Senate Majority Floor Leader Charlie Shields, R-St.Joseph, acknowledged that the committee's delay will make the bill a close call for this legislative session.
"The faster he (Schaaf) can get it into conference the better off we are. At this point it looks like its going to be the last week before he can get it into conference," he said. "I think we can get it done. It would be helpful if they could move it along a little faster."
Shields, who sponsored the original bill, testified at the hearing about the extensive changes Schaaf's newest draft would make. Shields' bill was passed by the Senate April 11. Schaaf's substitute draft was submitted on Monday as a result of criticisms Shields' bill received in a committee hearing last week.
Schaaf's substitute draft would increase reimbursement rates for physicians. Schaaf said this is an attempt to increase the number of providers in the program as well as access to care to HealthNet recipients.
"Clearly that is an issue that needs to be addressed. I think we've said on the Senate side, even though it wasn't in our version, that it does you no good to have a benefit card and nowhere to use your benefits," Shields said.
Schaaf's draft would completely eliminate the Senate bill's preference for federally qualified health centers. Instead, it would require federally qualified health centers to contract with willing providers before hiring their own physicians.
Susan Wilson, chief executive officer of Northwest Health Services, a federally qualified health center in northwest Missouri, testified that such a requirement would violate the federal requirements to maintain their status.
"If we decide to contract for services, we have to prove to our federal granting agency that that really is the best way to go rather than direct employment," Wilson said.
Shields testified at the hearing that he was concerned about that provision as well, saying that federally qualified health centers are a primary care access point funded and recognized by the federal government. In an interview after the hearing, Shields explained his concerns.
"FQHCs are the safety net for not only the Medicaid population but also for people without insurance, and we think it's appropriate to support them and give them a preference." he said.
The draft would expand some eligibility for disabled workers, add dental coverage, offer a different version of the women's health program that was in the Senate's bill, and partially reinstate the ticket-to-work program, which allows people with disabilities to work and still maintain their Medicaid coverage.
Shields testified about these expansions, saying that he suspects that the costs are getting "pretty high." He later said that he thought these expansions would likely lead to budget problems.
"Eligibility, certainly, is going to be a part of it. He's expanding services," he said. "We just don't know at this point what the size of the fiscal note will be."
If the committee passes the bill Tuesday, it would be Thursday or Friday of next week before debate could begin on the House floor, Schaaf said.