- Associated Press - Sunday, April 19, 2015

JEFFERSON CITY, Mo. (AP) - Missouri Republicans said early in the session Medicaid expansion was a non-starter again this year and despite Democratic attempts to address the issue using amendments and protests, they’ve stuck true to their word.

But Republican leaders have also said they want to see reforms to the Medicaid system. Some tweaks to the state’s Medicaid system are moving forward, including proposals encouraging the use of telemedicine, a raise to the asset limit for people with disabilities and more stringent policing of eligibility.

However, no comprehensive proposal to overhaul the state’s Medicaid system has gained traction. One group that advocates for Medicaid expansion says they’d be happy to see any reforms, combined with an expansion, move forward.

“I think the Legislature has chosen to just ignore this issue instead of really digging in and dealing with the issue and figuring out what the Missouri solution is,” said Michelle Trupiano, director of the Missouri Medicaid Coalition.

Senate President Pro Tem Tom Dempsey, R-St. Charles, said the Legislature is taking incremental steps toward addressing problems in the Medicaid system.

“I guess we’re taking reform in small bites, small doses,” Dempsey said.

One of the proposals moving forward this session, sponsored by Dempsey, raises the amount of money people with disabilities could have before qualifying for Medicaid. The measure would raise it from $2,000 for a single person and $4,000 for a married couple to $5,000 and $10,000 respectively by 2020.

The Department of Social Services estimated more than 6,000 more people would qualify for Medicaid due to the change. The measure passed the Senate and awaits a hearing in the House.

Dempsey said he didn’t think there would be that many more people added and said the higher asset limit would allow people to depend less on the state by taking care of their own needs.

The increase to the asset limit was one proposal that emerged from a 2013 Senate Interim Committee on Medicaid Transformation and Reform chaired by Sen. Gary Romine, R-St. Francois. Romine introduced a measure this session that included several large-scale proposals such as expanding managed care, creating coordinate care organizations to replace the fee-for-service model and subsidizing private insurance for some Medicaid participants.

But Romine said he did not think there was enough support for some of those proposals and he scaled back his measure to only address the issue of telemedicine in Medicaid. His proposal passed the Senate and a similar version has passed the House. He said reimbursing for telemedicine in Medicaid would reduce costs and improve access to specialists in rural areas.

“It’s one of our keynote pieces, I believe,” Romine said.

Other proposals seek to more tightly monitor eligibility for Medicaid. The House passed a measure last month requiring the state contract a third party to verify eligibility in Medicaid and other social services programs and a similar measure is awaiting debate in the Senate. The Senate has also approved a measure to explicitly kick people with out-of-state addresses off of the program.

House Speaker John Diehl said the Medicaid system has not been administered properly, referencing problems revealed by a federal audit claiming Missouri owes $34 million to the federal government.

“We’re not inclined to start pouring more money and more eligibility into a system that’s broken,” Diehl said. “Until it gets fixed, I don’t think it’s responsible to the taxpayers to try to put more money into it.”

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