Negotiators agree on Medicaid cuts

JEFFERSON CITY, Mo. -- Occasional eye exams are in, but not the glasses. Motorized wheelchairs will be covered, but not the batteries to run them.

That's the real-life effect for thousands of Missourians under a budget plan agreed to Monday by legislative negotiators that cuts the services available through the state's Medicaid health-care program.

All told, the budget would eliminate Medicaid coverage for a projected 90,604 low-income parents, seniors and disabled over the next year. Numerous others would be forced to pay more out of their pockets through premiums, copayments and personal medical expenses.

And hundreds of thousands of adults remaining on Medicaid would have their benefits cut. Besides eye glasses and wheelchair equipment, the state also would stop paying for such things as dental care, hearing aids, canes, crutches and rehabilitation therapies.

The proposed budget for the fiscal year starting July 1 adopts many -- but not all -- of the Medicaid cuts originally recommended by Republican Gov. Matt Blunt. The final version of the budget must be passed by the House and Senate by Friday.

Blunt and majority Republican lawmakers contend the health-care cuts are necessary to balance a roughly $19 billion budget that increases school funding without raising taxes. They claim the Medicaid program -- covering 1 million people at a cost of more than $5 billion annually in state and federal funds -- has grown to an unsustainable size.

The budget generally spares children, pregnant women and the blind from the cuts.

But the families of some children could have to pay new premiums to participate in the Mc+ for Kids health-care program. And the adoptive parents and guardians of an estimated 2,043 former foster children would lose monthly state subsidies.

Most of the Medicaid cuts would be accomplished by lowering how much people could earn to qualify for coverage.

For example, a single mother of two currently can earn up to $12,068 annually while receiving Medicaid coverage. Her children can be covered under the Mc+ for Kids program even if she earns three times that amount -- a threshold unaffected by the budget cuts.

But under the budget proposal, that mother could qualify for Medicaid only if she earned less than $3,504 annually -- or about $67 a week.

An elderly or disabled individual currently can qualify for Medicaid while earning $9,570 annually. The budget would lower that $8,135 annually.

Blunt had proposed an even lower income threshold for the elderly and disabled. Legislative budget negotiators adopted a Senate plan to restore part of that cut, but rejected another Senate proposal that would have restored part of the cut to low-income parents.

"I realize there is a lot of need, but I want to make sure we focus on those most in need," said Rep. Jodi Stefanick, R-Manchester, one of the lead architects of the Medicaid budget. "I think there is a greater need with the disabled and elderly than with an able-bodied adult."

But some cuts still would affect the disabled. For example, the budget eliminates funding for a program that has allowed the disabled who work as little as one hour a month to keep their Medicaid coverage even though their incomes exceed the eligibility cutoff.

Critics said some cuts to particular Medicaid services seem illogical. The budget would allow adults to go to the eye doctor once every two years, but wouldn't pay to correct any vision problems.

"If we're agreeing to do the eye testing but not the glasses, it's almost all for naught," said Rep. Yaphett El-Amin, D-St. Louis.

Jim Tuscher, who uses a wheelchair but is not on Medicaid, criticized the budget's elimination of coverage for such things as wheelchair batteries, foot straps or seat cushions.

"Some people have sensitive seating issues. If they're not dealt with, they'll end up with pressure sores" that could be life-threatening, said Tuscher, vice president of public policy at Paraquad Inc., a St. Louis not-for-profit that provides independent living services to the disabled.

Stefanick said legislators decided to fund the highest priority Medicaid services -- in addition to wheelchairs, such things as home oxygen equipment, insulin for diabetics, artificial limbs and ambulance transportation.