JEFFERSON CITY, Mo. (AP) - Missouri Gov. Jay Nixon says he's open to many of the Medicaid changes sought by Republican lawmakers as part of a plan to expand health coverage to low-income adults.
In an unusual move, the Democratic governor met privately for about 45 minutes Wednesday with House Republicans at the Capitol.
Republicans have repeatedly defeated Nixon's plan to expand adult Medicaid eligibility to 138 percent of the poverty level, which is about $32,500 for a family of four. A Republican-led House committee was to vote later Wednesday on an alternative that adds fewer adults to Medicaid while injecting more private-sector competition.
Nixon said he's open to a private insurance model for Medicaid and to new co-payment requirements for participants.
States that expand to 138 percent of poverty can receive full federal funding.
Among the witnesses testifying for the Republican plan Monday in a House committee were officials representing medical clinics, hospitals and business groups. Some of those same people have stood by Democrats in recent weeks as they embraced a proposed Medicaid expansion for lower-income adults.
But Missouri's Republican-led committees have repeatedly defeated the Medicaid expansion backed by Obama and Democrats.
The alternative by Republican Rep. Jay Barnes would cover fewer additional adults than Obama's version while also removing some children from the Medicaid rolls. Medicaid recipients would be covered through competitively bid managed care policies and could get cash incentives for holding down their health expenses.
Legislation to be filed Tuesday by Rep. Jay Barnes would stop short of Obama's call to expand Medicaid coverage to adults earning up to 138 percent of the federal poverty level, or $32,500 for a family of four. But it would add some adults to the Medicaid rolls while also removing some children whose parents earn up to three times the poverty level.
Private insurers would bid to offer managed care plans, and patients could get cash for avoiding costly medical care.
House Speaker Tim Jones says Barnes' plan is a "commonsense conservative" proposal. But he says it could be at least a two-year project.
Two separate House committees rejected the plan Monday. One shot down an attempt to add funding for a Medicaid expansion to the 2014 budget. Another panel defeated legislation that would have authorized the expansion of Medicaid coverage to an estimated 260,000 lower-income adults.
Both committees voted along party lines, with Republicans opposing the Medicaid expansion and Democrats supporting it. More than 30 people representing health care, business and social services groups testified in support of the proposed expansion.
The Medicaid expansion is called for by President Barack Obama's health care law and supported by Gov. Jay Nixon.
House Republicans are working on an alternative that may include a more modest expansion combined with cost-savings measures.
The plan presented Thursday by Budget Committee Chairman Rick Stream would also provide a smaller increase for public colleges and universities than Nixon had proposed for the 2014 fiscal year.
The Democratic governor wants to accept about $900 million from the federal government to expand Medicaid health care eligibility to nearly 260,000 lower-income adults. But Stream said he left that out of the budget because it runs contrary to Republican philosophy against bigger government.
Nixon had proposed a $34 million funding increase for colleges and universities. Stream's proposed budget pares that back to $20 million. It also provides less money for early childhood programs than Nixon had sought.
Missouri currently enjoys a triple-A rating.
But Moody's Investors Service last week assigned a negative outlook to Missouri because of the proportion of the state budget that already comes from the federally and state-funded Medicaid program.
If Missouri expands Medicaid eligibility as called for in the federal Healthcare Reform Act, it would get billions of dollars more from the federal government in coming years.