Newspaper article St Louis Post-Dispatch (MO)

Medicaid Needs Thoughtful Reform, Not Budget Cuts and Caps

Newspaper article St Louis Post-Dispatch (MO)

Medicaid Needs Thoughtful Reform, Not Budget Cuts and Caps

Article excerpt

Medicaid is our nation's largest health care plan, serving 65 million Americans and nearly a million Missourians. Importantly, Medicaid is the only public program that provides long-term care for the elderly and disabled. Two-thirds of Medicaid spending supports these vulnerable populations and their caregivers.

Medicaid operates as a federal/state partnership. The federal government sets program requirements, the states administer them, and both pay but not equally. Congress pays $1.72 for every $1 Missouri spends. To maximize federal outlays, Missouri taxes its health care providers. But, despite higher federal payments, Missouri reimburses many nursing homes at rates below the cost of care. Average 2016 state reimbursement was $155 per patient day compared to $170 average cost. This means that through taxes and under-reimbursement, nursing homes subsidize Missouri Medicaid twice over. This is both unfair and unsustainable. Many nursing homes have reacted by decreasing Medicaid beds. If underpayment persists, some will close.

Missouri is currently engaged in its annual budget balancing exercise that must be completed by May 5. Representing one-third of the state budget, Medicaid is on the cutting block in Jefferson City. Simultaneously, Congress is considering proposals to cap state payments and let the states manage Medicaid's explosive growth (driven by demographics and rising health care costs). These changes will mean less money for Missouri Medicaid, making a tough situation for nursing homes even tougher.

Recently, I visited Jefferson City and Washington, D.C., to advocate against Missouri cuts and federal changes. As chairwoman for Missouri's association of nonprofit senior living and health care providers, and a health care professional who has served Missouri's frail and elderly for more than 40 years, I had to raise my voice. Medicaid is a lifeline for 84,000 Missourians cared for in nursing homes and through home and community services.

A disturbing takeaway from my Capitol visits is that some policymakers are confused about long-term care coverage. I'm not arguing to expand Medicaid. …

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