By AP/KWMU
Jefferson City, MO – The Missouri Senate on Monday night gave initial approval to legislation that cuts back the state's Medicaid system, and also scraps Medicaid entirely by mid-2008.
The 20-12 vote came after more than 17 hours of debate.
The legislation would put into place much of Governor Matt Blunt's plan to tighten Medicaid eligibility standards as a way to help balance the budget for the upcoming fiscal year.
All Senate Democrats voted against it, saying the plan would "blow up" Medicaid. Two Republicans also joined the Democrats in voting no.
The measure needs one more vote in the Senate before moving to the House.
Aside from ending Medicaid in 2008, the legislation would also set up a legislative panel to recommend reforms by the end of this year.
The legislation, as passed in the Senate on Monday, includes the following provisions:
MEDICAID OVERHAUL
- Ends Missouri's current Medicaid program by mid-2008. Creates a commission of 5 State Senators and 5 Representatives to recommend "innovative" Medicaid reforms by Jan. 1, 2006.
ELGIBILITY
- Requires annual eligibility reviews for all Medicaid recipients and drops coverage for people who don't respond by verifying their incomes. This provision projects savings of $29 million by the expected elimination of 13,609 recipients.
- Allows the income eligibility thresholds for the elderly and disabled to be reduced below the federal poverty level ($9,570 a year for an individual) to the minimum coverage level required by the federal government (about $7,082 annually). This provision projects a savings of $74 million by the expected elimination of 14,607 recipients and the shifting of costs to an additional 18,504 people.
- Repeals a program granting Medicaid coverage to the disabled who go to work, whether earning only a slight amount or more than twice what's allowed under traditional Medicaid. This provision projects a savings of $52 million by the expected elimination of 9,529 recipients and the shifting of costs to an additional 4,753 people.
- Repeals a program granting Medicaid coverage to people unemployed because of temporary or permanent disabilities. This provision projects a savings of $13 million by the expected elimination of 3,046 recipients.
SERVICES
-Repeals mandatory coverage for adults (besides the blind and pregnant) of dental and optical care, podiatry, hearing aides, prosthetics, wheelchairs, rehabilitation services and hospice care. Projected savings of nearly $117 million, if none of the services are funded in the budget, by decreasing services to about 350,000 people.
CO-PAYMENTS
- Allows co-payments - projected between $0.50 and $3, depending on the cost of the service - to be charged to adult Medicaid recipients (besides the blind and pregnant) for all services other than mental health and personal care assistance. Deducts the cost of the co-payments from money the state pays to doctors and hospitals. Projected savings of less than $46 million.
- A provision amended to the bill repeals co-payments for families in the Mc+ of Kids program but requires premiums of more families. (a single parent of two would have to pay at least a $100 monthly premium if the parent earned more than $24,296 annually). Projected savings of nearly $24 million, based partly on the assumption that the families of 23,709 children would drop coverage rather than pay the premium.
ADOPTIONS
-Limits state subsidies to the adoptive parents and legal guardians of an estimated 5,000 children by requiring their families earn no more than twice the federal poverty level, or $38,700 for a family of four. Projected savings of $12.5 million includes assumption that some children would have to stay in foster care longer.
ANNUITIES
- Requires the Department of Social Services to review whether Medicaid applicants have invested in annuities within the past five years as a way to shield assets so they can qualify for Medicaid.
LIENS
- Increases the department's power to file liens against the property of institutionalized Medicaid recipients to recover some of the costs of their care.
NURSING HOMES
- Repeals part of a law enacted last year requiring Medicaid payments to nursing homes to be recalculated each of the next three years, which would have resulted in increased payments.
PRESCRIPTION DRUGS
- Creates a state-funded prescription drug program for seniors to cover costs not picked up by the new federal Medicare prescription drug benefit. This would replace the state's SenioRx Program, which expires at the end of the year.
IN-HOME CARE
- Transfers oversight of some in-home personal care services for the disabled to the Department of Health and Senior Services, instead of the Department of Elementary and Secondary Education.