(The Center Square) – It’s getting down to the nitty-gritty for Missouri lawmakers who will be casting budget votes Thursday – perhaps well into the night – and Friday, the last day in the 2021 session that appropriations bills can be approved.
After an eight-hour meeting Wednesday, budget-writers in the 10-member joint conference committee emerged with coalescing agreements that whittle back $3.1 billion in differences between preliminary chamber proposals.
The evolving plan more closely resembles the Senate’s $35.1 billion version than the House’s $32 billion one after boosting spending for hospitals and higher education institutions, providing forgiveness for unemployment overpayments and setting aside nearly $600 million in rent and mortgage assistance.
The budget does not allocate more than $2.8 billion in federal assistance Missouri will garner from the “American Rescue Plan” adopted by Congress in March. That one-time plug of federal money will be dispersed by lawmakers in an as-yet unscheduled special session.
The proposed budget also does not include the $130 million in state general revenues necessary to secure $1.9 billion in federal money to finance the Medicaid expansion for 275,000 working-age adults that Missouri voters approved in August.
Under Amendment 2, Medicaid expansion goes into effect July 1 if the Republican-controlled Legislature pays for it or not. Supporters are certain to sue if the funding is not provided – a court battle opponents believe they can win.
Support for defunding Medicaid expansion is coalescing behind a constitutional argument that implementing Amendment 2 would be unconstitutional under state law. Under the Missouri Constitution, initiatives that call for the state to spend money must provide a corresponding revenue source.
Amendment 2 fails to do that, Republicans argue, nor does it specifically direct lawmakers to appropriate money to fund expansion.
Some highlights in the proposed budget:
• $50 million to offset revenue losses to hospitals from a new Outpatient Simplified Fee Schedule set to go into effect July 1.
The new payment method is based on how Medicare pays for outpatient services, with a set fee for each type of service. Under the state’s existing process, the state’s Department of Social Services (DSS) pays a percentage of the fees charged by the hospitals.
The DSS lobbied lawmakers to adopt the Outpatient Simplified Fee Schedule because it ensures “hospitals will be paid the same for the same service as the payment is based on the procedure code being billed.”
The Missouri Hospital Association maintains transitioning to the Outpatient Simplified Fee Schedule will cost state hospitals about $60 million. The $50 million to help offset that expense was included in the Senate’s proposed budget but not the House’s.
• $24.2 million for higher education institutions, including a 3.7% increase in funding to four-year universities, an extra $7 million for community colleges and $2 million in new support for the State Technical College of Missouri.
The funding increase is designed to cover inflation since Parson last March withheld $140 million in state support for higher education. Much of that money was eventually restored to the budget through federal assistance allocations.
• $48 million to pay what an estimated 46,000 Missourians would owe after mistakenly being overpaid state unemployment benefits.
• $142 million for mortgage help and $442 million for rental assistance to prevent foreclosures and evictions for people who have lost income during the pandemic and help property owners who also have lost money during the eviction moratorium.
• $10.8 million in back payments to Amtrak dating to 2010 for the twice-daily Missouri River Runner train between St. Louis and Kansas City. Some lawmakers want to pay for just one daily run.