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Medicaid could take hit under Senate bill

April 29, 2003
By: Megan McCloskey
State Capital Bureau

JEFFERSON CITY -Medicaid coverage could be more easily cut under a bill passed by the Senate Tuesday.

In a bill sponsored by Sen. Wayne Goode, R-St. Louis County, certain Medicaid services would only be provided if funds are available and appropriated.

The bill is part of the Republican revenue generating package upon which the budget is based, and it is estimated to save the state $40 million. The bill, however, originally came from Gov. Bob Holden's office.

Medicaid is a social welfare program that is jointly funded by state governments and the federal government. The Medicaid program includes federally mandated services, such as physician and hospital care, for those who are eligible.

Goode's bill deals with Medicaid's optional services. Some of these include dental care, rehabilitation services, and prescription drugs.

"Most of us would rather see these services up and working," Goode said. "But it's a tough budget right now."

Sen. Ken Jacob, D-Columbia, questioned the legality of the bill. He said he thinks federal law prohibits states from stopping programs once they are started.

"What happens if we build our budget around this bill and we legally can't do it?" Jacob asked.

The unintended effect, Jacob said, may be further withholding from education in 2004, because the money the state thought it was saving is legally tethered to Medicaid.

The other option is to change the statute, but many senators did not want to go that far.

"If we repeal the programs by statute they may never come back," Goode said.

The original savings estimate for this bill was $65 million, but an amendment reduced that amount by about $25 million. The amendment eliminated any co-payments for Medicaid services and goods.

Originally, the bill only excluded in-home services from requiring a co-payment from the recipient.

Another part of the amendment, which was sponsored by Sen. Charlie Shields, R-St. Joseph, eased the burden on doctors who provide Medicaid services.

The state reimburses doctors for services rendered to Medicaid patients, and Shields' amendment makes sure they receive the full amount.

"More and more doctors are dropping out of Medicaid," Shields said. "This will result in giving needy citizens a card that entitles them to benefits, yet no one accepts the card."

The bill also deals with who is eligible for benefits. Under this bill not only services are affected, but also who the state defines as eligible for the services still intact.

Sen. Harold Caskey, D-Butler, offered an amendment that was approved, which widened the range of those eligible for old age assistance.

Senior citizens whose income exceeded 80 percent of the poverty level would not be eligible for benefits under the original version of the bill.

The 80 percent cap was designated in last years session but was set to change in July, because of the hardships that were reported to many in the General Assembly.

One couple said they had to chose between food and oxygen, said Sen. Bill Foster, R-Poplar Bluff.

The bill as it was first written locked in the eligibility level at 80 percent, but with the amendment the cap on eligibility is changed to 90 percent of the poverty level.