Directors address Medicaid overhaul

A new Medicaid system will seek to make disease prevention and the use of the most cost-effective treatments a priority while trying to serve a population that is sicker and older than the state as a whole, top officials from Missouri agencies that operate the program said Friday.

A group of about 75 health-care providers, ranging from administrators to surgeons to a few users of the program, listened to a presentation from George Oestreich, deputy director of clinical services for the Division of Medical Services, and Joseph Parks, medical director of the Missouri Department of Mental Health.

The two-hour session was the second meeting of PARE, or Providers Assuring Rehabilitation Efficacy, a think tank that had its origin in conversations between Rep. Nathan Cooper and Dr. Joel Ray, a Cape Gir?ardeau neurosurgeon.

Missouri lawmakers are debating whether to accept a proposal from Gov. Matt Blunt's administration to replace the Medicaid program with a proposal called MO Healthnet. Under the proposal, participants would choose a primary provider who would coordinate all medical care and receive credits for optional services by taking part in programs designed to keep patients healthier.

But while they explained the program, Oestreich and Parks pointed out some of the obstacles. The state serves about 826,000 people through Medicaid at a cost of about $6 billion a year. But about 20 percent of the total, mostly disabled and the elderly, consume about 80 percent of the money spent.

The number of participants is down from about 992,000 in 2005, when lawmakers enacted changes that dramatically lowered the income threshold for enrollment to save about $1 billion.

And the rate of common illnesses among Medicaid recipients is much higher than the general population, they noted. Medicaid participants suffer from congestive heart failure or chronic breathing diseases such as emphysema at almost three times the rate of other Missourians.

MO HealthNet would use managed-care organizations and administrative service contractors to help control costs, Oestreich said. "The philosophic basis of reform is to deliver services on the basis of need and monitor the costs," he said.

But some users of the system see problems with the changes.

Vicki Abernathy said she needs help to stay in her home. A small increase in her Social Security disability payment of $30 resulted in a higher monthly charge for her government-subsidized housing, a smaller monthly food stamp allotment and increased spending requirements to keep her Medicaid. She said the result is she could be forced into a nursing facility, at a much greater cost to the state.

"I am going to lose my home and be forced into an assisted-living situation," she said. "It is ludicrous. Why would we want to put everyone in a nursing home?"

The new program isn't designed to force that outcome, Parks and Oestreich said. The proposal hopes to keep people as independent as possible.

"I am sure there will be something that will substantially meet people's needs," Parks said.

The meeting helped clarify for providers that the overhaul of Medicaid will make it easier for them to treat patients, not harder, Cooper said. "This was a good explanation of MO Healthnet to those who provide care," he said.

rkeller@semissourian.com

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