Silvey to file bill expanding Medicaid through block grant

JEFFERSON CITY, Mo. — Calling it a direct response to conservative critics of Medicaid expansion, Sen. Ryan Silvey, R-Kansas City, will be formally introducing a bill today to expand Medicaid in Missouri by applying for a block grant from the federal government to operate the program.

Silvey — one of only a few Republicans publicly supporting expansion of Medicaid as called for under the Affordable Care Act — said that several of his Republican colleagues have voiced interest in seeking the funds to expand through a block grant, removing many of the strings that come with federal money.

Under the bill, which Silvey plans to introduce today, the Missouri Department of Social Services would seek approval to operate MO HealthNet under a block grant through the creation of the “Healthcare Transformation Trust Fund.” The fund would allow individuals making up to 138 percent of the federal poverty level to be eligible for Medicaid, closing the infamous “coverage gap.” Silvey’s legislation would also designate a joint committee of 5 senator and 5 representatives to promulgate rules to implement MO Healthnet and oversee its operation.

That move, Silvey said, is a way of keeping Gov. Jay Nixon from getting a blank check from the federal government to “totally remake” the Medicaid program.

“In most states if you had a Republican legislature ask for a block grant, you’re going to have a Republican governor. There are things that I’ve put forward that [Nixon] wouldn’t implement if it’s up to him,” Silvey said. “Additional workforce participation requirements? He won’t do that. Expanding options for private insurance? He won’t do that.”

Silvey said the federal government was becoming increasingly comfortable with granting waivers and block grants to states to operate their Medicaid programs as its seen the bitter legislative fights surrounding Medicaid expansion ensue. Under Silvey’s bill, no expansion would take place if the block granted were not given.

Silvey’s support for Medicaid expansion occasionally draws the ire of some of his fellow Republicans, who say expansion is merely adding most money and costs to a largely broken healthcare system. He’s been vocal this year about his desire to support “closing the coverage gap” and even filed veterans-only expansion bill as just one way to force the discussion in the Senate. Silvey says he knows that legislative hurdles still exist to expansion, but says he’s increasingly optimistic.

“I’m looking for solutions,” Silvey said. “I’m confident many of my colleagues do recognize that we have a problem with the coverage gap. This is one possible solution for it, and we need to be having those conversations. This is one solution that some conservatives have suggested. So, here’s the conversation.”