Vows line-item vetoes
Subjects thousands to suffering
By American staff
On Tuesday Gov. Matt Blunt signed Senate Bill 539, signaling the defeat of efforts to stop the Republican majority in Jefferson City from drastically cutting the state’s Medicaid program.
He also vowed to use line-item vetoes to prevent any partial reintroduction of Medicaid funding into the state budget during his tenure.
The new law, which takes effect Aug. 28, calls for about 100,000 people to lose Medicaid coverage when combined with cuts advanced in state budget proposals. That is approximately 10 percent of Missourians currently covered by the state’s Medicaid program.
About 27,000 people, mostly the disabled or elderly, will lose medical coverage when the law takes effect. The legislation also cuts subsidies to parents who adopt children through Missouri’s foster-care system. Most effected will be adoptive parents of difficult-to-adopt children, many of whom are African-American.
Blunt justified the drastic law by saying it eases the state budget, targets “fraud, waste and abuse” and protects “the long-term sustainability of our state’s social welfare services.”
State Sen. Joan Bray (St. Louis) said the new law states nothing about dealing with provider waste, fraud or abuse in the program.
“We have negotiated and argued and filibustered this bill, but we have been met with cold stares throughout the entire process,” Bray said.
Minority Chairman State Sen. Pat Dougherty called Gov. Blunt’s cuts to health care cruel and shortsighted.
“This legislation corrupts what makes up a moral and just society,” Dougherty said. “This bill cuts the elderly, the disabled and children from desperately needed health care. They have no other place to go.”
Dougherty added that Missouri now will lose hundreds of millions of dollars in matching federal funds. He pointed out that state money only pays for about 21 percent of Missouri’s total Medicaid expenses. Federal funds are an important source of income for pharmacists, nursing homes, hospitals and doctors, who are likely to pass new costs on to the public.
“Health care has been an essential part of maintaining Missouri’s economy, and while I agree with Gov. Blunt that our economy is anemic, this is certainly no way to deal with it,” Dougherty said.
He referenced independent studies from Saint Louis University that say this legislation will cost Missouri in excess of $737 million and 10,130 jobs, making it the largest job-killing legislation in Missouri’s history.
As for cuts in adoptive subsidies, Joe Kroll, executive director of the North American Council for Adopted Children, told the Kansas City Star, “You will watch adoptions drop dramatically, and the state of Missouri will be out of compliance with federal guidelines. They’ve started down a road that’s paved with trouble.”
Details of the new law
The following changes, which would save the state $367.6 million, are included in the Medicaid law.
MEDICAID OVERHAUL
€ Creates a commission of 10 lawmakers to study and recommend new Medicaid approaches by January.
ELIGIBILITY
€ Requires annual eligibility reviews for all Medicaid recipients and drops coverage for people who do not verify their incomes. Projected savings: $29.1 million; 13,609 recipients eliminated.
€ Drops income eligibility for elderly and disabled persons from the federal poverty level – $9,570 annually for an individual – to the minimum coverage level required by the federal government, about $7,369 annually. Projected savings: $74 million; 14,607 recipients removed. An additional 18,504 persons would have to pay more before receiving services.
€ Repeals a program granting Medicaid coverage to disabled persons who work. Projected savings: $52 million; 9,529 recipients eliminated and costs shifted to an additional 4,753 persons.
€ Repeals Medicaid coverage to people unemployed because of temporary or permanent disabilities. Projected savings: $13 million; 3,046 recipients eliminated.
SERVICES
€ Repeals mandatory coverage of most adults for dental and optical care, podiatry, hearing aids, prosthetics, wheelchairs, rehabilitation services and hospice care. Projected savings: nearly $117 million; services to 350,000 people eliminated. Coverage continues for those who are blind and for pregnant women.
CO-PAYMENTS:
€ Allows co-payments – projected between 50 cents and $3, depending on the cost of the service – to be charged to adult Medicaid recipients (besides the blind or pregnant) for all services other than mental health and personal care assistance. Projected savings: less than $46 million.
€ Repeals co-payments for families in the Children’s Health Insurance Program but requires premiums of more families. For example, 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: nearly $24 million, based partly on the assumption that the families of 23,709 children would drop coverage rather than pay the premium.
ADOPTIONS
€ Eliminates state subsidies for adopting foster children when the adoptive parents have household income of more than twice the federal poverty level, or $38,700 for a family of four. Projected savings: $12.5 million based on the assumption that some children will linger longer in foster care.
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 Medicaid recipients in nursing homes to recover some of the costs of their care.
NURSING HOMES
€ Freezes Medicaid rates to nursing homes by repealing the phase-in of a rate increase approved last year.
PRESCRIPTION DRUGS
€ Replaces the state’s drug subsidy program for low-income senior citizens with a state-funded program that covers costs not picked up by the new Medicare prescription drug benefit.
IN-HOME CARE
€ Gives state officials the job of evaluating the services clients need. It eliminates a conflict of interest in which independent living centers helped determine their own fee by helping assess clients’ needs.
For more information on S.B. 539, visit www.moga.state.mo.us, click “Joint Bill Tracking” and enter the bill number.