Reject a mismanaged Medicaid proposal in Missouri

Health care oversight for Medicaid patients is too important to rush through the Missouri General Assembly.
Health care oversight for Medicaid patients is too important to rush through the Missouri General Assembly. Bloomberg

A hasty and ill-timed attempt to make a major policy change regarding how to oversee health care services for about 200,000 Medicaid recipients in Missouri requires a quick burial.

In the early hours of Wednesday morning, Republican Sen. Kurt Schaefer succeeded in pushing through a plan to extend the use of for-profit companies to manage Medicaid in much of the state’s rural areas.

The full Senate narrowly sent the managed care idea on to the House as part of a $26 billion annual state budget. That’s where it should die.

Schaefer’s rationale — this is all about using privatization to “rein in welfare growth” — is misguided and mean-spirited. If his measure remains, Gov. Jay Nixon should veto it.

Sen. Rob Schaaf, of all people, is right this time. We noted last year that the Republican senator from St. Joseph had “an outspoken contempt for people in need of government help.” Yet during the long debate on managed care, Schaaf correctly said it was wrong to slip this change into the budget without public hearings. That’s where the managed-care companies’ claims could be vetted and challenged.

Missouri Hospital Association officials and a report from the Department of Social Services both question the quality of services provided by managed care. Legitimate concerns also exist about how the change could affect hospitals’ abilities to get federal matching funds while treating Medicaid patients.

As we have seen with KanCare in Kansas, moving to a managed care system for Medicaid is complex and deserves a thorough review before taking action. KanCare’s record in its first 18 or so months of existence into late 2014 was mixed. Positively, few low-income families complained of being denied services. Emergency room visits dipped.

But families of some patients with traumatic brain injuries were angry and fearful about proposed cuts in assistance, while families of developmentally disabled patients were concerned about future care, too. KanCare also has suffered from late payments of claims submitted by hospitals, nursing homes, doctors, pharmacists and other health care providers. Long term, no one knows yet whether the managed care companies will make money without cuts in service.

If Missouri wants to convert to managed care as part of Medicaid expansion, similar to what Arkansas did, that would be a different story. But even that should be carefully worked out.