Lawmakers should fix Missouri’s social services, not affix blame
The Missouri Legislature, having systematically gutted the state’s Department of Social Services, now says it’s operating so poorly that there’s no way it should be given the extra responsibility of running an expanded Medicaid program.
The hypocrisy is staggering.
The Legislature will adjourn Friday. For the third straight year, it will have failed to extend Medicaid health care coverage under the Affordable Care Act. This is costing the state about $1.5 billion a year in federal health care dollars, to say nothing of the jobs that money would pay for, never mind the well-being of adults in households earning up to 138 percent of poverty level — about $27,700 for a family of three.
Estimates from researchers at Harvard and the City University of New York are that 700 Missourians a year will have died prematurely because of the failure to expand Medicaid. If the Legislature fails to act again next year, the total number of premature deaths will reach 2,800. This is not quite as many as died in the Sept. 11, 2001, terrorist attacks.
In the two previous years, legislative leaders have mostly blamed this failure on the first three syllables in “Obamacare.” This year there’s a new wrinkle: Blame the problems at the DSS.
“There doesn’t seem to be any progress or remedial action taken on fixing the problem we have in service,” House Speaker John Diehl, R-Town and Country, told the Post-Dispatch’s Jordan Shapiro. “Why would we add more (eligible people) if we can’t take care of the current ones?”
In a rational world, the proper response would be: Fix the problems. Then people who need help are taken care of. In Jefferson City, the response is to cut budgets, whack jobs, make things worse and then say, “Look how horrible things are.”
The social services department, which administers the Medicaid program, food stamps, Temporary Assistance for Needy Families and other safety-net programs, is a mess. It’s been that way for decades. But rather than fix it, lawmakers — Republicans and Democrats alike — have treated it at best with benign neglect and at worse with outright hostility.
Poor people, you know. Welfare cheats.
Federal auditors last month reported that DSS had overbilled the federal government by $34 million and had failed to file for rebates from drug manufacturers.
Waiting times for certification for various programs have mounted, apparently causing some applicants to just give up. The feds say Missouri has overbilled for treating people with developmental disabilities and passed out $27 million in benefits to dead people.
Nearly all of these problems are paperwork issues, and the paperwork involved in social services is substantial. Somehow other states seem to manage it. Not Missouri.
Democratic Gov. Jay Nixon, who has boasted about the number of state jobs he’s cut since taking office in 2009, bears a lot of the blame. As demand for services increased, the number of people charged with providing those services decreased by about 1,200.
Mr. Nixon “reorganized” the department, hiring outside contractors to run phone and data processing centers. Another outside contractor may be hired to verify the eligibility of applicants for programs.
Outsourcing would make sense if it made things run more smoothly. It hasn’t. However, outside contractors can make campaign contributions.
Consider Centene Corp. of Clayton, which employs 10 lobbyists and which in the last two years donated more than $325,000 to Missouri politicians. Centene makes its money managing health care programs for 23 state governments.
In Missouri, Centene has 15 percent of the business of providing managed care services for Medicaid patients in 53 counties and the city of St. Louis. Patients who want services have to see providers who have contracted with Centene or two other managed care companies.
Centene has long yearned to expand to the rest of the state, even in counties where there aren’t many health care providers and where doctors might be reluctant to accept the managed care companies’ terms.
Rather than getting a lawmaker to sponsor a bill and have it vetted in a set of hearings, Centene persuaded state Sen. Kurt Schaefer, R-Columbia, to slip the change into this year’s appropriations bill for the Department of Social Services. Mr. Nixon signed the bill last week. Mr. Schaefer is planning to run for attorney general next year, apparently on a help-the-rich, soak-the-poor platform.
It’s a sweet deal for Centene, but not quite so sweet as it might have been. A last-minute change required the managed care providers to pay doctors who aren’t members of their networks.
The managed care firms got 200,000 new customers. The state might save a few bucks, but DSS says managed care doesn’t work too well with Missouri Medicaid patients, and besides, the federal government pays most of the $1.2 billion that Missouri spends on Medicaid managed care.
Meanwhile, the budget bill cut social service programs 4 percent to 6 percent across the board and reduced spending by $40 million. Oh, and the bill eliminated 76 more social services jobs. That ought to improve things.