Cathy Brown didn’t see this coming.
Brown, the director of public policy for disability advocate Paraquad, knew Missouri was facing a tough budget year. She also knew tough decisions would be made that could affect people with disabilities.
But Gov. Eric Greitens’ plan to end state-funded care for more than 20,000 disabled Missourians nearly left her speechless.
“People are shocked, and people are scared,” she said. “There’s a lot of uncertainty right now.”
Greitens included the change in his proposed $27 billion state budget. He hopes to save $52 million by requiring people to display more severe disabilities to qualify for in-home care or nursing home services.
The result: More than 20,000 people could lose those services.
“This would be absolutely devastating to people with disabilities around the state,” Brown said.
So far, Greitens hasn’t spoken about the proposed cut. He didn’t mention it in his budget speech Thursday afternoon, nor in a video his office released Friday. And Greitens didn’t respond to several requests for comment by The Star.
But the cut to aid for the elderly and disabled does line up with a major policy priority of Republicans entering the 2017 legislative session:overhauling the state’s rapidly expanding Medicaid program.
With President Donald Trump in the White House, and GOP majorities in Congress exploring changes to Medicaid at the federal level, Missouri Republicans are more confident than ever that they’ll get the chance to put their vision for the program in place.
“We could fix the Medicaid system in a handful of years in this state, if only given the opportunity to do so,” Assistant Senate Majority Leader Bob Onder, a St. Charles County Republican, told the press last month.
According to acting state Budget Director Dan Haug, lawmakers budgeted $10.3 billion for Medicaid in the current fiscal year that ends July 1. The governor’s proposed budget calls for $10.7 billion in Medicaid spending in the next fiscal year.
Medicaid in Missouri covers low-income seniors, people with disabilities, children, pregnant women and very low-income parents — those making less than 19 percent of the federal poverty level, or roughly $4,000 a year for a family of three.
The majority of Medicaid funding comes from the federal government. According to the liberal think tank Missouri Budget Project, for every dollar Missouri spends on coverage, the federal government provides $1.72.
About one in six Missourians is on Medicaid, with children making up 63 percent of recipients. But a vast majority of Missouri’s Medicaid costs — roughly 65 percent — come from care for the disabled and the elderly.
Lawmakers and the governor have pointed to the growth of Medicaid spending as the biggest issue facing the state’s budget. And they’ve vowed to work to reduce those costs.
“Medicaid is an entitlement program, where states have an open-ended commitment to match federal spending,” said state Sen. David Sater, a Cassville Republican. “That has resulted in runaway spending that is going to bankrupt this state.”
Sater is sponsoring legislation set to be debated in the Senate that would seek a waiver from the federal government allowing a dramatic overhaul of Missouri’s Medicaid program. The intent is to seek a block grant that would provide the state greater flexibility on how to spend federal dollars.
President Barack Obama’s administration was loath to grant waivers to states unless they expanded eligibility for Medicaid. But under Trump, Sater says the likelihood is high that Missouri would get a waiver to overhaul the program.
Critics of the approach say a block grant would mean the amount Missouri receives from the federal government would not be tied to the actual cost of care. If costs exceed the money allotted, they argue, the state would either have to dip into its own revenue to cover health care costs or find ways to ration care.
“Medicaid has traditionally had lower administrative costs than private insurance,” said Jeanette Mott Oxford, executive director of Empower Missouri. “Why not build on the strengths of the program instead of engaging in a dangerous experiment?”
Mott Oxford says that while Medicaid costs are rising, that’s not why the budget is in bad shape.
In recent years, lawmakers have passed a $600 million income tax reduction that has yet to kick in; a $127 million phase-out of the corporate franchise tax; and a change in how corporations allocate profits that has reduced tax collections by $200 million.
During that same period, lawmakers cut the lifetime limits for Missouri’s cash assistance program for the poor; implemented strict work requirements making it harder to qualify for food stamps; and reduced the number of months someone who was laid off can receive unemployment benefits.
“Missouri has made a series of tax and revenue policy decisions that endanger the adequacy of state revenue and make it very hard to fix the problems,” Mott Oxford said.
As for Greitens’ proposal to cut the in-home care program, disability advocates expressed fear and dismay Friday.
“The budget seems to be targeting people who rely on the system in order to live independently,” said Michael Riley, public policy specialist for The Whole Person.
Carol Hudspeth, executive director of the Missouri Alliance for Home Care, said she’s “deeply concerned about the impact the reduction of services will have on the elderly and disabled.”
Brown said the changes included in Greitens’ budget may save the state money in the short term. But in years to come, the state will end up spending more money because the changes will cause a “greater institutionalization of people with disabilities.”
“If a bunch of people get kicked off this program that helps them remain independent in their homes,” she said, “their health and function will deteriorate to the point where we will eventually end up paying for nursing home care.”
The state’s budget is now in the hands of state lawmakers, who Brown said she trusts will do the right thing for people with disabilities.
“I have a lot of faith that the General Assembly will take a more measured approach,” she said, “to ensure we’re not ripping apart the safety net for some of the most vulnerable people in our state.”