Missouri will enroll most adults who apply for expanded Medicaid services in a managed care plan, with an option to purchase employer-provided coverage if it makes financial sense.
That’s just two of the items in a draft plan for the program that begins July 1 posted online Thursday for public comment. The comment period ends Feb. 15.
The expanded program was approved by voters in August and Gov. Mike Parson is asking lawmakers to approve $1.9 billion to cover 275,000 people in the first year.
The Alternative Benefit Plan, which must be submitted to the Center for Medicare and Medicaid Services, is the state’s assurance to the federal government that all the essential health benefits included in the Affordable Care Act will be available to new enrollees.
Those benefits include hospital care, physicians visits, outpatient services including family planning services, prescription drugs and rehabilitation therapy.
The MO HealthNet Division, which oversees the Medicaid program, currently contracts with three companies to provide managed care plans for Medicaid clients.
“MO HealthNet is working closely with the contracted (managed care organizations) to ensure that networks are sufficient to accommodate additional participants,” the draft document states.
The Department of Social Services did not respond to a request for comment on the draft plan.
Under expanded Medicaid, people living in households with incomes 138 percent or less of the federal poverty guideline are eligible for coverage.
That is $17,774 a year, approximately the equal of working 33 hours a week at the state minimum wage of $10.30 per hour. For a family of three, the eligibility income will be $30,304 a year, which is equal to full time work for a year at $14.50 per hour.
As an alternative to managed care, enrollees who work for employers that offer health insurance could have their premiums paid by Medicaid. If the cost of coverage, including the anticipated out-of-pocket costs, are less than the cost of a managed care plan, the state will pay for enrollment.
“The program reimburses for premiums and cost sharing responsibilities,” the draft plan states. “There is no required contribution by the employer or the participant.”
The draft can be accessed here.
Comments may be submitted in writing by mail to the MO HealthNet Division, P.O. Box 6500, Jefferson City, MO 65102, Attention: MO HealthNet Expansion
Comments also may be submitted by e-mail to [email protected] Use “MO HealthNet Expansion” in the subject line.