INDEPENDENCE, Mo. — With disproportional share payments gone upon enactment of the federal health care law, some in the Missouri health care industry are concerned about the future of their financial stability if state lawmakers reject funds for Medicaid expansion.

A state committee of legislators and citizens convened for the first time on Wednesday for a meeting of their Working Group on Medicaid Eligibility and Reform. Committee members heard testimony from various interested parties, but perhaps the most striking testimony came from John W. Bluford, CEO of Truman Medical Centers, who testified that hospitals which cater to those without insurance may be hardest hit if Medicaid is not expanded.

DSH payments, as the payments are known, are set to be phased out on the same timeline that Medicaid expansion is to be phased in — between 2014 and 2020. Missouri hospitals handle some $1.1 billion in uncompensated care — $130 million for Truman, Bluford said — and those federal dollars help them make up their uncompensated costs.

“We are left with the slippage, but not the fallback,” Bluford said. “It jeopardizes the hospitals of the state.”

According to his numbers, contrary to what some may expect, most of those patients — 45 percent — come from non-metro areas in Missouri, like the rural southwest, southeast, and northern Missouri. Nearly a third of the patients are from the St. Louis region, and 21 are from the Kansas City area.

In President Barack Obama’s budget this year, he sought to hold off on implementing the cuts to DSH, but that proposal did not move forward. Nationally, hospitals are lobbying to delay the provision, but in Missouri, hospitals have joined the Missouri Chamber of Commerce and others business groups urging the General Assembly to expand the state’s Medicaid system using federal funds.

Under the plan proposed by Gov. Jay Nixon, Medicaid would be expanded to some 300,000 Missourians using federal funds for the first four years, before the federal government ultimately cut back its share to 90 percent in 2020.

Currently, nearly 894,000 Missourians are enrolled in the program — the highest concentration of whom are located in southeast Missouri. Like uncompensated care patients, the highest concentration of Medicaid recipients lie not in the state’s urban areas, but in rural Missouri — southwest and southeast Missouri, Republican stomping ground.

Nixon’s plan, flat out opposed by the GOP, would expand Medicaid to those making 138 percent of the federal poverty level, or just over $32,000 a year for a family of four.

Republicans stalled on expansion this year, but it appears the issue is likely to reemerge, on their terms, when the General Assembly reconvenes next January. The legislature has set up a handful of committees to review the program. Wednesday’s panel of House members and citizens, as well as a Senate panel, began meeting this week, and another House panel is expected to kick off too, as lawmakers spend the next six months in interim committees.