Medicaid: Time reveals the facts
January 24, 2006
This past legislative session the Missouri Legislature tackled several difficult issues – education, transportation, worker’s compensation, and many others. However, tugging at the heartstrings was the issue of Medicaid, a program intended to help the state’s poorest of poor – a program plagued with waste, fraud and abuse.
As of May, in a state of 5.5 million people, there were more citizens enrolled in Medicaid than there were students enrolled in our entire K-12 and public universities combined. The cost to the state was staggering and investigations found deceased individuals, people living outside the state and upper income families receiving Medicaid dollars and benefits.
Changes were made to address this waste, fraud, and abuse and the response of the media outlets like the Kansas City Star and St. Louis Post Dispatch began giving the public misleading information. However, the changes to Missouri statutes and the reform enacted have reaped the cataclysmic results many had come to fear.
Gov. Matt Blunt established a vision for transforming Missouri’s aged and antiquated Medicaid welfare program into a system that ensures protection for those with the greatest needs. Both the legislature and the governor saw the waste, fraud and abuse in Missouri’s Medicaid program, and saw that its course and path was unsustainable.
Failures by previous administrations have created loopholes allowing millionaires to access taxpayer-funded welfare benefits. Without change to Missouri’s Medicaid programs, legislators would have had to adopt a $350 million tax increase each year to keep pace with the program’s growth.
Amidst the changes made by the legislature, 900,000 Missourians are receiving taxpayer-funded welfare assistance through Medicaid.
Medicaid has seen unprecedented growth over the years. In 1968 the program comprised only 4% of the state budget. Today the program now comprises 26% of the state budget.
Media outlets like the Star and Post Dispatch distorted the truth to advance a personal agenda for socialized medicine in Missouri. The following is the truth:
• Reporters have falsely suggested that feeding tubes are being removed from Medicaid recipients. This is not true.
• Despite media reports, a medical exception process is in place to ensure that Medicaid recipients with a medical necessity for a feeding tube will be protected.
• Despite media reports, changes to the Children’s Health Insurance Program will not require any children to be removed from the program. Some additional parents will be asked to participate in nominal cost-sharing activities that will never exceed more than 5% of their family income.
• Assistance for the elderly, disabled and blind is being provided to 85% of the federal poverty level (FPL). This represents an increase over what was provided just two years ago, when the income limit was established at 80%.
• Wheelchairs, oxygen equipment, ambulance services, diabetic supplies, artificial limbs, hospice care, eye exams, and supplies will remain covered for those that receive Medicaid services.
Legislators created the Medicaid Reform Commission to transform Missouri’s antiquated Medicaid welfare system into a 21 st century program that is efficient, effective and fair. The Commission has been meeting around the state and collecting testimony and ideas from citizens, welfare recipients, care providers, and others about how to ensure sustainability and effectiveness of Missouri’s safety net.
The Commission is scheduled to present its findings soon.
What about real instances of abuse?
• Upon discovery that 1,862 Medicaid welfare recipients were receiving taxpayer-funded sexual enhancement drugs like Viagra and Cialis at a cost of nearly $500,000, the governor ordered the elimination of coverage for these drugs by Medicaid.
• Phil Melguin of Integrity Home Care testified of the need for preventing family members from being paid as personal care assistants. He gave the example of a patient for whom they had provided care. Her husband divorced her, moved into the garage and set up a “penthouse” including a hot tub. He then fired the independent care providers that had assessed his wife’s care needs at 20 hours a week and had been providing her those services. This allowed him to assume the role of her primary care giver and to be paid for 40 hours of work for providing those same care services to his wife. This significantly increased costs to the state. (source: “Testimony before the House Committee on General Laws,” March 30, 2005).
• A St. Louis County Department of Social Services worker testified that she recently randomly selected more than 400 CHIP cases for eligibility verification in December. Of those 400 cases, most had NOT been reviewed within the established yearly review guidelines. She found that nearly 50% of them should have been closed because of ineligibility. She then sent letters to each of those recipients indicating their case files would be closed and that they could appeal the decision. As of the date of her testimony to the Senate committee, NOT ONE single case closure had been appealed. (source: “Testimony before the Senate Committee on Pensions, Veteran’s Affairs, and General Laws,” March 7, 2005).
• Another Department of Social Services worker testified that one case in which she followed departmental rules and guidelines resulted in someone receiving Medicaid coverage, even though they had more than $160,000 in the bank. (Source: “Testimony before the House Committee on General Laws,” March 30, 2005).
• A Department of Social Services employee testified that she routinely handles cases in the Medical Assistance for Workers with Disabilities program that manipulate the system. She indicated the program was intended to provide an incentive for people to work in order to get taxpayer-funded assistance but that loopholes in the law allowed one of her clients to get access to taxpayer-funded benefits by walking his neighbors’ dog every other week for $5. (Source: “Testimony before the Senate Committee on Pensions, Veteran’s Affairs, and General Laws,” March 7, 2005).
These are just a few of the examples of waste, fraud, and abuse found in our system. Combine this with people living in Oklahoma, Kansas, and Arkansas receiving Missouri Medicaid dollars and you see that we are in desperate need of real reform.
Yet, amidst the reforms passed by the Legislature, public servants have not forgotten the important need to care for our poorest. As a part of the reforms to Missouri’s Medicaid system, some medical services were made options, i.e. they are not covered under the Medicaid system unless the following exception consideration criteria are met. The optional services pertain to durable medical equipment such as:
• Communication / speech devices
• Ostomy supplies
• Oxygen and respiratory equipment
• Canes and crutches
• Wound care supplies
• Diabetic shoe and inserts
• Nutrition for tube-feeding
• Commodes, bed pans, and urinals
• Hospital beds
• Patient lift trapeze
• Wheelchairs and accessories
• Orthotic and prosthetics
In order to meet the exception consideration criteria, requests must support and demonstrate one or more of the following conditions:
• The item or services is required to sustain the recipient’s life.
• The item or service would substantially improve the quality of life for a terminally ill patient.
• The item of service is necessary as a replacement due to an act occasioned by violence of nature without human interference, such as a tornado or flood.
• The item of service is necessary to prevent a higher level of care.
Missouri has not forgotten the poor and needy. We are making sure that every tax dollar that is used is used to help the the neediest of our state. We are also preventing citizens from taking advantage of this system and costing the state valuable resources needed to help the poor. We will continue to care for Missouri’s most vulnerable citizens and make Missouri a great place to call home.
These facts are important when addressing citizens who favored the former system. What they propose is socialism, regardless of how they term it. Our Democratic Republic was not founded on welfare, nor was that ever accounted for in the U.S. Constitution.
The Medicaid reforms passed by the Legislature have saved funds.
Here is another important fact: Nearly one million people are still served by Medicaid and health services. That is 20% of our population. The most needy and disabled are being taken care of.
Further, biblically we must, as Christians, hold our leaders accountable to be good stewards of our tax dollars.
Proverbs 20:10 says, “Differing weights and differing measures, both of them are abominable to the Lord.”
Proverbs 20:23 says, “Differing weights are an abomination to the Lord, and a false scale is not good.”
Our system of health care has been full of false weights, allowing people to cheat the system and essentially take resources from those that need it the most. The governor is working to restore stewardship and trust so that we can follow Scripture – Proverbs 19:17, “He who is gracious to a poor man lends to the Lord, and He will repay him for his good deed.”
As we seek to help the truly poor and disabled we must also remember Proverbs 10:4, “Poor is he who works with a negligent hand, but the hand of the diligent makes rich.”
The fact is we are helping the truly needy and poor in our state and working to stop waste, fraud, and abuse. Let us focus on being good stewards of that which God has provided. (Rep. Brian L. Baker, R-Belton, also is executive pastor, First Baptist Church, Belton.)