The detailed cost estimates presented by Rep. Jay Barnes assume that
Missouri would expand its Medicaid eligibility to a level sufficient
enough to trigger a lucrative influx of federal money — something his
fellow Republicans repeatedly rejected earlier this year.
The projections also assume Missouri would reap savings by ending
Medicaid coverage for tens of thousands of children living in
lower-to-middle-income families, something that has faced resistance
from both Democrats and Republicans. Barnes, of Jefferson City, stressed that the potential changes weren’t a
formal proposal but rather a starting point for discussions by the
House Interim Committee on Medicaid Transformation, which he leads. The
panel is to meet again later this month as it tries to develop
recommendations for the 2014 legislative session.
The bottom line of Barnes’ projections is that Missouri could gain $42
million in state general revenue in the 2021 fiscal year if it adopted
numerous eligibility and structural changes to the Medicaid program.
That year is important because it’s the first full year in which
Missouri would receive a 90 percent — instead of 100 percent — federal
payment for the expanded adult Medicaid coverage.
The financial projections are likely to change somewhat before the next legislative session. But “it is safe to say, with the right amount of reforms, that we can stay in positive territory,” Barnes said. Missouri’s Republican-led House and Senate repeatedly rejected
Democratic efforts earlier this year to expand adult Medicaid
eligibility, often citing concerns about the potential long-range costs.
Some Republicans remained skeptical Wednesday about the financial
projections presented by Barnes. They noted the savings assume some
people no longer eligible for Medicaid would instead get federal
subsidies to buy private insurance through a federally run website. Some
Republicans questioned whether the federal government could afford that
over the long run.
“As a state, it may have a negligible or even positive effect on the
general revenues, but as a nation, I think it’s putting concrete shoes
on a future generation,” said Rep. Keith Frederick, a Republican and
orthopedic surgeon from Rolla.
The financial projections outlined by Barnes assume about 225,000
adults living in poverty would be added to the Medicaid rolls, and the
state would subsidize private insurance policies through the federal
website for an additional 82,000 adults with incomes slightly above the
federal poverty level. That expansion would cost an estimated $147 million in state general revenues in the 2021 fiscal year.But that would be partially offset by eliminating or paring back
Medicaid eligibility for blind adults, women’s health services and
children whose family incomes and circumstances make them eligible to
buy federally subsidized insurance policies. Barnes did not have an estimate of how many people could be removed
from the state’s Children’s Health Insurance Program, but he said:
“There would be a substantial reduction in eligibility.”
Some lawmakers appeared uneasy about that possibility.“I would just as soon take care of the kids,” said Rep. Sue Allen, a
Town and Country Republican, a member of the interim committee and
chairwoman of the House Appropriations Committee for Health, Mental
Health and Social Services.
The potential changes outlined by Barnes assume that additional federal
Medicaid dollars flowing to Missouri would result in greater income
taxes and sales taxes for the state.
The financial projections also assume Missouri would save money by
expanding the number of Medicaid recipients covered through managed care
plans and enlarging the number of people whose mental health services
are paid with federal Medicaid dollars instead of solely with state
funds. The potential changes also assume that expanded mental health
coverage would lead to a reduction of people in prison, saving the state
millions of additional dollars.
