State to get new health care program
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State to get new health care program

Date: December 6, 2006
By: Kathryn Buschman
State Capitol Bureau

JEFFERSON CITY - Unarguably, the biggest issue to face Missouri lawmakers when they begin their 2007 legislative session January 3 will be to restructure of  the state's largest welfare program -- Medicaid.

Last year, Missouri's General Assembly passed a June 30, 2008 sunset on Medicaid in an effort sponsors said was designed to force the state to look at restructuring the entire program.

Despite the magnitude of the program that consumes more than $5 billion per year, the state administration's efforts at putting together a new program have been kept under wraps and unannounced.

Various members of the governor's cabinet, executive department heads, and other experts have been working together to recommend the new health care program, according to a spokesperson for the governor. But neither the members of the group nor their meeting schedules have been announced.

"There's not a group, and it hasn't been the same group that has met all the time, " said the governor's spokesperson, Jessica Robinson. "The nature of it is that it is an on-going discussion, they've pulled in different division directors and subject matter experts depending on what they were talking about."

The executive directors, deputy  directors and legal council of and the departments of  Mental Health, Senior Services and Social Services have consistently been involved in the meetings.

The proposal is scheduled to be finalized by the end of December -- just days before lawmakers begin their session. The governor will review the proposal, and then propose it to the General Assembly.  

"The intent is to create a better program that works better for the participants," Robinson said.  "One that is simpler; that allows and empowers them to live a healthy lifestyle."

In addition to the governor's group, a formal "Medicaid Reform Commission" drafted a plan last year for changing Medicaid. 

The commission was created by the legislature in the same year it adopted the Medicaid termination date.  The commission's plan stressed preventive care efforts and modernizing medical information systems.  The commission was created as part of the 2005 legislation that included the Medicaid termination date and cut more than 94,000 Missourians off the program.

The commission submitted their recommendations before the start of the 2006 legislative session, but its ideas went no where in the legislature.  Legislative leaders decided to postpone action on of the recommendations until the 2007 session.

The one recommendation that was brought before the legislature died in a House-Senate stand-off.  It would have established a grant program to help health-care providers to modernize their information systems.

"I think the report serves as the basis for much of the recommendations for the administration," said the Commission's chair, Sen. Charlie Shields, R-St. Joseph.

Since the commission presented it's plans, the top leaders for health and welfare programs in Missouri have left the administration.  Resigned or departed are the directors of the Social Services Department, Health and Senior Services Department and the Mental Health Department -- along with the director of the Medical Services Division that administers the Medicaid program. 

Robinson said the new health care system will be something the General Assembly is likely to consider this session. "It wouldn't be surprising if it is going to be part of his state of the state. We know that it is an important objective that is going to be happening the next 18 months."  

Missouri was facing a 1.1 billion budget shortfall with a Medicaid system that was growing way out of control, said Ana Compain-Romero, spokesperson for the Department of Social Services. 

"If the system continued to grow in that manner it would have single-handily crippled the state's economy. The choice was either to increase taxes, and Missourians have consistently voted against that, or to make changes to the system."

While the Blunt administration has been tight-lipped about their plans, last year's commission adopted a lengthy, detailed report after hours of public meetings.  The group recommended that the new program place more of an emphasis on prevention. 

"We have a health care system focused on paying for disease, and not paying for wellness, Shields said.   "We will pay to keep a diabetic in the hospital but we won't pay for a nutritionist to work with a diabetic patient to keep them out of the hospital. The biggest change in the new system will be more of a focus on wellness prevention."

The governor's working group has discussed several ideas but nothing has been proposed, Robinson said. Some of the ideas that have been discussed include: making the application process on line, rewards for healthy choices, and a rating system to chose a provider.

Shields, the Senate's majority leader and the leader on health care issues in the Senate, said his conversations with the administration's task force on the issue have been minimal with the last conversation being in August.  "In terms of direct conversations  there haven't been many with putting the new system together, but that is primarily due to the fact that the plan has its basis in our report, but it won't look exactly like the recommendations we put forth." 

House Democratic Floor Leader Jeff Harris said the most important aspect of a new health care program is not the specifics, but who is going to be covered. "To what extent if any are the 100,000 Missourians whose health care was cut, to what extent is their coverage going to be restored?" Harris asked. "That's how you evaluate how good or not good a plan is, frankly to talk to much about specifics is like polishing the knobs on the Titanic."

Harris said Democrats will evaluate the new plan by who it covers.

Currently 828,802 Missourians receive Medicaid and 486,488 are children. More than $5 billion is spent on Medicaid in Missouri every year. "Forty cents for every dollar spent on Medicaid is state general revenue, said Compain-Romero. "So the feds provide the balance for that."