MO HealthNet Program Changes SFY 2008
Senate Bill 577 creates a new program that transforms Missouri's current Medicaid program to one which emphasizes personal wellness, prevention, and responsibility and increases access to healthcare for our most needy and vulnerable citizens. On September 1, 2007, the Department of Social Services, Division of Medical Services, the administrator of the federal Medicaid program in Missouri, begins its transformation by changing our name to the MO HealthNet Division. Some of the other major changes include the following:
Eligibility Enhancements
- Foster Care Children to age 21 — Effective July 2, 2007, extends medical coverage to former foster care children who lost coverage at age 18 and provides support for foster children as they transition into adulthood. Approximately 970 children will be affected.
- Income Disregard for Sheltered Workshop Employment — Income earned by individuals eligible for certified extended employment at a sheltered workshop will not be considered income in determining MO HealthNet eligibility. Approximately 1,604 Missourians will be affected.
- SCHIP Affordability Test — Changes affordability to 3% for 100-125% FPL; 4% for 126-225% FPL; and 5% for 226-330% FPL. This extends coverage to an estimated 6,350 children in Missouri, subject to appropriation.
- SCHIP Combination Program — Allows the state to pursue a combination MO HealthNet/SCHIP program based on the uncertainty surrounding SCHIP funding (new eligibles 3,450).
- SCHIP Affordable Insurance and Preexisting Conditions — Provides for affordable insurance to not include plans that exclude pre-existing conditions, subject to appropriation (new eligibles 2,353).
- SCHIP Children exceeding Annual Insurance Limits — Provides that children exceeding annual insurance limits for all health services are considered uninsured, subject to appropriation (new eligibles 1,367).
- Ticket to Work — Restores MO HealthNet eligibility to the working disabled who meet the eligibility requirements definition under the federal guidelines for Supplemental Security Income. Implementation of this program is subject to appropriation and is expected to affect 3,240 disabled Missourians, of which 1,930 will be new eligibles.
- Women's Health — Expands the uninsured women's health program eligibility
requirements to include all women 18-55 years of age at or below 185% of the
federal poverty level. It is estimated that an additional 81,788 women in Missouri
will be eligible for a limited health benefit.
- Drug Court — Individuals participating in drug court will have their MO HealthNet eligibility extended 60 days despite removal of a child/children from their custody. This program is subject to federal approval.
- Spenddown Deduction— Allows MO HealthNet participants who have paid requested spenddown amount and subsequently pays out-of- pocket costs to apply that expense to future spenddown amounts for up to three months from the date of the expense.
Uninsured Missourians Provisions
- Insurance Premium Offset Program — Authorizes a pilot program to assist low income Missourians in obtaining health care coverage, subject to appropriation.
- Long Term Care Partnership — Provides mechanisms to fund long term care through private insurance and MO HealthNet to allow future MO HealthNet participants to qualify for benefits.
Rate Increases
- Physician — Effective July 1, 2007 physician related services rates increased to approximately 55% of the Medicare rates.
- Home Health — Effective July 1, 2007 Home Health services received an increase of $0.48 to the per visit rate. A visit is a personal contact for a period of time, not to exceed three continuous hours, in a patient's place of residence.
- Nursing Facility — Increases nursing facility per diem rates approximately $9 per day.
- Ground Ambulance — Effective July 1, 2007 rates increased for ground ambulance services from $152 per trip to $177 per trip.
Service Restorations
- Dental and Optical Services — Extends medically necessary dental and optical benefits to eligible adults subject to electronic prior authorization and appropriation.
- Durable Medical Equipment — Extends durable medical equipment benefits to adult eligibles that is medically necessary based on best medical evidence, care, and treatment by establishing an electronic prior authorization system.
Quality of Care Provisions
- Pay for Performance — Establishes a Professional Services Payment Committee to develop and oversee a pay for performance program component linking financial incentives to evidence-based performance measures.
- Health Care Home — Provides funding for all MO HealthNet participants to be enrolled in a health improvement plan and provided with a health care home.
- Health Risk Assessment — Provides limited funding for health care home providers to conduct a health risk assessment for enrolled participants and develop a plan of care.
MO HealthNet Program Studies and Pilots
- MC+ — Actuarial study funded to expand managed care to an estimated 50,000 parents and children living in counties contiguous to the current managed care area.
- Nursing Facility Pilot Project — Funds pilot project for one or more skilled nursing facilities in Greene County to determine the cost and benefit to MO HealthNet program of Electronic Medical Records (EMRs) in a long term care setting.
- Physician Rate Increase — Mandates a study and development of a plan to increase physician related service fees to 100% of the Medicare rates over a four year period.
