Audit: Medicaid Program Rife With Problems

Posted on by Patrick Ishmael

At this point, it goes without saying that Missouri’s Medicaid program has issues. From technical snafus to indisputable quality and access problems, the state’s Medicaid program has a long track record of failure that should dissuade responsible lawmakers from compounding the problem with an expansion of the program.

This fact is made all the more obvious by this story, reported last week.

Missouri’s Medicaid program could have recovered as much as $27 million from more than 30,000 estates of deceased patients but did not file claims in time, according to a statewide audit of federal programs released Tuesday.

Federal and Missouri laws allow the state to recover Medicaid funds spent on a participant as a state debt but a claim against the person’s estate in probate court must be filed within a year of their death. Of 9,321 cases closed in fiscal year 2014 by the MO HealthNet Division, an average of $15,000 was recovered from 6 percent of those, according to the audit.

The $27 million estimate is based on a similar estimated recovery rate for the 30,000 cases that were past the deadline to file. . . .

According to the audit, “MHD personnel indicated there are not sufficient staff in the Probate and Estate Unit to process all probate estate cases timely and cases are not prioritized in an effort to maximize recovery.” The department says it will work to fix the problem but that response is a recurring theme in audits of Missouri’s Medicaid program.

Indeed, there were more problems uncovered by the audit that a short news story frankly can’t get to, including documentation, oversight, payment, and coding problems. In fact, the sentence construction of “As noted in X previous audits” dots the report’s summary. In other words, many of these are enduring, not passing, problems.

If you believe in good government, the department’s semiannual refrain of “We’ll do better next time” should be intolerable. The solution isn’t growing the program; it’s fixing it. There are ways to make the Medicaid program in Missouri better. Expanding a broken status quo is not one of those ways.

How Dangerous Is an Unlicensed Music Therapist?

Posted on by Brittany Wagner

800px-Musicoterapia_lmidiman_flickr

Legislators will ask themselves this question tomorrow when they consider House Bill 189. Music therapy is a type of treatment that involves creating, singing, moving, or listening to music. It is often used to treat children with developmental disabilities such as Autism. While groups like the American Music Therapy Association seek to elevate the status of music therapists, it is unclear whether or not obtaining a license would actually help a music therapist become more effective.

The Southeast Missourian reported that supporters of music therapy say that untrained music therapists are harming clients. The article did not discuss what kind of harm was being inflicted. It’s difficult to imagine that the creation of music could ever be harmful. Still, Missouri legislators are considering a bill that will make people obtain a special certification to practice music therapy.

As Show-Me Institute analysts have pointed out, certifications create unnecessary barriers to entry, ultimately limiting access for consumers to important services. Studies on occupational licensing have shown that when the government institutes a program like the one House Bill 189 is proposing, the cost of services increases.

Sending Out Subsidies Until the Cows Come Home

Posted on by Michael Rathbone

Missouri has a long history of spending on items of dubious merit. That’s why my stomach shouldn’t curdle when the legislature approves spending on something that seems udderly ridiculous. Yet still it does.

milkingLast week, the legislature approved the Missouri Dairy Revitalization Act, which, among other things, would provide up to 70 percent reimbursement  to dairy farmers who pay their federal Margin Protection Program insurance premiums. The total estimated cost to Missouri taxpayers is between $2 million and $5 million a year. That’s a lot of moolah.

Now, I have nothing against dairy products or dairy farmers, but I am wary awarding state subsidies to agriculture, even if it’s for insurance premiums. Why can’t the private sector provide insurance for dairy farmers? Why is the state supplementing this federal program? Are the premiums too high? If so, shouldn’t that be a warning sign that there is something wrong with the federal program itself? I am genuinely curious, but if we end up getting cheesy answers from proponents of this legislation, then it shouldn’t be enacted. Legislators have better things to do than cowtowing to agricultural special interests. Unfortunately, this bill already has passed the legislature, and by overwhelming margins. Currently, it’s awaiting the governor’s signature, so there is a decent chance this bill will soon become law.

I want Missouri to have a thriving dairy industry, but surely there are butter ways to spend taxpayer money. I know this might sound tired, but a whey better option would be across-the-board tax cuts for businesses. If everybody, including dairy farmers, were allowed to keep more of their money, things like dairy insurance would be more affordable and the government wouldn’t be giving special handouts to favored industries.

New Kansas City Rideshare Rules Need a Rethink

Posted on by Joseph Miller

Kansas City has proposed new for-hire vehicle regulations that are designed to allow ridesharing companies like Uber and Lyft (also known as Transportation Network Companies [TNCs]) to operate. Uber has cried foul over the new rules and threatened to pull out of the Kansas City area altogether. Lyft has expressed guarded optimism. The city holds that revised regulations are fair and designed to protect the public.

The draft ordinance allows TNCs to apply to operate, free of charge, in Kansas City. Drivers for the TNCs must have insurance, pay a $250 annual permit fee, a $44 inspection fee, and get the medical permission to drive. If the TNC agrees to pay $10,000 to the city, individual drivers need only pay $150 annually, and they do not have to pay an inspection fee if they can provide proof of a state inspection.

Paying $294 to drive for Uber or Lyft may not sound like a lot, but the majority of ridesharing partners drive less than 15 hours a week. The higher the permit costs and ancillary requirements, the fewer drivers will be available. One might ask why, if Kansas City permits the overarching ridesharing company (who is required to perform background checks and carry insurance), the individual drivers need city permits at all? At a hearing on possible state regulation of TNCs, a representative from Kansas City’s Regulated Industries Division gave an answer to that question. The representative stated that even though the city could enforce existing safety laws it could take considerable time and effort. It is more effective for the city to be able to pull a driver permit at will. The representative worried that without the permits, the city “won’t have anything to regulate.”

TNCs aside, the proposed taxi regulatory changes are completely disappointing. Taxi permits are still capped at 500 (applicants must have at least 10 cabs to apply). Prices are still regulated, private bus routes are still illegal, and apparently Kansas City is still protecting customers from drivers wearing jogging suits. How long do Kansas City officials think that highly regulated segment of the market will last in competition with (even hampered) TNCs?

The horror!
The horror!

While Kansas City may be changing the name of its taxi code to “for hire vehicle code,” they are a long way from a holistic, safety-driven approach to transportation regulation. Control is still paramount for city officials, and balkanized market controls pervade the code. If officials go forward with changes as they are, they will likely cause instability and a need for further changes in the future.

Finally Some Agreement: Get Corporations Off the Dole

Posted on by John Wright

These days it seems like our political discourse has become more polarized. However, there are some issues we all can agree on. Corporate welfare, the practice of subsidizing big business at the expense of everyone else, is one of those issues. This week, the American Federation of State, County and Municipal Employees (AFSCME) published a piece blasting big business for accepting generous corporate welfare packages.

aFrom the release:

Boeing, a top recipient of federal grants, tax credits, loans, loan guarantees and bailout assistance, received more state and local subsidy money than any other company. In 2013, Boeing got the largest tax break awarded to a single company in any state’s history: $8.7 billion, an enticement for the company to build its 777X plane in Washington state. The company told state lawmakers it would pursue other options if it didn’t receive a sweet deal from the Legislature, along with concessions from workers.

My colleagues at the Show-Me Institute have written about corporate welfare packages directed at Boeing before. See Exhibit B:

With free-market think tanks and government unions both critical of corporate welfare, it’s surprising that the states haven’t done a better job of addressing issues like TIFs, tax credits, tax abatements, enterprise zones, public stadium funding, et cetera.

Depending on who you ask, Missouri is one of the top states in corporate welfare. I hope we can all agree: This needs to change.

Low Alcohol Regulations Benefit Missouri Business

Posted on by Joseph Miller
photo by Caitlin Hartsell
photo by Caitlin Hartsell

Over the weekend, I visited a whiskey distillery, StilL 630, in downtown Saint Louis. The owner and operator of the company talked about why he chose to set up in the city. Missouri’s reasonable alcohol regulations were one factor that made his business possible. In Missouri, unlike many other states, a brewer or distiller of any size can produce, sell, and distribute their own product.

The ability of a company to sell and distribute its own product seems like common sense, but that right is under attack in neighboring states. For example, just last Friday, Kentucky enacted a law that bans breweries from distributing their own products. This law, which legally protects three-tiered beer sales, was a blatant attempt to protect independent alcohol distributors and may force companies like Anheuser-Busch to sell its Kentucky distributors. Missouri has flirted with these types of regulations in the last couple years. As Director of Development (and former Policy Analyst) David Stokes wrote in 2013 regarding SB 412:

I recognize that the rules for alcohol distribution have been in place for a long time, but that is not a justification in 2013 for new rules that prevent a maker of alcohol from simply having an ownership interest in a distributor of alcohol. . . . I can imagine no market failure or public good problem that this proposed law would address. The point here seems to be the preservation of existing distributorships and the limiting of competition. . . . Simply put, the government should not mandate the use of a middleman.

Missouri’s reasonable alcohol regulations promote small-business creation, helps large companies operate efficiently, and can ultimately benefit the consumer. Missouri should hold onto that advantage and resist any temptation to move in the direction of Kentucky’s legally enforced three-tiered system.

Is School Consolidation an Issue of Local Control?

Posted on by James V. Shuls

Which Missouri school district spends the most money per pupil? If you guessed the Clayton School District, you’d be wrong. Clayton ranks sixth. Brentwood? Wrong again. Brentwood ranks 14th. At nearly $26,000 per pupil, the highest-spending district in the state is Gorin R-III; enrollment 19. If this shocks you, it shouldn’t. Eight of the 10 highest-spending districts per pupil are small districts with fewer than 100 students. In all, Missouri has 62 districts with fewer than 100 students.

Whereas larger districts often benefit from economies of scale—fixed administrative costs can be spread out over a large student body—small school districts do not. This naturally leads to higher costs per pupil; costs that many of these small districts could not bear were it not for additional state support for small school districts.

This is exactly the reason for House Bill 1292. Based, in part, on school consolidation in Arkansas, House Bill 1292 calls for the consolidation of school districts with an enrollment of less than 350 students. The Arkansas consolidation law came from a 2003-04 special session specifically targeted at fixing the state’s education funding system. Consolidation of small districts was seen as a way to save money on administrative costs.

The idea of school consolidation is sure to cause some arguments in the state capitol. Indeed, some believe it is an attack on local control of schools. However, when roughly 45 percent of funding comes from the state, as it does for the average district with fewer than 350 students, there may be a strong argument that the state has a considerable interest in the financial well-being of Missouri’s small school districts.

 

Rank District Enrollment Current Expenditure Per Average Daily Attendance
1 GORIN R-III 19 $25,931.71
2 CRAIG R-III 66 $21,812.23
3 MALTA BEND R-V 74 $19,355.81
4 BRECKENRIDGE R-I 72 $19,133.25
5 LESTERVILLE R-IV 250 $17,406.10
6 CLAYTON 2,587 $17,394.30
7 NORTH DAVIESS R-III 70 $16,764.86
8 CAINSVILLE R-I 88 $16,510.60
9 COWGILL R-VI 25 $16,483.03
10 BOSWORTH R-V 80 $16,135.35

 

Charter Schools: From B to A

Posted on by Brittany Wagner

Missouri has made significant gains in its use of charter schools as educational options. Recently, the state earned a B grade on a charter school report card, ranking 12th strongest out of 43 charter laws. By comparison, Missouri’s charter law is better overall than many other states, but the demand for charter schools still outweighs the supply.

charter school rankings

According to the guide, most schools reported waiting lists of nearly 300 students each. The table below shows how many students transferred out of both charter schools and public schools during the 2013-14 school year. The low percentage of students transferring out of charters is an indication that waiting lists remain populated.

 

Students Transferring Out of Public and Charter Schools
  Total Enrollment Transferred Out Percentage
Kansas City Public Schools 15,627 2,441 16%
St. Louis Public Schools 25,200 8,070 32%
Kansas City Charter Schools 10,159 587 6%
St. Louis Charter Schools 9,219 444 5%

 

The availability of seats is affected by the number of new charter schools that open. Currently, Missouri charter schools do not receive any money for school facilities. In order for Missouri to become a grade-A charter school state, shifting some public funds is just one helpful reform.

There are other areas where Missouri can show improvement. For example, the charter law could be expanded to allow charters to more easily open in accredited and provisionally accredited districts.

B’s may be “above average,” which is better than where Missouri usually finds itself, but the Show-Me State is capable of much more.

Are Things Looking Up in Kansas?

Posted on by Michael Rathbone

Ulysses_grant_001There is an old story from the Civil War that takes place after the first day of the Battle of Shiloh. The Union Army of the Tennessee under General Ulysses S. Grant had been surprised by Confederate forces and had been pushed back to the Tennessee River. That evening, Brigadier General William Tecumseh Sherman remarked to General Grant, “Well Grant, we’ve had the devil’s own day, haven’t we?” Grant replied, “Yes. Lick ’em tomorrow though.” With the assistance of Union reinforcements that evening, that’s exactly what they did.

Now, the economic border war is not nearly as serious as actual combat between two opposing armies, but like Confederate General P.G.T. Beauregard, opponents of the tax cuts in Kansas are eager to declare a complete victory. The truth is that it appears Kansas just received some reinforcements, this time from the Bureau of Labor Statistics (BLS).

1024px-Pgt_beauregardAccording to the BLS, Kansas private-sector job growth in 2014 surpassed that of Missouri (1.87 percent vs. 1.16 percent). Also, earnings in Kansas have grown nearly five times the rate that they have in Missouri (2.98 percent vs .59 percent). Does this mean we, as tax cut proponents, should declare victory? No. The next couple of months’ job or wage figures could change how the two states stack up. Overall, I think we just need more time to determine the tax cut’s effects. I definitely wouldn’t go as far as to say that these tax cuts are leading Kansas toward a disaster of biblical proportions.

As I’ve said many times, tax cuts are not everything. There are many factors that influence how an economy performs. However, with that being said, taxes do matter and income taxes in particular are harmful to economic performance. I hope these latest figures can give opponents a moment of pause before writing Kansas’ tax cut obituary.

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