JEFFERSON CITY, Mo. -- Changes announced Friday to the state's Medicaid program could lessen the financial strain for thousands of disabled and elderly Missourians due to be affected Oct. 1 by a new Medicaid policy.

Advocates for the disabled, who held Capitol protests and raised concerns with Gov. Bob Holden, said the changes would help some, but do nothing for an equal or greater number of people.

The latest Medicaid changes, also to be effective Oct. 1, have the potential to help almost half of the roughly 25,000 people who receive Medicaid coverage under the so-called "spend-down" provision.

Pleas by the disabled convinced government officials that something needed to be done, said Holden's budget director, Linda Luebbering.

"We realize that just changing 'spend-down' and not doing anything else was just not appropriate," she said. "We felt we needed to do a few things to make that transition easier."

To qualify for Medicaid, most single adults can earn no more than 77 percent of the federal poverty level, or about $6,828 annually.

The "spend-down provision" allows people with higher incomes to qualify if their medical expenses reduce their available income to 74 percent of the federal poverty level -- $6,562 annually for an individual.

In the past, if people incurred enough medical costs in one day to qualify, then the Medicaid program would pay their full bill. The provision was used frequently by the disabled, who had regular bills for medications and personal care attendants.

Under pressure by the federal government, Missouri agreed to change its spend-down provisions Oct. 1 so that people must pay -- not just incur -- their initial medical expenses, much like an insurance premium. After that, Medicaid will pay any additional costs.

Some disabled people with large medical bills said the change could force them to give up medications, do without personal care attendants and move into nursing homes.

On Friday, Holden announced the state was raising Medicaid's income cutoff for the disabled, blind and elderly to 80 percent of the federal poverty level -- about $7,094 annually for an individual. The change would not affect married couples, whose eligibility level already was at 82 percent of the federal poverty level, Luebbering said.

About 4,600 people previously covered under the spend-down provision would become eligible for traditional Medicaid because of the change.

Holden's office said the Department of Mental Health and Department of Health and Senior Services also would use existing funds to provide services to the neediest people covered under Medicaid's spend-down program, or help them pay their medical bills so they can qualify for Medicaid.

About 5,000 people could be helped through the Mental Health Department and more than 3,200 through the health department, Luebbering said. Those figures could include some people who receive services from both agencies, she said.

"Anything that we can receive in this area will be a help, no doubt," said Steve Vaughn, a lobbyist for the Disabled Citizens Alliance for Independence, based in Viburnum. "But this is still going to leave an awful lot of people in a real vulnerable position.

"I think that there will be many of that remaining number that will be forced into institutions," mainly nursing homes, he said.

Vaughn said the group would continue to push for more Medicaid changes during the legislative session that begins in January. Among other things, the group wants Medicaid's income eligibility level to be raised to 100 percent of poverty.

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On the Net

Missouri Medicaid: http://www.dss.state.mo.us/dms