one accident away from permanent disability?

The current SSI level for an individual is $530 a month, but the poverty level is $696. People affected by the spend-down requirement are officially living in total poverty, and the spend down keeps them there.

I have learned that it is not only people with physical disabilities whose lives are compromised by the spend-down requirement. I have felt and have observed the human tragedies that occur when psychiatric patients, making mere dollars over the SSI limit due to previous work history or for circumstances beyond their control, are forced off medications during their spend down. They wind up in the hospital after a suicide attempt. They desperately and definitely need and should be guaranteed the opportunity for medical compliance.

In the legislature, cost is cited for the delay on legislation to change the eligibility requirements. However, the hidden costs for families, the criminal-justice system and hospitalizations for which we all wind up paying aren't reflected. The significant costs for social and caseworkers to collect clients' receipts and process complicated paperwork every three months have likewise been ignored. Freeing clients with incomes up to $696 a month from the process of spending down also frees the staff workers who serve them to concentrate more on therapies to improve their clients' quality of life. The overall net affect would certainly be a huge saving for Missouri.

There is still hope. Gov. Bob Holden included the following in his end-of-the-session statement: "I will call the legislature into special session concurrently with the veto session to get our seniors the prescription-drug cost relief and Medicaid spend down they did not receive this session."

Between now and the September special session, the governor and legislators of both parties will be working hard for a policy that is not only more efficient, but more humane. They need to hear from us.

Credit should be extended to state Sen. Peter Kinder, president pro tem of the Senate, and state Rep. Jim Kreider, speaker of the House, for movement of their respective spend-down bills through the legislative process in time for consideration during the regular session.

Janet Knoderer resides in Oran, Mo.