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Access to women's contraception threatens Missouri Medicaid funding amid FRA fight

Mike Parson, Mike Kehoe
Posted at 3:05 PM, Jun 21, 2021
and last updated 2021-06-21 16:05:58-04

KANSAS CITY, Mo. — “Abortion language” is at the heart of a legislative impasse over extending Missouri’s federal reimbursement allowance, or FRA.

Gov. Mike Parson is expected to call a special session this week and force lawmakers back to Jefferson City to hammer out an FRA extension before the new fiscal year begins July 1.

The FRA is a critical funding mechanism for MO HealthNet, which is the state’s Medicaid program.

The FRA is a separate issue from the ongoing fight over funding for Medicaid expansion, which Missouri voters passed at the polls last August.

Expansion and the FRA are closely tied together, however, since the latter provides the bulk of the federal funding for Missouri’s low-income health insurance program for the working poor and their families.

Sen. Greg Razer, a Democrat from Kansas City, called the FRA “a technical piece of legislation that frankly people should never have a reason to know about.”

“It’s just how we draw down federal dollars,” Razer said. “It’s a nuts-and-bolts piece of legislation that got hung up this year because certain members of the majority party wanted to ban contraception for poor women in the legislation, which would put the entire program in jeopardy (and) would be against federal regulations. Plus, I’m just not comfortable telling poor women in Missouri that you can’t have birth control.”

The FRA is a tax paid by Medicaid providers — including hospitals, nursing homes and assisted-living facilities, pharmacies and other health care facilities — in Missouri.

The federal government more than matches the money generated, which is returned to the state to offset the cost of MO HealthNet.

The federal reimbursement allowance began in 1991 under then-Gov. John Ashcroft and is the third-largest source of revenue for the state of Missouri, according to the Missouri Hospital Association.

Sen. Mike Cierpiot, a Republican from Lee’s Summit, acknowledged that the FRA is a critical piece of funding — and one that can’t be allowed to lapse.

“We need to get the FRA resolved before July 1, for several reasons, and it’s much bigger than just new eligibility for the enhancement,” he said. “It covers nursing homes. It covers hospitals. It covers a lot of things, so we need to work to get that done.”

Cierpiot said in an interview last week that Missouri has something of a sweetheart deal with the federal government with respect to Medicaid funding, but one that the feds have signaled will be reworked if the FRA ever lapses.

An FRA extension passed the House of Representatives during the regular legislative session, but two Republican state senators — Sens. Paul Wieland, of Jefferson City, and Bob Onder, of Lake St. Louis — have led the opposition to renewing the FRA unless it includes language that forbids the use of Medicaid dollars for women’s contraceptive devices.

Wieland’s proposed language includes any drugs or devices “that may cause the destruction of, or prevent the implantation of, an unborn child.”

Effectively, it would prevent funding for birth control or the morning-after pill for women on Medicaid — a bridge too far for Democratic lawmakers.

“Those in power in Jefferson City have decided to play political games with the health care of Missourians,” said Rep. Maggie Nurrenbern, a Democrat from Clay County.

She called the GOP-backed effort to scuttle Medicaid expansion and hold up an extension of the FRA “a double crisis.”

Nurrenbern called the FRA “a basic tax that is fundamental to funding our Medicaid system."

"It is maddening that our tax dollars are being used to fight Missouri voters in court and pay for a costly special session instead of providing health care for our most vulnerable,” Nurrenbern said.

Democrats are quick to point out that the tax isn’t new, having been around for 30 years, but failure to extend it would require a tax hike or massive spending cuts to a wide range of state programs.

“This isn’t a tax on Missourians,” Razer said. “The hospitals provide that money that is our share of the Medicaid program. Then, the federal government more than matches that. It brings in about $3.5 billion to the state of Missouri, which now is in jeopardy if we don’t come back in special session and get that passed. That’s money that’s going to have to come out of education, higher education, all the other things that we do as a state.”

Rep. Ingrid Burnett, a Democrat from Jackson County and the Minority Caucus Chair, said failure to renew the FRA would blow a $3 billion hole in Missouri’s budget, which would “have to come out of our operating budget for State services” and jeopardize the state’s economic recovery after the COVID-19 pandemic.

“Now, more than ever, adequate health care may be the singular most important factor keeping people employed, employable, and productive,” Burnett said. “If we really want to see Missouri flourish, we should be providing the conditions that help her people be healthy.”

State lawmakers anticipated Parson would call a special session this week to work through the FRA with the July 1 deadline looming next Thursday.