JEFFERSON CITY • Measures intended to require new working-age Medicaid recipients to participate in the workforce drew questions at a House committee hearing Monday.

The hearing focused solely on the cost-saving and “reform” elements of a proposal put forward by Rep. Noel Torpey, R-Independence. Those include treatment for those with drug or alcohol problems, lessening emergency room use, encouraging the use of private plans and requiring providers to give cost estimates.

The proposal to require new enrollees who are not currently eligible for Medicaid to prove “workforce participation” garnered criticism from legal analysts and community advocates. That proposal, along with a requirement that new participants pay at least one percent of their income in cost-sharing, would require federal waivers for the state.

Sidney Watson, a professor at the St. Louis University School of Law, said that based on the language and federal interpretation of the Affordable Care Act’s Medicaid provision, these waivers were unlikely to be granted. Watson said that the statute specifically defined who would be eligible for the expanded Medicaid program and that in Iowa, where a waiver was granted, the “premiums” were very limited and used to encourage healthy behaviors.

“It’s dubbed a premium, but it’s operating in quite a different way,” Watson said. “My concern is this ‘premium-lite’ idea is not tied to any healthy behaviors.”

Joel Ferber, a lawyer with Legal Services of Eastern Missouri, said tying the granting of the waivers to Medicaid expansion and other provisions of the bill was a mistake and would delay everything in the bill.

“This (Center for Medicare and Medicaid Services) is not going to see these work requirements as furthering the goals of the Medicaid act,” Ferber said. “They’re not going to see this as moving the ball forward in health care by cutting off a bunch of people because their caseworker says they aren’t working.”

Pennsylvania is the only state to have tried to get a federal waiver for a Medicaid work requirement. The state recently dropped that idea and will instead seek an allowance to provide incentives for work.

Committee chair Rep. Jay Barnes, R-Jefferson City, said that even if the federal government refused a waiver to Pennsylvania, that would not deter Missouri. He was skeptical that the Department of Health and Human Services lacked the authority to grant such waivers, because the administration has made so many changes to the Affordable Care Act.

“What authority was there to delay the employer mandate?” Barnes said. “I don’t even know any more how many provisions were delayed.”

Torpey said he wanted to make sure students, pregnant women, people with disabilities, elderly people and the “medically frail” were exempt from any cost-sharing measures or work requirements. But when asked about the costs for those making less than 100 percent or 50 percent of federal poverty, Torpey said it was important for people to have “ownership” to improve outcomes. “I think it really does make a difference,” he said.

The part of the bill to expand Medicaid will have a hearing after the Legislature’s spring break, Barnes said.

The bill is HB 1901.

Marie French is a reporter in the Jefferson City bureau. You can follow her on Twitter @mre545.