By DAVID A. LIEB
(JEFFERSON CITY, Mo., AP) — Private insurers would gain a greater role in Missouri’s Medicaid program and patients could get rewarded financially for holding down their medical costs under a plan introduced Thursday by a key Republican senator.
The legislation by Sen. Gary Romine follows many of the recommendation of a special Medicaid study panel he led, which sought to revamp the health care program for the poor without expanding eligibility.
The bill would require Missouri’s Medicaid program, called MO HealthNet, to adopt managed care policies for parents and children statewide instead of relying on a fee-for-service model currently used in many rural parts of the state. The new policies would begin in 2015.
Insurers winning the right to offer managed-care Medicaid policies would have to include incentives for patients to lead healthier lifestyles and for medical providers to hold down their costs.
Patients could choose from among several insurance policies, including a high-deductible plan in which the state would set up a personal savings account — financed with at least $1,000 — to pay any medical costs under the deductible. Patients then could keep a portion of any money not needed for their medical expenses.
Seniors and disabled wouldn’t be included in the managed care policies but would instead be covered through regional “accountable care organizations,” which would consist of a group of health care providers responsible for the patients’ care.
Among other things, the legislation also would increase the amount of assets people could have while still qualifying for Medicaid.
Romine, a Republican from Farmington, described his legislation as a “reform and update” of the current program.
“It’s bringing the Medicaid program into the 21st century,” he said.
But some health-care advocates remained unimpressed, because the bill doesn’t expand coverage for lower-income adults as allowed under President Barack Obama’s health care law.
States that extend coverage to adults earning up to 138 percent of the poverty level — an annual income of about $32,500 for a family of four — initially can receive full federal funding for those enrollees, with the state’s share of the costs rising gradually rising to 10 percent. The state currently cuts off eligibility at less than $4,500 annually for a family of four. Missouri generally covers less than 40 percent of the health care costs, with the federal government paying the rest.
About half the states have embraced the Medicaid expansion.
Missouri’s Republican-led Legislature has repeatedly rejected expansion proposals made by Gov. Jay Nixon and his fellow Democrats.
But as long as Republicans omit an eligibility expansion, any Medicaid legislation will fall short of a success in the judgment of some Democratic lawmakers and health care organizations.
“The most import Medicaid reform for this state is expanding coverage for the people who need it,” said Jen Bersdale, executive director of the advocacy group Missouri Health Care for All.