Missouri set to reform Medicaid, boost doctor pay

Washington -- Missouri physicians' Medicaid payment rates would climb a little now and maybe a lot later under legislation passed by the General Assembly last month.

The fiscal year 2008 state budget bill includes $25 million to increase Medicaid physician payments from about 44% to 55% of Medicare rates.

Also, a comprehensive Medicaid reform bill would require the state's Medicaid agency to create a plan to raise Medicaid pay to match Medicare rates by 2012. About $86 million more is needed to achieve that goal.

The budget and Medicaid bills were still being reviewed by Missouri Gov. Matt Blunt. Tom Holloway, director of governmental relations for the Missouri State Medical Assn., said Blunt is expected to sign them because the governor championed Medicaid reform. Blunt has until July 14 to decide. The MSMA supported the Medicaid increase but did not take a position on the reform bill.

The Medicaid measure is expected to cost between $178.5 million and $287.9 million, said Jim Uffman, interim director of the Missouri Dept. of Social Services' budget division.

Medicaid reform has been a back-and-forth issue in Missouri. Legislation adopted by the General Assembly in 2005 created a Medicaid reform commission and required lawmakers to reauthorize the state's Medicaid program by June 30, 2008. Missouri has about 825,000 Medicaid enrollees, including 484,000 in the State Children's Health Insurance Program.

The new bill satisfies the reauthorization requirement. But 2005 eligibility cutbacks and re-qualification requirements for enrollees shrunk the program by about 95,000, said Sara Anderson, Missouri Dept. of Social Services spokeswoman. In a sense, this year's reforms are expected to reverse that loss by adding about 98,000 people to Medicaid and SCHIP, mostly through the addition of about 82,000 enrollees to a health program for uninsured women.

The Medicaid bill also would create a pay-for-performance committee. Half of its members must be physicians. The measure would require the Dept. of Social Services to create and administer health improvement plans for all beneficiaries by July 2011 and would establish an oversight committee to manage Medicaid overall.

Missouri has about 700,000 uninsured residents out of a population of 5.8 million, according to Census Bureau estimates.

A compromise on payment

The Missouri House and Senate had very different ideas on how to improve Missouri's Medicaid program.

The House version would have paid physicians at the Medicare rate to improve access to doctors, while the Senate version included more managed care and a card system allowing Medicaid patients to collect points for showing up on time to office visits and meeting other basic standards. Points would have been used to acquire additional health benefits.

Final-hour negotiations produced a bill that would give Medicaid enrollees a choice of managed care plans but includes no cards and calls only for a plan to increase physician pay and a study of Medicaid enrollees' access to physicians.

Connie J. Cunningham, executive director of the Missouri Academy of Family Physicians, spoke positively of the bill's preventive care and medical home provisions.

Corinne Walentik, MD, MPH, president of the Missouri Chapter of the American Academy of Pediatrics, said the measure didn't go far enough. "It still leaves much to be desired in terms of accessibility for children."

The bill was a plus overall, but more work on the Medicaid physician access -- especially specialists --is needed, said Joseph Pierle, executive director of the Missouri Primary Care Assn., which represents 19 federally qualified health centers serving 310,000 patients. "We can give everybody in the country an insurance card, but if they can't get in somewhere, what's the point?" Pierle said.

Missouri physicians, by accepting Medicaid patients at about 44% of Medicare rates, provide the Medicaid program with between $250 million and $300 million each year in subsidies, said Rep. Rob Schaaf, MD, a family physician and a Republican who was a lead negotiator of the final version of the legislation.

The bill could be the first step to fixing that problem, he said. "Hopefully in five years it will mean that no longer in Missouri will providers lose money every time they see a Medicaid patient."