SS SB 539 -- HEALTH CARE AND SOCIAL SERVICES PROGRAMS

SPONSOR:  Purgason (Stefanick)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
General Laws by a vote of 5 to 3.

This substitute changes the laws regarding health care and social
services programs, including the Missouri Medicaid Program, the
Missouri Rx Plan, and personal care assistance programs.

MISSOURI MEDICAID PROGRAM

The substitute reduces income levels for eligibility for medical
assistance and eliminates some optional services, including
medical assistance for the working disabled and general relief
medical assistance, and lowers the income level of parents of
uninsured children in the MC+ for Kids Program that are required
to pay a premium from 226% to 151% of the federal poverty level.
The Family Support Division within the Department of Social
Services is required to conduct annual income eligibility and
verification reviews of all recipients of medical assistance.
The division must send a re-verification form letter annually to
recipients and require the recipient to respond and provide
income verification documents within 10 days.

The substitute changes the division of assets procedure for the
purposes of determining eligibility for Medicaid when one spouse
enters a nursing home and the other spouse remains in the
community.  Currently, resources that are allocated to the
institutionalized spouse can be diverted to the community spouse
to provide an income stream for the community spouse.  The
substitute requires an institutionalized spouse to divert income
to the community spouse to raise the community spouse's income to
the level of the minimum monthly needs allowance.  The diversion
of income must occur before the community spouse is allowed to
retain assets in excess of the community spouse's protected
amount described in federal law.

For purposes of determining Medicaid eligibility, investment in
annuities is limited to those that are actuarially sound, provide
equal payments for the duration of the device, and provide the
state secondary or contingent beneficiary status.  The department
must establish a 60-month look-back period to review any
investment in an annuity by an applicant for Medicaid benefits.
The department is allowed to enforce federal TEFRA (Tax Equity
and Fiscal Responsibility Act) liens on the property of
permanently institutionalized individuals, which include those
persons the department determines cannot reasonably be expected
to be discharged and return to the home.

Subject to federal law, the department is required to promulgate
rules that require recipients of medical assistance to
participate in cost-sharing activities for all covered services,
except for personal care, mental health, and health care for
uninsured children programs.  The cost-sharing provision will
also not apply to other qualified children, pregnant women, or
blind persons.  A health care provider may not refuse to provide
a service if a recipient is unable to pay a required fee.
However, upon approval from the department, a provider may
terminate future services to an individual with an unclaimed
debt, as long as it is the provider's routine business practice
and the provider gives advance notice and a reasonable
opportunity for payment to the individual.  The department is
allowed to apply for federal Medicaid waivers as necessary if the
cost to the state as a result of the waiver does not exceed an
additional $1 million.  The request for a waiver will not become
effective except by an executive order of the Governor.

MISSOURI RX PLAN

The substitute allows the Missouri Rx Plan to select one or more
prescription drug plans as the preferred plan for purposes of the
coordination of benefits between the Missouri Rx Plan and the
Medicare part D drug benefit.  The Department of Health and
Senior Services must give initial enrollment priority to
individuals who are eligible for both Medicare and Medicaid.  The
successive enrollment priority is Medicare eligible participants
with an annual household income at or below 150% of the federal
poverty level.

The plan is the payor of last resort and is meant to cover costs
to participants that are not covered by Medicare part D.  Persons
ineligible for coverage under the Missouri Rx Plan include
individuals qualified for coverage for prescription drugs under a
public assistance program other than the Medicare Modernization
Act, persons who are not considered dually- eligible, and persons
qualified for full coverage under another plan of assistance or
insurance.

Persons eligible for services under the current Missouri Senior
Rx Program on December 13, 2005, will continue to be eligible for
those services until January 1, 2006.  The provisions of the
current Missouri Senior Rx Program will expire following notice
to the Revisor of Statutes by the Missouri Senior Rx Program's
Advisory Commission that the Medicare Modernization Act of 2003
has been fully implemented.

PERSONAL CARE ASSISTANCE PROGRAM

The substitute transfers the Personal Care Assistance Program for
Disabled Persons from the Department of Elementary and Secondary
Education to the Department of Health and Senior Services which
will provide financial assistance to physically disabled persons
for personal care assistance services through eligible vendors.
The requirements for eligibility and annual eligibility review
are specified; and upon determination of eligibility, the
department must develop a personal care assistance services plan
for each disabled person.

Disabled persons receiving personal care assistance are
responsible for the supervision of the attendant, while the
vendor is responsible for the Medicaid reimbursement process,
including filing claims and mailing individual payments directly
to the assistant.

The services are not authorized if the primary benefit of the
services is to the household unit and the household may
reasonably be expected to share or do for one another when they
live in the same household.  A personal care assistant who is
listed on any of the Family Care Safety Registry's background
checklists cannot be employed unless a good cause waiver is first
obtained from the department.

The Department of Social Services will conduct hearings for the
personal care assistance program.

The duties of certain persons to report instances where it is
reasonably believed that a disabled person has been neglected,
abused, or their property or funds have been misappropriated are
specified.  The duties of the department's case manager to
investigate instances of abuse are also specified.  A mandated
reporter who fails to report abuse will be guilty of a class A
misdemeanor.  An employee disqualification list will be
maintained by the department for attendants who commit fraudulent
acts.

MISCELLANEOUS PROVISIONS

The substitute removes provisions specifying certain costs
reports for future nursing facility reimbursement rebasing that
were to be effective starting July 1, 2005, and then successively
on July 1, 2006, and July 1, 2007.

The Medicaid Reform Commission consisting of 10 members, five
from the House of Representatives and five from the Senate, is
established to study and review the current Medicaid Program and
make recommendations for reforms.  The directors of the
departments of Social Services, Health and Senior Services, and
Mental Health will serve as ex-officio members.  The commission
must make recommendations to the General Assembly by January 1,
2006, on reforming, redesigning, and restructuring a new
innovative healthcare delivery Medicaid system to replace the
current system which will sunset on June 30, 2008.

The substitute provides that the adoption subsidy may not be
granted to children who reside in a household with an income that
does not exceed 200% of the federal poverty level or who are
eligible for Title IV-E adoption assistance.

FISCAL NOTE:  Estimated Income on General Revenue Fund of More
than $93,730,236 in FY 2006, More than $43,242,069 in FY 2007,
and More than $20,140,292 in FY 2008.  Subject to appropriations.
Estimated Income on Other State Funds of Unknown in FY 2006, FY
2007, and FY 2008.  Subject to appropriations.  Oversight assumes
unknown revenues are greater than unknown costs.

PROPONENTS:  Supporters say that the bill will allow changes to
the Missouri Medicaid Program that will ensure the program keeps
up with changes in the delivery of health care and sets the
groundwork for implementing the prescription drug coverage
provisions in federal law.  There are several areas in the
Medicaid Program that can be improved to ensure that those who
need help are able to get it.

Testifying for the bill were Senator Purgason; Representative
Stefanick; Phil Melugin; Mary Mullings; Shelly Tripp; Sherry
Davis; Crystal Brown; and Rita Pearson.

OPPONENTS:  Those who oppose the bill say that it will result in
cost-shifting and will cause the loss of jobs in the state.  The
bill will put holes in the safety net for vulnerable populations.
There are other viable solutions other than cutting eligibility
or benefits which will result in declines in overall health of
Missourians.

Testifying against the bill were Representative Storch; Midwest
Foster Care and Adoption Association; AARP; Darren Mead; Susan
Remelius; Dawn Zeterberg; Paraquad; Missouri Association of
Osteopathic Physicians; Missouri NEA; Missouri Association of
Homes for the Aging; Tom Kruckemeyer; Missouri Budget Project;
National Epilepsy Foundation of America; Epilepsy Foundation of
America St. Louis Region; Epilepsy Foundation of America Kansas
and Western Missouri; Kathy Gerst; Donna Nichols; National
Alliance for the Mentally Ill of Missouri; Grass Roots
Organization; Metropolitan Congregation United-Greater St. Louis;
Marshelle Vickers; Shawn Vickers; Services for Independent
Living; Shawn Spradling; Shannon Aller; West Central Independent
Living Solutions; Independent Living Center Southeast Missouri;
Missouri Association for Social Welfare; Missouri Catholic
Conference; Alice Kitchen; and Andrew Haffner.

OTHERS:  Others testifying on the bill say it is a companion bill
to budgetary reductions.  Missouri is not the only  state
grappling with the increasing cost of the Medicaid Program.  Many
of the changes have been proposed in the past.  Moving the
personal care assistance program from the Department of
Elementary and Secondary Education to the Department of Health
and Senior Services will increase efficiency and consistency in
the delivery of services.

Others testifying on the bill were Department of Elementary and
Secondary Education; Department of Health and Senior Services;
Department of Social Services; and Mickey Wilson, Oversight
Division.

Amy Woods, Senior Legislative Analyst

Missouri House of Representatives
93rd General Assembly, 1st Regular Session
Last Updated August 25, 2005 at 1:21 pm