Doctor greeting patient
Patrick Ishmael

Although much of the legislative air has been consumed by Right to Work in the last few weeks, two other bills—both dealing in health care policy—are slowly making their way through the legislative process, and chances are good that our readers will hear quite a bit about them in the months ahead.

The first proposal, brought forth in the Senate, would request a "global waiver" from the federal government for Missouri's Medicaid funds. A global waiver would deliver federal funding to the state's Medicaid program without all the strings attached. Such a dramatic change in policy would allow for enormous flexibility for state legislators to craft a Medicaid program that can best help our state's most vulnerable citizens without the similarly enormous burden of federal regulations that currently bedevil the program.

This is how Fox 2 describes the idea:

A Senate committee heard testimony Wednesday on a bill that would direct the state Department of Social Services to seek a “global waiver” from federal Medicaid requirements to remake the state’s program.

Sponsoring Sen. David Sater says the intent is to ask the federal government to provide Missouri’s Medicaid money as a block grant, giving the state greater flexibility over how to spend it. Federal Medicaid dollars currently are provided on a matching basis for each state dollar that’s spent on health care services.

Translation: Missouri would decide how best to serve Missouri Medicaid patients. Crazy, right?

Now if the waiver sounds to our longtime readers a lot like the block grant idea we've written about in the past, that's because functionally, it is. Our full proposal would take the grant money and split it into HSAs for low-income beneficiaries, empowering them to make decisions about their health while simultaneously providing incentive for participants to save money and shop for care. These ideas are largely captured in the second bill I referenced in the introduction. That HSA idea is, of course, just one of many potential reforms to the Medicaid program that could happen under a waiver or block grant, so Missouri's plan could be different from plans agreed to in Florida, Illinois, or any other state. That's a feature of the block grant, and given that a block grant proposal is currently being floated by the President, we may soon have the opportunity to see the laboratories of democracy at work in an effort to provide and better-tailor care in the Medicaid program.

But to get there? The doors to those labs need to be thrown open, and that's where the waiver and block grants come in. I hope these ideas continue to work their way through the legislative process, as they are likely to be front and center during this legislative session—especially, as seems reasonably likely, if the federal government green-lights block granting of Medicaid from its end.

About the Author

Patrick Ishmael

Patrick Ishmael is the director of government accountability at the Show-Me Institute.