Washington, D.C. – A report released today found that the proposal (SB 577) to replace the current Medicaid program for aged, blind, and disabled individuals that was introduced in the Missouri state legislature in February of this year will have serious consequences for Missouri’s most vulnerable Medicaid recipients.
The report, released by the consumer health organization Families USA, examined the key issues of the bill—how it would affect individuals currently enrolled in Missouri’s Medicaid program and the pitfalls of this approach. The report found that, without proper implementation, this legislation could have catastrophic consequences for many Medicaid recipients, especially for the chronically ill and people with special health care needs.
In 2005, more than 100,000 Missourians lost their Medicaid coverage, and more than 300,000 people were affected by service reductions. Not only were these cuts some of the largest by any state in history, but the state legislature also agreed to end Missouri’s Medicaid program by June 30, 2008.
“At a time when most state economies are strong, including Missouri’s, and many states are expanding Medicaid and making great strides at covering their uninsured populations, SB 577 is a step backwards and does not even restore the grievous Medicaid cuts that hurt so many people” said Ron Pollack, Executive Director of Families USA.
The Missouri legislature must come up with a plan to either extend the sunset date or replace the program. The proposal to replace Missouri’s current Medicaid program builds on plans unveiled by Governor Blunt in January 2007, and SB 577 incorporates some new—and very troubling—ideas not seen in either of the earlier plans.
The report questions why these cuts are not being restored now that the governor is reporting that the economy in Missouri is “strong, prosperous and vibrant” and that “the days of economic uncertainty are in the past.”
The report also found that one of the biggest problems with the legislation is that it is extremely vague, and it gives unelected bureaucrats too much license to determine the most critical details. It underscores the dangers of moving the most vulnerable Missourians to private plans, which may be ill-equipped to handle their health care needs.
“This population is extremely diverse and has many different kinds of special and complex health care needs,” said Pollack. “Therefore, real effort needs to be made to ensure that these individuals do not fall through the cracks.”
This group includes not only the elderly, but people with physical and developmental disabilities, people with severe mental illness, and people who are dually eligible for Medicare and Medicaid. Many of these individuals require a variety of medical and supportive services from multiple providers in a range of settings.
If these individuals fall through the cracks during the transition to managed care and suffer a lapse in care, real harm could result. “Without access to their medications, people with mental illness could end up homeless. Without access to regular therapy or daily medications, people with chronic physical illnesses could be denied essential and timely care and seek care in the emergency room, which would ultimately be much more expensive for the state” said Pollack.
The report identifies key concerns with SB 577. The bill will move all Medicaid recipients, including all elderly and people with disabilities, to private insurance plans called “health improvement plans.” Concerns include:
- Under SB 577, the elderly and people with disabilities will be automatically enrolled in one of these health improvement plans, but it is unclear whether their specific health care needs will be taken into account when they are enrolled. They may also be assigned to a plan that does not include their current physician.
- These populations have complex health care needs and require a variety of medical and supportive services from multiple providers in a range of settings. SB 577 provides no protections that the new plans will have adequate networks and experience to handle these specialized needs.
- For people with disabilities, ensuring access to appropriate specialty care is extremely important. Missouri has a shortage of providers in many regions of the state, including the types of specialists needed to treat people with disabilities and the elderly. There are no provisions to address this problem under the new health improvement plans in SB 577.
- SB 577 creates “health care advocates” who will make important decisions about the type of care individuals will receive and could create a barrier between individuals and their physicians making health care decisions together.
