Newspaper article St Louis Post-Dispatch (MO)

GOP Floats Its Take on Medicaid

Newspaper article St Louis Post-Dispatch (MO)

GOP Floats Its Take on Medicaid

Article excerpt

JEFFERSON CITY A key Republican in the Missouri House has unveiled a plan to shift Medicaid eligibility for thousands of Missourians allowing some new people into the health care program for the poor while kicking others, including some children, out.

Republican House leaders for weeks have been discussing the potential for Medicaid transformation as an alternative to an outright expansion proposed in the federal Affordable Care Act, but the bill Rep. Jay Barnes filed Tuesday which he has dubbed market- based Medicaid is the first clear indicator of the changes they will pursue.

On Monday, a House committee rejected a federal-model plan supported by Democrats, including Gov. Jay Nixon, to expand Medicaid eligibility to an estimated 300,000 more Missourians.

Barnes alternative would expand eligibility for some mostly childless adults while pushing others to subsidized private insurance. It also seeks to cut costs through creating cash incentives for Medicaid recipients who make an effort to keep their health costs low and shifting Missouris Medicaid program to private insurer-based managed care systems.

Barnes, R-Jefferson City, estimates that his changes would save the state $741 million over the next eight years.

Missouri taxpayers cannot afford a straight Medicaid expansion, he said. But by transforming the system and streamlining eligibility, we create a fiscal note so positive that Missouri taxpayers cant afford not to transform this broken system.

The net effect, he said, would be fewer people eligible for Medicaid, rather than the expanded coverage Democrats want.

About 880,000 Missourians are enrolled in Medicaid, which has varying degrees of coverage based on income.

The federal health care law proposes coverage for anyone who falls below 138 percent of the federal poverty level, or about $32,500 for a family of four or $15,800 for a single person.

Barnes plan would set income eligibility at the federal poverty level currently $23,550 for a family of four or $11,490 for a single person. That would drastically reduce eligibility for children, which in Missouri is currently set at 300 percent of poverty level, or $70,650 for a family of four. According to estimates in Barnes proposal, about 44,000 children currently in the program would no longer be eligible.

Those who no longer qualify for Medicaid under the shift would instead have access to private coverage bought through a federal health insurance exchange, Barnes said. The federal health care law creates subsidies for people in lower income brackets who buy insurance through the exchange.

At the same time, several thousand people who are not currently eligible for Medicaid would be able to enter the system mostly childless adults and parents who make too much at the states current income limit of 19 percent of poverty, or about $2,183 for a single person or $4,474 for a family of four. …

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