Blunt administration turnover among Medicaid worries

JEFFERSON CITY, Mo. -- It's somewhat like heading out to play the biggest game of the season with a radically different lineup.

Fans and critics don't know what to expect, and teammates could take some time to get comfortable with one another -- not the situation you'd want with the season on the line.

But it may be just what Gov. Matt Blunt's administration is facing as it prepares to unveil perhaps its biggest policy proposal to date -- a revamping of the Medicaid health-care program for the poor.

Since July, the directors of state departments of social services, health and mental health all have quit, as has the state Medicaid director himself. Two of the departures came in November alone.

The Republican governor has been working with the departments on his proposal to overhaul the state health-care system and plans to offer it to the legislature early next year.

Blunt has named new leaders for the Department of Social Services and the Department of Health and Senior Services, in both cases choosing people who had worked in the agency previously, along with an interim Medicaid director, a longtime agency employee. The Mental Health Commission is working to find a new director for that agency.

But legislators who served on the Medicaid Reform Commission last year spent many hours and meetings with those former directors and have raised concerns about the turnover in leadership just as the governor prepares to unveil the new plan.

"It is not going to deter us from moving forward to develop and implement health-care reform on behalf of the people of Missouri," said Senate President Pro Tem Michael Gibbons, R-Kirkwood.

"But it is a concern when all the department heads who participated in the Medicaid Reform Commission hearings are no longer there," he added. "I have called the governor and talked to him specifically about those concerns."

Gibbons said Blunt assured him that the plan will move forward because the department workers who know the details haven't changed.

"He feels like the people who know the nuts and bolts of their direction on reform are still in place," Gibbons said. "He assured me there is no reason to panic."

Although specifics are scarce, the new program is generally expected to put more emphasis on personal responsibility by patients and to include a new focus on preventing health problems, not just reacting to them.

Advocates for the poor are generally worried about what the new health-care program will look like, and say the change in department leadership is just another reason the idea shouldn't be rushed.

The governor and Republican legislative leaders want to move ahead next year. The current Missouri Medicaid program is to end by July 1, 2008. But others think the timetable should be extended to be sure the changes are the right way to go.

"People have to start over building relationships with each other, knowing who to talk to. This is happening at a critical point in development of a policy plan which is probably the most complex policy the state has," said Amy Blouin, executive director of the Missouri Budget Project, a St. Louis group that analyzes state fiscal issues for their effects on the poor. "It should be raising red flags about how fast people really want to move through reforms."

Rep. Margaret Donnelly of St. Louis, a Democratic member of the Medicaid commission, also expressed concerns that lawmakers will put a new system in place whether it's ready or not.

"My goal is to be sure that we have a program that's going to work and actually provide more coverage and more accessibility for people who don't have any other choices," Donnelly said. "Until we get some indication of what they plan to do it's hard to know whether we have a realistic timeline."

Lawmakers also say they have received no good explanations of why so many directors left in a short time.

But Blunt's office says legislators and the public should not be alarmed.

"There's no bigger concern and no reason for concern when truly, especially in regards to the new health care delivery system, this was a path defined by the Medicaid Reform Commission," Blunt spokeswoman Jessica Robinson said. "We are still headed down that path to a better medical system, regardless of who's sitting in the director's chair."

Countered Donnelly: "When you're dealing with something as significant as the Medicaid structure, it can be problematic to not have some of the same leadership from beginning to end."

Lawmakers and advocacy groups have voiced their concerns, while Blunt's office says there's nothing to worry about. All eyes will be watching how the new department leaders respond as they step up to the plate.

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Newswoman Kelly Wiese covers state government and politics for The Associated Press.