By Jodi Stefanick

A Kaiser Foundation study indicates Missouri leads the nation in Medicaid spending growth over the past decade. Averaging 16 percent in annual growth, Missouri's Medicaid program has expanded faster than any other state's program.

State government now measures compassion by the number of people added to welfare rather than the quality and access to health care. This focus on quantity rather than quality jeopardizes funding for those who cannot care for themselves.

Here are some important facts about House Bill 1566:

Welfare accountability -- The bill restores Medicaid welfare accountability by returning spending decisions to elected leaders rather than unelected judges. Gov. Bob Holden brought this concept to legislators last year. The bill requires that optional Medicaid services follow the same budget process established for nearly all other areas of state spending, including education. Changes in funding would only occur if the House, Senate and governor all agree to increase or decrease dollars for an optional service.

Program integrity -- Medicaid was designed to help Missouri's most vulnerable. System failures allow some to legally gain access to taxpayer-funded health coverage through loopholes. More disturbing is that our Medicaid system currently fails to comply with federal regulation that requires the administration to annually verify that Medicaid welfare recipients are actually eligible.

HB 1566 builds on Holden's initiative to restore Medicaid program integrity by requiring annual eligibility verification.

Welfare loopholes -- New practices are emerging in which lawyers are helping Missourians hide hundreds of thousands of dollars in assets and sign up for Medicaid. This annuity loophole diverts dollars from the most vulnerable. Lawyers are legally abusing the system.

Fair treatment -- Holden has proposed ensuring fair treatment for all Medicaid recipients. Currently, elderly and disabled Missourians seeking Medicaid coverage can have no more than $1,000 in assets with several exemptions.

Our state's Children's Health Insurance Program allows a family of five earning up to $66,090 that has $250,000 in assets to gain access to taxpayer-funded health insurance for their children. Holden has proposed reducing the amount of allowable assets to $25,000 and make the exemptions consistent with what is in place for the elderly and disabled. HB 1566 would place Holden's proposal into law.

Personal investment -- Holden proposed asking Medicaid recipients to bear a small portion of the costs associated with taxpayer-funded health care that they receive by paying nominal co-payments that do not exceed $3 for services. Federal law prohibits states from requiring Medicaid recipients that earn $3,000 monthly from paying more than $150 a month in health care.

HB 1566 accepts Holden's recommendation. The bill also expands current premium and co-payment requirements for CHIP insurance coverage in a reasonable and measured approach.

The critics -- Critics of HB 1566 have used scare tactics so that the entitlement mentality of welfare recipients will be protected. Despite their rhetoric, HB 1566 does not cut programs for the elderly or disabled, mental health or in-home care services, emergency transportation, hearing aids, wheelchairs or prosthetic limbs, care for autistic children or psychiatric services to children.

Medicaid expansion has not increased the quality of care for the truly needy. Adding 140 recipients a day has put the program on the verge of collapse. This bill is a reasonable and measured approach toward ensuring that our highest priorities, including education funding, will be protected.

Jodi Stefanick of Ballwin, Mo., is the state representative from the 93rd District. She is vice chairman of the Health Care Policy Committee and a member of the Appropriations Subcommittee for Health, Mental Health and Social Services, the Special Committee on General Laws and the Professional Licensing and Registration Committee. She was chairman of the 2003 Interim Committee on Medicaid Cost and Containment.