Bill > SB648

This bill expands MO HealthNet, Missouri's Medicaid program, to include individuals aged nineteen to sixty-four who are not otherwise eligible, starting January 1, 2017, provided they meet specific federal income guidelines of up to 133% of the federal poverty level plus an additional 5%. This expansion is based on federal regulations (42 U.S.C. 1396a(a)(10)(A)(i)(VIII) and 42 CFR 435.119) and will provide them with a "health benefits service package" that aligns with benchmark or benchmark-equivalent coverage as determined by the Department of Social Services. Importantly, providers serving these newly eligible individuals will be reimbursed at rates comparable to commercial insurance, with these higher rates applying only to this specific group. The bill also includes provisions for discontinuing this expanded eligibility if the federal medical assistance percentage drops below ninety percent or if the General Assembly votes to do so, requiring the MO HealthNet oversight committee and the Department of Social Services to provide financial and health outcome information to the legislature before such a vote. The MO HealthNet oversight committee is tasked with researching potential cost savings and revenues associated with this expansion, investigating a federal matching rate threshold for maintaining eligibility, and exploring options like capped cost-sharing, expanding coverage for state-financed services, and enrolling individuals in private health plans.