Missouri Mental Health Advocate Not Optimistic About Medicaid Managed Care

Missouri’s next budget assumes an expansion of Medicaid managed care, but not everyone believes it will make things better for beneficiaries.

According to published reports, Dr. Chuck Hollister of the Missouri Psychological Association told a legislative committee he questions where private contractors will find savings to pay themselves.

“Your Medicaid providers haven’t received an increase in reimbursement in 25 years,” he said. “There is no money left for managed care to earn a living on. When you talk about managing care, there’s nothing to manage.”

Under the plan, an estimated 200,000 Medicaid beneficiaries are scheduled to move into managed care; the blind, elderly, and disabled will be exempt. Other speakers told the legislative panel that low reimbursement rates keep providers from taking Medicaid clients, and even critics of Medicaid have decried waits of 3 months or more to see certain specialists. But others say there are plenty of providers in Missouri’s system.

Missouri is an anomaly in the Medicaid landscape. It is 1 of only 3 states led by a Democrat that has not expanded Medicaid, as permitted by the Affordable Care Act. The question of whether to expand remains a volatile issue, with Republican candidate for governor Catherine Hanaway vowing to fight any attempt to expand “Obamacare” but decrying the “gaps” it has left for rural hospitals.

Those gaps, in fact, are the result of the loss of federal funds to cover the cost of uncompensated care; those funds have declined around the country on a schedule that assumed states would expand Medicaid to those earning between 100% and 138% of the federal poverty line.

In Missouri and elsewhere, business and hospital leaders have pushed for expansion but run into opposition from legislators opposed to anything that evokes support for the ACA. Broader use of managed care, which was already afoot, has been seen as a way to control costs, both in expansion and non-expansion states.

Earlier this month, Missouri lawmakers largely ignored a report from the White House that spelled out the benefits of Medicaid expansion in the state. Without expansion, the report said, the state stands to waive $1.37 billion in federal dollars in 2016; with expansion, Missouri could cover an additional 191,000 uninsured and vastly increase the number of residents eligible for mammograms, cholesterol screenings, and treatment for depression.