Missouri ‘Eases’ Effect of Medicaid ‘Spend-Down’ Policy Change

New rules regarding eligibility for Missouri's Medicaid program are set to take effect Oct. 1, the AP/St. Louis Post-Dispatch reports. To qualify for Medicaid, Missouri residents must have annual incomes that do not exceed 77% of the federal poverty level, or $6,828 for an individual. However, spend-down provisions allow people with incomes too high for Medicaid to qualify if their income minus medical costs equals 74% of the federal poverty level or less. Under previous rules, if a person incurred "enough medical costs in one day" to qualify under the spend-down provisions, the program covered all medical costs. However, "pressure from the federal government" prompted Missouri to change the program rules, the AP/Post-Dispatch reports. On Oct. 1, the 25,000 people who qualify under the spend-down provisions will have to pay -- "not just incur" -- their preliminary medical expenses, similar to paying an insurance deductible. Medicaid will pay for any further costs. However, some people with disabilities and seniors said the policy change could force them to go without needed medications and services such as personal care attendants. As a result, Gov. Bob Holden (D) on Sept. 20 announced that as of Oct. 1, the disabled, blind and elderly would qualify for full Medicaid benefits if their incomes did not exceed 80% of the federal poverty level, or about $7,094 for an individual. Under the new eligibility limits, nearly 4,600 people who previously qualified under the spend-down provisions would qualify for traditional Medicaid benefits and thus would not be responsible for initial medical costs. The state also will use existing funds from the mental health and health and senior services departments to help up to 8,200 of "the neediest people covered under Medicaid's spend-down program" with their initial medical costs. Linda Luebbering, budget director for the governor, said, "We realize that just changing 'spend-down' and not doing anything else was just not appropriate. We felt we needed to do a few things to make that transition easier." Steve Vaughn, a lobbyist for the Disabled Citizens Alliance for Independence, said, "Anything that we can receive in this area will be a help, no doubt," adding, "But this is still going to leave an awful lot of people in a real vulnerable position" (Lieb, AP/St. Louis Post-Dispatch, 9/22).