How are companies helping with Medicaid?

    As the United States wrestles with the devastating Coronavirus (COVID-19), and as Missourians’ expectations of their hospitals continue to increase, I find it ironic that MO HealthNet is proposing major cuts in Medicaid reimbursement of approximately $340 million annually to Missouri hospitals. This includes major revisions in Medicaid outpatient payments, as well as the elimination of Medicaid payments to Missouri hospitals for treating out-of-state enrollees (even though they are mandated to do so).


    Amidst all the state government’s conversation about promoting and enhancing rural health care, MO HealthNet continues to neuter the Missouri Medicaid program with additional reimbursement cuts and by refusing to pay millions of dollars to Missouri hospitals for overdue Medicaid Rural Health Clinic Cost Report settlements as far back as Fiscal Year Ended 2014. This non-payment is creating cash flow issues for many Missouri hospitals that have provided the services over the past five years but cannot realize reimbursement for same from the State of Missouri.
    This disheartening phenomenon is occurring regardless of the reality that Missouri taxpayers are forced to pay three private managed care companies an aggregate of approximately $170,000,000 per month for Medicaid enrollees they simply administer. Rest assured these companies are paid on time, but they are proficient at denying and rationing medical services and/or stalling payment to the health care professionals who actually provide the patient care. They are not the ones investing millions of dollars in life-saving CT scanners, MRI units, and critical lab, therapy and rehabilitation equipment. Yet, Missouri hospitals are expected to survive on reimbursement of just pennies on the dollar. Many carry a charitable, not-for-profit designation.
    This cash flow problem is greatly exacerbated for hospitals by the fact that health care is the only industry in the United States still suffering from sequestration. This two percent reduction has been imposed by the federal government on Medicare reimbursement until 2025.
    With regard to the Missouri Medicaid situation, there are three important questions that need to be considered in Jefferson City and by the public. 1) Has anyone audited these managed care Medicaid companies to see if they are performing according to contract? 2) Have there truly been any cost savings realized by the State because of these added for-profit “middlemen?” 3) Are Missouri Medicaid enrollees medically benefiting from this complicated process and additional red tape?
    If officials in Jefferson City want to see more hospital closings and further decline in Missouri’s rural health services, they will continue down this path. I for one do not agree and am advocating for preserving our health care delivery system. It’s a sad day when our State government is more concerned about paying private, for-profit managed care companies than taking care of the medical backbone of our health care system and communities.
    I hope you have a wonderful week! As always, please do not hesitate to reach out with any questions, concerns, or suggestions you might have. I can be reached by email at This email address is being protected from spambots. You need JavaScript enabled to view it. or by phone at 573-751-0246.
Rep. Jim Neely
District 8

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