Missouri Senate set for showdown debate on Medicaid hospital tax extension

(The Center Square) – Missouri’s 34 state senators could be in for some long hours Friday into Saturday in Jefferson City as they attempt to extend a hospital tax that pays for about one-third of Missouri’s $11 billion Medicaid program.

If Thursday’s second day of the special session is an indication, consensus in finding a way around objections to the use of public funds for abortifacient drugs or devices and “contraceptive treatments,” and demands that the state Medicaid program not contract with providers – such as Planned Parenthood – that offer abortion services, will be a difficult task.

Missouri’s regular legislative session featured heated contention over Medicaid funding as lawmakers decided against funding Medicaid expansion that voters narrowly approved in August. Cole County Judge Jon Beetem Wednesday upheld the Legislature’s decision in a ruling expected to be appealed.

But lawmakers also adjourned without extending the Federal Reimbursement Allowance (FRA), a hospital tax that is used to pay the state’s portion of the federal health care program for low-income residents.

Extending the FRA would allow the state to collect $1.28 billion in hospital taxes to draw $2.391 billion in federal Medicaid funding each of the next two years. The FRA expires Sept. 30, but its extension must be passed by July 4 to be implemented Oct. 1.

During the session, Sens. Paul Wieland, R-Imperial, and Bob Onder, R-Lake St. Louis, objected to using Medicaid money for abortifacients and contraception.

Wieland attached an amendment to the FRA-extension bill banning use of FRA funds for drugs or devices “that may cause the destruction of, or prevent the implantation of, an unborn child” and bar the use of public money for “contraceptive treatments.”

Onder added an amendment to ban any organization with affiliates that perform abortions from the state’s Medicaid provider list.

The amendments stalled the bill’s advance, prompting Parson to call a special session Monday.

In his special session proclamation, Parson said he supports Wieland’s and Onder’s amendments. He said Monday that if the FRA is not extended, he has a nine-page list of $722 million in budget cuts he’ll authorize.

The full Senate Friday will consider one or more of four bills, each outlining different scenarios, that were heard before the Senate Appropriations Committee Thursday.

Senate Appropriations Chair Sen. Dan Hegeman, R-Cosby, filed the bills Wednesday, setting FRA reauthorization framed in anti-abortion language in two measures – Senate Bill 1 and SB 2 – and offering “clean” authorization in SB 3.

A fourth bill, SB 4, sponsored by Sen. John Rizzo, D-Independence, is also a “clean” extension, but was not on the committee’s agenda.

On Wednesday, Wieland said he was “alarmed” about Hegeman’s three bills and Onder on Thursday wondered if it was a ruse.

“I hope the idea of filing multiple bills isn’t some sort of a trick,” Onder said. “So what we need to do is to take up the FRA; it is an important bill, it is a must-pass bill, it is responsible for a large portion of Missouri Medicaid funding. And we need to add pro-life protective language to it and send it to the House.”

Sen. Mike Cierpiot, R-Lee’s Summit, said if the state did as Onder demands, Missourians could lose billions of federal health care dollars. “What you’re saying is, we’re going to throw the dice and dare CMS to defund us – where many of us are not going to be willing to take that chance,” he said.

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