- Associated Press - Wednesday, April 2, 2014

JEFFERSON CITY, Mo. (AP) - A bill revamping the management of Missouri’s Medicaid program was set aside Wednesday after debate turned tense between two Republican senators who are at odds over whether to accept billions of federal dollars to expand health coverage for low-income adults.

Sen. Ryan Silvey wants to use Medicaid money available under President Barack Obama’s health care law to provide insurance for an estimated 300,000 adults who are not eligible under Missouri’s current Medicaid program.

Sen. John Lamping doesn’t want to do that, even if the expansion is paired with Medicaid changes embraced by Republicans in some other states. He and several other GOP senators have vowed to stand firm against any Missouri measures stemming from Obama’s health care law.

“By no means do I think we should further expand our financial relationship with the federal government,” Lamping, R-St. Louis County, told Silvey. “You have far much more trust in government than I.”

Silvey had previously accused lawmakers of “a dereliction of duty” for refusing to deal with big problems, such as “a doughnut hole of several hundred thousand Missourians” who earn too little to qualify for Missouri’s Medicaid program but too much to qualify for federally subsidized insurance policies.

“Where we are today is a political quagmire,” said Silvey, R-Kansas City. “You have people who are more interested in sound bites and more interested in obstructing then they are in realizing what the reality of the situation is and dealing with it.”

The legislation pending in the Senate would not expand Medicaid eligibility as envisioned under Obama’s health care law. But supporters and opponents of Medicaid expansion both view the bill as a likely candidate for an amendment expanding health care coverage.

As drafted, the legislation focuses on structural changes to the Medicaid program, including the statewide extension of managed care insurance policies for parents and children and a new model of coordinated care for many seniors and disabled patients.

The bill’s sponsor, Sen. Gary Romine, R-Farmington, halted the debate between Silvey and Lamping by requesting that the bill be set aside for the day. He said afterward that the debate had been getting confrontational.

Senate Majority Leader Ron Richard said he wasn’t sure when - or if - he would return to the legislation for more debate.

“It was getting personal, and they weren’t accomplishing anything,” said Richard, R-Joplin.

Missouri’s Medicaid program covers about 830,000 people at an annual cost of nearly $9 billion, much of which comes from the federal government.

Under the federal health care law, states can receive enhanced federal Medicaid payments if they expand adult eligibility to those earning up to 138 percent of the poverty level - nearly $33,000 for a family of four. Missouri’s current eligibility cutoff is the lowest allowed under federal law - about $4,500 for that same family of four. Missouri covers adults only if they have custody of children, are disabled or are seniors.

Democratic Gov. Jay Nixon, who supports Medicaid expansion, has said Missouri could reap about $2 billion annually in additional federal Medicaid dollars if it expands eligibility. The federal government would initially pay the full cost to cover that group of adults, but states would be required to gradually pick up a 10 percent share in future years.


Medicaid bill is SB509.


Senate: https://www.senate.mo.gov .


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