Money to expand Medicaid left out of Missouri House budget

JEFFERSON CITY | Gov. Jay Nixon's request that lawmakers accept $900 million in federal money to expand Medicaid to an additional 260,000 people has not been included in the first draft of the House budget.

But that doesn't mean the discussion is done.

House Budget Chairman Rick Stream, a Kirkwood Republican, said he had to file a version of the budget today, and he made the decision not to include funding to expand the public health insurance program for the poor.

"But it can be added back by the committee, by the full House or in the Senate," he said. "This is not the end of debate. It's just the beginning."

Republicans are still looking at the idea of Medicaid expansion, Stream said, to see if there is a way forward.

"It's still very early in the process," he said.

The federal health care law, known as the Affordable Care Act, calls for an expansion of Medicaid to cover millions of low-income residents who can’t afford insurance. The federal government would pay the additional cost initially, with states picking up 5 percent beginning in 2017 and 10 percent by 2020.

The expansion in Missouri would eventually cover an additional 300,000 adults earning up to 133 percent of the federal poverty level.

Nixon, a Democrat, included $900 million of federal funds in the budget proposal he unveiled last month. Additionally, the governor's budget factored in an estimated $46 million in savings and increased revenue resulting from the Medicaid expansion.

Republican lawmakers, who hold veto-proof supermajorities in the House and Senate, have been less than enthusiastic about Nixon's plan.

Last week, a Republicans pointed to a report by Moody’s Investors Service that said because of the amount of federal money included in the state budget, any downgrade in the federal government’s credit rating would likely mean a downgrade in Missouri's as well.

Adding more federal money into the budget could make that even more likely, they argued.

Meanwhile, Nixon has been touring the state to build support for the idea, arguing Thursday that state mental health care services could suffer if Republicans reject the additional federal funds.