Bill > SB961

This bill expands MO HealthNet, Missouri's Medicaid program, to include individuals aged 19 to 64 who are not otherwise eligible, provided they meet specific income requirements (at or below 133% of the federal poverty level plus an additional 5%) and qualify under federal guidelines (42 U.S.C. 1396a(a)(10)(A)(i)(VIII) and 42 CFR 435.119). Beginning January 1, 2017, these individuals will receive a "health benefits service package," which refers to benefits covered by MO HealthNet as determined by the Department of Social Services to meet federal benchmark coverage requirements. Importantly, reimbursement rates for providers serving these newly eligible individuals will be comparable to commercial insurance payment levels, with the higher rates only applying to this specific group. The bill also outlines conditions under which this expanded eligibility could be discontinued, including if the federal medical assistance percentage (a key funding component) drops below 90% or if the General Assembly votes to discontinue eligibility after receiving information from the MO HealthNet oversight committee and the Department of Social Services regarding costs, savings, and health outcomes. The MO HealthNet oversight committee is tasked with researching potential cost savings and revenues associated with this expansion, investigating the federal funding threshold for maintaining eligibility, and exploring options like capped cost-sharing, expanding coverage for state-financed services, and enrolling individuals in private health plans.