JEFFERSON CITY - Less than a week before the federal marketplace for health insurance launches into action, a bipartisan group of Mo. lawmakers met to discuss plans for the state's Medicaid program. Democratic Governor Jay Nixon pushed for Medicaid expansion in the previous legislation session, but lost the battle against Republican-controlled legislature.

Although Republicans voiced strong opposition to a Medicaid expansion in the past, opposing parties teamed up in an interim hearing to brainstorm ways to fix the state's Medicaid program. The Republican committee chair, Rep. Jay Barnes, Jefferson City, led packed hearing room. Lawmakers on both sides of the aisle acknowledged that they would need to work together to come up with a workable options.

Barnes annouced that there will be a series of hearings to discuss different parts of the Medicaid expansion, but stated federal waivers would be the topic for Thursday afternoon. Federal waivers vary, but they ultimately allow states to try out a system that works for them under federal guidelines.

"There are options for states to pick and choose a Medicaid program they want," Sidney Watson, St. Louis University law professor, said. "Every state looks different so they have the ability to pick different plans."

To apply for Medicaid, a potential recipient would have to fall below 133 percent of the federal poverty line. Governor Nixon wanted to expand Medicaid to close the gap for those below the 133 percent of the federal poverty line. Currenlty Missouri law provides coverage for able-bodied persons below 18 percent federal poverty. When the Medicaid expansion failed, it left nearly 260,000 low-income adults without Medicaid coverage. Professor Watson told the committe if Medicaid were to be expanded, but stayed below 133 percent, Missouri would not enjoy 100 percent of federal coverage of those expanded benefits.

Much of the hearing was spent looking to other states for guidance. Arkansas, Iowa and Indiana were among the states who have Medicaid programs that appealed to the committee because of their ideas to privatize Medicaid. Barnes also brougt up U.S. Rep. Paul Ryan's, R-WI, Patients Choice Act which raises Medicaid eligibility to 200 percent of the federal poverty line by tax credits and providing working poor families with a debit card for them to buy private insurance. Barnes said Ryan's plan promotes people to participate in earning their healthcare rather than being merely a recipient.

"All the plans go beyond 138 (133 due to a margin of 5 percent) percent, they all contemplate some kind of financial subsidy to encourage people to participate intelligently in their health care," Rep. Chris Kelly, D-Columbia, said.

Kelly also voiced his concerns over how the program should deal with the misuse of emergency rooms and innapropriate or unnecessary treatments that come at a high price for the state.

"There has to be some way to recover money," Kelly said. "People actually engaging in criminal behavior is different than just innapropropriate behavior."

Rep. Kelly and Rep. Sue Allen, R-St. Louis County, agreed a propsal would have to be made to better manage the overuse of healthcare for unnecessary reasons. Allen said there is a myriad of social programs, and there needs to be a return on investment from Medicaid so they can have funding for other important parts of the budget such as education.

Barnes annouced the upcoming hearing dates as follows:

• Oct. 15: Medicaid fraud, including provider and consumer fraud; Services that are not covered by Medicaid but could be in the future (i.e. substance abuse treatment, physical therapy, chiropractic services)
• Oct. 29: Managed care and delivery methods (i.e. traditional care, Administrative Services Operations, Accountable Care Organization, fee-for-service)
• Oct. 30: Cost- sharing, debit cards, Paul Ryan's Patients Choice Act
• Nov. 6: Eligibility levels
• Nov. 19: Wrap-up of aforementioned discussions

Barnes attempted to reform Medicaid in April with a bill that would have expanded eligibility to 100 percent of the federal poverty level while reducing eligibility for pregnant women and the State Children's Health Insurance Program.