This article first appeared in the St. Louis Beacon, April 3, 2013 - After meeting privately with House Republicans, Missouri Gov. Jay Nixon indicated that he agreed with some of the GOP's proposed changes in the state’s Medicaid program – provided that they go along with his proposed expansion.
So far, Republicans have been opposed to the expansion requirements in the federal Affordable Care Act, although business groups and the Missouri Hospital Association side with Nixon in favor. Expansion is voluntary, but certain requirements must be met to receive the federal money, which would cover all of the expansion costs for the first three years and then at least 90 percent thereafter.
“I appreciate the House leadership for facilitating an open and honest discussion,” Nixon said in a statement issued after the meeting. “With the House currently considering a Medicaid bill that would implement significant reforms, today’s meeting was an opportunity to discuss these and other ideas for making our health system more efficient and effective.”
The governor added, “Medicaid reform the Missouri way will protect taxpayers, reward work, promote personal responsibility and bring the tax dollars Missourians send to Washington back to work here in Missouri.”
The House approved a proposed state budget for the coming fiscal year without the expansion. However, members now are considering a proposal by state Rep. Jay Barnes, R-Jefferson City, to expand access to Medicaid for some people who don’t now qualify, while cutting off others – including children – now in the program.
A centerpiece of Barnes’ plan would increase the eligibility to 100 percent of the federal poverty level; the state’s ceiling is now 19 percent for adults (and up to 185 percent for some children). The ACA requires that the ceiling be raised to 138 percent for adults to obtain the federal funding.
Nixon previously has indicated concerns about some aspects of Barnes’ bill, but Wednesday he also signaled support for some provisions. As his statement observed: “Among the reforms being considered: financial incentives and penalties to promote personal responsibility and accountability among beneficiaries; safeguards to protect taxpayers, such as sunsets and triggers; using Medicaid funds to purchase private insurance, an option being explored in Arkansas; improving care coordination; and co-pays and cost-sharing arrangements to give Missourians a greater stake in their coverage as they move up the income ladder.”
