Missouri House approves budget, no money for Medicaid expansion

Gov. Jay Nixon and other Democrats, as well as health care and business groups, have spent several months pushing for a federal Affordable Care Act-driven expansion of the health care program for the poor.

But the Republican-controlled House blocked multiple attempts this week to add the more than $900 million in federal dollars to the state budget proposal and expand eligibility to an estimated 300,000 Missourians.

The budget now goes to the GOP-controlled Senate for consideration and changes. The Legislature has until May 10 to adopt a final spending plan, which will take effect July 1.

Most of the budget priorities have garnered bipartisan support, so Medicaid expansion became the highlight of the budget debate on the House floor this week.

Republicans repeatedly have said they don’t want to take the federal money for Medicaid expansion without significant reforms to the program.

“The easiest decision would be for us to just hold our nose and take the handout,” said Rep. Caleb Rowden, R-Columbia.

House Republicans have been pushing alternative efforts that would include reforms to the system, but no such proposal was counted in the budget bills the House approved.

Under the federal Affordable Care Act, states can expand their Medicaid eligibility requirements to cover more people, and the federal government will pick up the full cost of new recipients for the first three years and most of the costs beyond that.

About 880,000 Missourians are enrolled in Medicaid, which has varying degrees of coverage here based on income. The federal proposal would set eligibility at 138 percent of the poverty level, or about $32,500 for a family of four or $15,800 for a single person.

“We all know that Medicaid is the signature issue of this body — of both chambers — this year,” said House Minority Leader Jake Hummel, D-St. Louis.

He said he hopes the money can be added as the budget moves through the process, but Senate leaders also have largely resisted the effort.

Other questions also remain. The House-approved budget relies on three separate bills that have yet to pass the Legislature this session, including a proposal to eliminate a tax credit program for elderly and disabled renters. Nixon called for ending the so-called “circuit breaker” tax credit in his budget proposal earlier this year, but other Democrats disagree.

“I think it’s a disservice to a lot of the senior citizens throughout the state of Missouri,” said Sen. Jamilah Nasheed, D-St. Louis. “At the end of the day, we should keep our hands off of children and the elderly.”

House Budget Chair Rick Stream said lawmakers would have to find $65 million to carve out of the House-approved budget proposal if that legislation didn’t pass this session.

The House budget includes a $65 million increase to basic education spending for school districts, but it is still several million short of fully funding the state’s K-12 foundation formula.

It also calls for a $20 million bump in funding universities and colleges and increases for mental health, including programs that benefit the developmentally disabled and alcohol and drug treatment services.

State employees would receive $500 pay raises — an attempt to address Missouri’s status among the nation’s lowest-paying states. Workers who make below $70,000 a year received 2 percent increases when the current budget took effect in July, after five years without across-the-board raises.One area where lawmakers pared back was in the Department of Revenue. House Republicans stripped $157,000 from the agency’s funding because of claims that the agency has been scanning and retaining personal documents that Missourians use to obtain drivers’ licenses. DOR has denied any wrongdoing.