JEFFERSON CITY, Mo. (AP) -- Some Missouri Republicans have
remained adamantly opposed to expanding Medicaid to hundreds of thousands of
adults by tapping into billions of federal dollars available under President
Barack Obama's health care law.
Yet support has been quietly growing among some of those
same Republicans for a mini Medicaid expansion.
Some Republicans have teamed up with Democrats to back a
proposal that would double the amount of assets people could have without being
disqualified for Medicaid coverage. The change is projected to expand Medicaid
to nearly 8,200 elderly and disabled residents at an eventual annual cost of
around $160 million in combined federal and state funds.
"I think it will cross the finish line. I think we will
change those asset limits," said Sen. Dan Brown, a Republican from Rolla
who is chairman of the chamber's health committee.
Brown's support for the higher asset limits is notable
because he's one of more than half of a dozen Republican senators who have
vowed to block any attempt to enact the larger Medicaid expansion envisioned
under Obama's health care law.
Under that federal law, states initially can receive full
federal funding - but eventually must pay a 10 percent share - if they expand
Medicaid eligibility to adults earning up to 138 percent of the poverty level,
which is nearly $33,000 for a family of four.
About half of the states have adopted the expansion.
Missouri could reap more than $2 billion annually from the federal government.
But Missouri Republicans have repeatedly said "no." This past week,
some GOP senators derailed debate on a Medicaid overhaul bill out of a fear
that it could be amended to include Medicaid expansion.
One of the things tucked into that bill was the proposed
increase in Medicaid asset limits. But none of the debate focused on that
provision.
Under a 1968 law that remains in place today, senior and
disabled residents cannot qualify for Medicaid if individuals have more than
$1,000 of assets, or $2,000 for married couples. That calculation excludes the
home they live in but not the money needed to repair the roof. A vehicle
similarly would not count toward the limit, but the money needed to repair the
transmission would.
A lot of other things have changed in the 46 years since
those asset limits were last adjusted. If the limits had kept pace with
inflation, they would now stand at more than $6,700 for an individual and
nearly $13,500 for married couples.
Missouri's low limits mean the disabled and elderly must
essentially drain their bank accounts in order for Medicaid to cover in-home
care services that can help them remain self-sufficient and out of nursing
homes, said Andrew Lackey, a public policy analyst for the Missouri
Developmental Disabilities Council.
"You can't accrue savings to deal with unforeseen
emergencies," Lackey said. "The rest of society is encouraged to
save, but we have a system that discourages saving."
This past week, Lackey helped lead a disability rights rally
at the Missouri Capitol. There wasn't much discussion of expanding Medicaid
eligibility under Obama's health care law. Instead, participants were lobbying
for higher asset limits and Medicaid coverage for adult dental care.
A bipartisan Senate health committee has twice endorsed
bills this year that would raise the asset limits to $2,000 per individual and
$4,000 per married couple. It included the provision in a larger Medicaid bill
now stalled in the Senate. It also endorsed the change as a stand-alone bill.
Legislative researchers estimate the higher asset limits
could cost a total of $125 million in 2015, with more than $30 million coming
from state general revenues and the rest from federal and other sources. That
total is projected to rise to $163 million by 2017, with nearly $40 million
coming from state general revenues.
"I'd have concerns about the cost," said Senate
Appropriations Committee Chairman Kurt Schaefer, R-Columbia, whose panel is to
begin work Monday on the next state budget.
Sen. Rob Schaaf, an appropriations committee member, said he
believes raising the asset limits ultimately could save the state money by
helping to keep people out of nursing homes.
"I don't want to expand Medicaid," said Schaaf,
R-St. Joseph. But he added: "I would support that" higher asset
limit.
For Brown, the quest to raise the asset limits has become
personal. His 84-year-old father has been paying out-of-pocket to reside in an
assisted-living center for the past three years. Within the next six months,
he's likely to run out of money and may have to apply for Medicaid, Brown said.
"I wish he could have a greater asset limit when it
gets to that point," Brown said. "I personally would love to see it
raised."
Author: David Lieb
Associated Press
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