JEFFERSON CITY, Mo. -- Gov. Jay Nixon led a three-front charge Tuesday to expand Missouri's Medicaid program, meeting privately with reluctant state senators, rallying publicly with hundreds of disability advocates and chatting with the nation's top health-care official about whether particular Medicaid proposals could win federal approval.

Nixon, a Democrat, has made Medicaid expansion under the terms of President Barack Obama's health-care law his top legislative priority this year, despite resistance from a Republican-led Legislature over expanding eligibility to as many lower-income adults as envisioned by the federal law.

Seeking potential areas of compromise with GOP lawmakers, Nixon said he spoke by phone Tuesday with U.S. Health and Human Services Secretary Kathleen Sebelius about how much flexibility Missouri might have to change its Medicaid program and still receive full federal funding under the 2010 federal Affordable Care Act.

Sebelius has said the law requires states to expand adult Medicaid eligibility to 138 percent of the poverty level to qualify for full federal funding for the first three years, and a gradually reduced 90 percent federal share after that. Nixon said he wasn't asking Sebelius to reconsider that decision, though a Republican bill pending in the Missouri House would seek that.

Nixon said his conversation with Sebelius was intended "to make sure that we're operating in a right area when we talk about 'triggers' and 'sunsets' and co-pays and promoting responsibility and these market-based approaches" to Medicaid. "I want to make sure that we're staying in real time with what other states are doing."

Nixon wants to include a clause in Missouri's legislation that would automatically trigger an end -- or sunset -- to Missouri's Medicaid expansion if the federal government failed to follow through on its pledge of enhanced funding. Other proposals embraced by Nixon and included in a bill by Rep. Jay Barnes, R-Jefferson City, would require co-payments from Medicaid recipients and offer incentives for them to make cost-conscious health care decisions such as visiting a primary care doctor instead of an emergency room.

The governor met privately about Medicaid last week with the House Republican caucus, the first time he had done so since becoming governor in 2009. He met with the Senate Republican caucus Tuesday and then later with the Senate Democratic caucus.

Senate President Pro Tem Tom Dempsey, R-St. Charles, said Nixon "gave his most persuasive argument to date to the Republican caucus as to why he believes we need to move forward on Medicaid expansion." Nixon said he answered about two dozen questions from Republican senators during "a really substantive, thoughtful discussion" that lasted about an hour.

But there was no immediate agreement on a Medicaid expansion.

Whereas Nixon says a Medicaid expansion could improve both the health of Missouri's residents and its budget, Republican lawmakers are concerned that it could cost the state in the long run and consume money that might otherwise go to education.

"He makes a very emotional argument that the state should take the federal money," said Senate Appropriations Committee Chairman Kurt Schaefer, R-Columbia. But "there is a cost to this expansion going forward ... What I want to know is where is that money going to come from? Because I am not willing to issue a blank check."

Between talking to Republican and Democratic senators, Nixon spoke to several hundred disabled residents and advocates rallying at the Capitol. Nixon encouraged them to press lawmakers to support a Medicaid expansion. If Missouri skips the chance to expand Medicaid, Nixon said the state would become like a town from the 1860s that shunned the railroad or a city from the 1960s that said "no" to an interstate highway and thus no longer is vibrant.

"This moment for us is that inflection point on health care. It is that important," Nixon said. "The states that move forward -- and most states are, regardless of partisan politics -- are going to have the advantage. And we won't."

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