By AP/KWMU
Jefferson City, MO – State officials released recommendations Thursday on how the state should overhaul the Medicaid system.
For one, they recommend calling it 'Missouri HealthNet' rather than Medicaid.
The current Medicaid system is set to go away in 2008. The recommended replacement would put more emphasis on preventative health care, reward healthy habits, and pay doctors more to treat the healthnet patients. The governor will use the recommendations to form his own proposal that he'll send to lawmakers next year.
When lawmakers cut hundreds of thousands of Missourians from Medicaid a couple years ago, they also gave the program an expiration date as a way to force them to come up with something new.
One recommendation is to establish a system by which patients set goals - like losing weight or quitting smoking - making them eligible for more benefits as they meet more goals.
Health care coverage could be expanded to some children, and small businesses could get state aid to offset the cost of providing insurance to lower-to-middle income employees, under the proposal crafted by the departments of Social Services, Health and Senior Services, and Mental Health.
"These recommendations provide everyone in the process, including myself, the opportunity to refine opinions and shape what has the potential to become a model of innovation in health care delivery for the entire nation," Blunt said in a written statement.
Begun in 1967, Missouri's Medicaid program will expire June 30, 2008, unless lawmakers either replace it or extend it.
The law that sets an expiration date also created a legislative Medicaid Reform Commission, whose recommendations served as the basis for the more specific report released Thursday by Blunt's departments.
Missouri's Medicaid program cost about $6.1 billion in state and federal funds last year. About 826,000 people now are enrolled down from a peak of more than 1 million in early 2005.
Because certain Medicaid benefits are mandated by the federal government, everyone eligible for the program would continue to received benefits even if they refuse to go along with self-help requirements of a restructured program.
The report assumes the Medicaid overhaul would cost almost $200 million more in state funds, though not all of that would hit in one budget year. It projects savings of more than $50 million annually in future years as people become healthier.
Under the recommendations, the program would work like this:
When participants enroll, they first would be called by a state employee who would help them chose a "health care home," essentially a health care clinic or primary care physician.
That health care provider then would appoint a person like a specific doctor, nurse or health coach to serve as that patient's health care coordinator.
That health care coordinator would assess a patient's health risks and help develop a plan of care, setting goals for such things as exercise, losing weight and quitting smoking, outlining what medications they need and setting a schedule for regular doctor's appointments.
People who follow their plan of care would be eligible next year for additional health services, like adult dental care, expanded optical care or rehabilitation services.
As a general approach: "It's see your health care provider, and have a plan of care that helps you stay well, or achieve the best health state possible," said Department of Social Services Director Deborah Scott.
Other parts of the plan would expand eligibility in the State Children's Health Insurance Program to an estimated 13,800 people; add health care coverage for about 1,000 former foster care children between the ages 18-21; and restore coverage to about 1,800 disabled workers who were among those cut from the Medicaid rolls last year.
The expanded coverage drew praise from Sharon Feltman, the policy and communications director for the Missouri Association for Social Welfare. But she said the recommendation to provide extra health benefits to people who meet certain criteria appears "complicated and almost impossible to implement in any kind of fair way."
"Health care should not be a bonus that we dole out to certain people because they behave healthy," Feltman said.
Another portion of the plan would increase the state's Medicaid payment rates for physician-related services to the levels now paid under the federal Medicare program for the elderly. Missouri's Medicaid payment rates currently are just 40% of the Medicare level for most services, although a few categories were increased last legislative session, said Steve Renne, interim director of the state Division of Medical Services.
The proposed rate increases would not apply to hospitals or pharmacies.
But Mary Becker, the senior vice president for the Missouri Hospital Association, said the group was pleased with the general concepts in the proposed Medicaid overhaul particularly the premise of personal responsibility for health care and expanded eligibility for children.
Scott said the hospital association has been working on a model proposal for one of the report's recommendations expanding health care to the uninsured through state subsidies to small businesses.
For small-business employees whose household income is less than twice the poverty level about $40,000 for a family of four the state would pick up about 30 percent of the employees' and employers' health insurance premiums, Scott said.