Keeping Medicaid alive

Without good guidelines, even Missouri's neediest residents could lose their state-funded health benefits.

Taking away the health-care benefits provided by Medicaid is bound to bring protests from those who think government has a responsibility to care for the poor, elderly and disabled. And that's what Medicaid does. The Missouri program provides medical, dental and eye care for nearly 1 million of the state's residents.

More than 4,000 Missourians a month are being added to the Medicaid rolls, due in part to the huge increases in private and company-sponsored health plans whose premiums have skyrocketed in recent years, forcing many Missourians to drop the insurance programs they were paying for. Many of the recipients of state-funded health care are among the state's neediest residents.

But like any welfare program that is allowed to add benefits and recipients without good guidelines, the Missouri Medicaid program is headed for collapse. This would mean even the state's most deserving beneficiaries of the program might find their health -- or even their lives -- in jeopardy because of the bureaucratic morass that would be left behind.

The Missouri House has addressed some of the Medicaid program's most pressing problems in a bill that is being widely described as "cutting" benefits or participants. What the bill -- passed recently by a partisan vote -- does is establish qualifying guidelines intended to make sure only those who really need state aid the most will get it.

The bill eliminates some medical care covered by Missouri's program that isn't required by the federal government, which supplies a major portion of the $4.2 billion state system. Since 1968, Medicaid's cost in Missouri has grown from 4 percent of the state budget to 23 percent.

To control the expansion of the program, the House bill sets limits on assets Medicaid recipients can possess, authorizes small co-payments -- as little as 50 cents -- for doctor visits and establishes small monthly premiums for some participants.

Some of these changes, including the co-payments and the asset limits, were recommended by Gov. Bob Holden.

With these changes, the state can save millions of dollars -- savings that will strengthen the program for Missourians who truly need assistance and cannot afford health care on their own.

Without making some adjustment in the Medicaid program, the state's ability to care for its most needy residents will be in serious jeopardy.