Changes in Medicaid have broad impact

Missouri -- Medicaid in Missouri is dead, or at least it has changed its form and been renamed.

While no one disputed that helping Missouri's less prosperous families get health care was a good thing many critics did say that the old system was plagued by waste, fraud and mismanagement. Enter MO HealthNet, a system that replaces Medicaid but has already garnered its own set of critics. Governor Matt Blunt announced the changes during his State of the State address in Jan., 2007.

"Since I took office, I have been visiting with Missouri-ans about their health care concerns," Blunt said. "Missourians are worried about those who lack insurance. This is my concern as well. Tonight I promise to deliver improved access to affordable health care for every Missourian and the guarantee that the sick and the poor will be well served.

"With the advice and suggestions of many in this Chamber and thousands across our state, we developed MO HealthNet to replace the old Medicaid system. What I propose with MO HealthNet is not a minor reform. It is an entirely new system."

"It will stand apart from what any other state has done or is doing. The Medicaid program we inherited was a paper-based system, basically unchanged from its original 1967 model," Blunt said.

"HealthNet will put people first. The old Medicaid failed to focus on prevention and wellness. HealthNet will improve the health of the sick and the poor."

One way MO HealthNet is intended to help is to make it easier for small employers to purchase insurance for their employees by forming association health plans. Such plans could reduce the cost of premiums by 40 to 50 percent with smaller companies benefiting the most.

Some provisions of MO HealthNet are intended for uninsured children and is funded through the State Children's Health Insurance Program. Additionally, some premium is required for families who earn at least 100 percent of the Federal Poverty Level. These premiums range from $12 to $294 depending on how far above the poverty level the family income is.

The plan also has copay amounts that must be paid by the person getting the service to the service provider just like a private insurance plan. The copay amounts vary by type of service and start as low as 50 cents.

Provisions in the new plan call for people receiving benefits to develop health improvement plans and work to achieve healthy lifestyles. Physicians will not have to report to the State on their patient's compliance and will not be in the position of having to deny medically necessary services to their own patients.

In previous years durable medical equipment had largely been excluded except for a narrow list of items.

The new program provides that prescribed, medically necessary durable medical equipment will be provided and mandates that "an electronic, Web-based prior authorization system using best medical evidence and care and treatment guidelines, consistent with national standards shall be used to verify medical need."

While the new program provides for dental and optometric services it does not have a funding method and those services will only be provided if funds are separately appropriated by the legislature for them.

State Representative Barney Fisher, R-District 125, said Governor Matt Blunt was proposing Insure Missouri, a program that would work together with MO HealthNet to provide coverage to a large percentage of low-income Missourians including some working poor.

"Right now we have about half a million to 700,000 uninsured Missourians," Fisher said. "He (Blunt) is proposing an Insure Missouri program, I haven't studied all the nuts and bolts of it, but it would pick up another 200,000 of the low-income individuals and low-income families of uninsured in Missouri. How that is going to tie that into Missouri HealthNet we don't know, we'll have to see his proposal in more detail."

Talking about the State Children's Health Insurance Program, SCHIP, Fisher said that the proposal that President Bush vetoed would have expanded the program to adults up to 25 years of age and would have been a $35 billion expansion.

"When the president vetoed it that thing would take a child or an adult all the way to age 25," Fisher said. "It was a $35 billion expansion in the program. It would have covered illegal immigrants children."

Fisher said that in Missouri children's health programs had not been affected.

"Children's insurance programs in the state of Missouri, regardless of what anybody says, have not been affected."

Fisher said that the program pulled children off of private insurance plans and into publicly funded programs.

"Parents are smart," Fisher said. "One of the most frequent questions when MC+, when that children's program was started was 'How long do my children have to be off of my policy before the state will pick them up?' and a lot of parents gambled that their children wouldn't get sick during that time. Essentially what they were saying was 'I want to lower my premiums and have the taxpayers of Missouri pick up the tab for my kid's medical expenses.' People aren't stupid. They figured that out right away."