Newspaper article St Louis Post-Dispatch (MO)

Medicaid Ouster Is Puzzling to Many; Nixon's Office Offers No Reason, but Others Say Director Was Forced Out

Newspaper article St Louis Post-Dispatch (MO)

Medicaid Ouster Is Puzzling to Many; Nixon's Office Offers No Reason, but Others Say Director Was Forced Out

Article excerpt

JEFFERSON CITY * Questions continued to swirl in the state capital Tuesday about the sudden departure last week of Missouri's Medicaid director, a widely respected physician who had navigated choppy political waters for six years.

Health care advocates and legislators said that former Medicaid chief Ian McCaslin was forced out by Gov. Jay Nixon's office. But none could pinpoint why.

"He was called on the phone, basically told, 'Today's your last day, clean out your stuff,' " said Rep. Jeremy LaFaver, D-Kansas City. "I can't figure it out. He's about as good a person as worked in state government as I have ever met."

The puzzlement grew this week with the resignation of McCaslin's boss, Department of Social Services Director Alan Freeman, who is leaving after only five months on the job.

Freeman quit his Cabinet-level post to return to his old job as president and CEO of Grace Hill Health Centers in St. Louis, effective May 31. Freeman said in his resignation letter that he preferred running a health care organization. A request for an interview with him was declined Tuesday by the department.

Nixon's office and the social services agency refused to explain the circumstances surrounding McCaslin's exit from his $161,376-a- year job. The department cited privacy laws.

Medicaid, the health care program for the poor, has been the prime focus of Nixon's attention this year. After refusing to take a position in last year's election campaign, the Democratic governor repeatedly flew around the state this year, holding news conferences with hospital executives and business leaders who backed the governor's proposal to expand the program.

But the Republican-led Legislature never gave the plan serious consideration and ended its annual regular session Friday without passing it.

Medicaid currently pays for doctor visits, prescription drugs and other services for about 880,000 Missourians low-income seniors, people with disabilities and some families with children. The program costs state and federal taxpayers about $8.5 billion a year.

The expansion would have covered an additional 260,000 people most of them uninsured, working adults. Nixon's proposal counted on about $900 million in extra federal funds to pay for it.

Opponents said the program needed to be reformed first. They said the expansion was financially unsustainable because the state would have been required to gradually pick up part of the cost for the new participants. House and Senate interim committees may be appointed to study alternatives that encourage efficiencies, add personal responsibility on behalf of recipients and curb fraud.

Advocates in the coalition that worked for the expansion said it would be difficult to blame McCaslin for the plan's defeat.

"Not one person I've come in contact with has said, 'Oh, good, Ian's gone,'" said Andrea Routh, who oversees the Missouri Health Advocacy Alliance, a network of consumer groups and health care providers that lobbied for the expansion. …

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