Barnes said Missouri should test the flexibility of the Obama administration.
"If they don't cooperate, we're not going to do it," he said.
Barnes' legislation would require the state to seek competitive bids from private insurers to offer managed-care policies to Medicaid recipients. Enrollees would have to make co-payments for medical services and could get cash incentives for holding down their health care costs — for example, by avoiding hospital emergency rooms for routine problems that could be treated by a primary care physician. It also could shift thousands of children from the Medicaid program to government-subsidized private insurance policies that are to be available through online insurance marketplaces.
After meeting for more than 45 minutes with Republican lawmakers, Nixon told reporters Wednesday that he's open to Medicaid changes that require more "personal responsibility" and cash from participants and more competition among insurance plans. Nixon said he also supports efforts to lower costs through better coordination of care. But he stood firm on the need to cover adults earning up to 138 percent of poverty.
The governor used a fairy tale analogy to describe the prospects of passing a Medicaid bill following Wednesday's meeting with House Republicans.
"Under the 'Three Bears' analysis, the porridge is a little warmer," Nixon said. But "we've got a lot of work to do, and we're a heck of a long way from the finish line."
Senate Majority Leader Ron Richard, R-Joplin, said Wednesday that lawmakers may need to create a special committee to study the issue further before the 2014 legislative session.
"I don't think anything is going to happen this year," Richard said.
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