Managed care expansion on track after vote in Missouri Senate

April 27--JEFFERSON CITY -- A bid to scuttle managed care health insurance programs in Missouri sputtered Wednesday as members of the Senate approved its version of a state budget.

Days after butting heads with Gov. Eric Greitens over attack ads being run by a nonprofit linked to the Republican chief executive, Sen. Rob Schaaf again dominated activity on the Senate floor. This time, in a failed attempt to stop a statewide roll-out of managed care.

Schaaf, R-St. Joseph, said he doesn't believe the managed care approach to health insurance saves money or provides better care for patients.

"There is a serious question whether it's going to save the state any money," Schaaf said. "There are a lot of reasons why we shouldn't expand managed care."

Schaaf, however, lost one key argument in his quest to kill off managed care when the federal government approved a special waiver needed to move forward with an expansion. A long-awaited letter outlining the approval from U.S. Department of Health & Human Services was issued Tuesday.

On a vote of 10-22, Schaaf's colleagues rejected his proposal, setting the stage for 750,000 Missourians to receive insurance via managed care companies on May 1.

The chairman of the Senate budget committee dismissed Schaaf's complaints as overblown.

"I have heard no complaints from patients. I have heard no complaints from doctors," said Sen. Dan Brown, R-Rolla.

Others said it would be irresponsible to eliminate an expansion when patients are set to be added to the program in just a matter of days.

"It throws them into mass chaos," said Sen. Caleb Rowden, R-Columbia.

Action on health care costs in the $27.8 billion budget came a day after the Senate approved the education portion of the spending plan by joining the House in fully funding the school aid formula.

The health care portion of the budget has a price tag of more than $9.5 billion.

Greitens had sought to raise the threshold for elderly and disabled Missourians to receive care as a way to save more than $50 million. He also called for a 3 percent reduction in rates paid to nursing homes and other Medicaid providers.

The House rejected that idea and instead approved a plan to avert those cuts by eliminating a tax credit benefiting about 100,000 elderly renters.

The Senate was unable to approve the House plan, leaving them to propose a compromise that will have to be reconciled with the House during talks next week.

But it was Schaaf's attacks on managed care that created the most fireworks.

Under managed care, private companies are paid a fee each month for each participant. That's opposed to a fee-for-service model in which health care providers are paid for each service performed.

Three companies, including Clayton-based Centene, provide managed care for most Medicaid recipients in 54 counties along Interstate 70. Beginning May 1, recipients in all of Missouri's 115 counties will be under managed care. Seniors and disabled people are not affected by the change.

For now, the House and Senate appear on track to have a budget on Greitens' desk by May 5. But, any delay in the timetable could set the stage for a special session dedicated to getting a spending plan in place for the fiscal year that begins July 1.

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