JEFFERSON CITY, Mo. – Republicans in the Missouri Senate have voiced strong opposition to expanding Medicaid in Missouri.

But State Sen. Ryan Silvey, R-Kansas City, has his own idea.

Silvey has legislation that would couple long-sought reforms to the state’s entitlement programs with the components of Medicaid expansion included in legislation like that supported by Rep. Noel Torpey, R-Independence, in the House.

Silvey’s latest plan would strengthen the state law prohibiting food stamp recipients from using their benefits for purchasing alcohol or tobacco, require a photo to be on electronic benefit cards, require a card to be suspended if it is not used during a period of 90 days, and require recipients to be seeking education, a job, or to participate in community service in order to receive benefits. The legislation would also require annual renewal of benefits.

In addition to the changes to the state-administered Temporary Assistance for Needy Families program, the plan also includes provisions that would expand essentially Medicaid. The plan would provide health care coverage through private managed care for individuals between the ages of 19 and 65 years of age who make between 19 percent and 100 percent of the federal poverty level. Silvey’s package would charge co-pays for non-emergency use of the emergency room, and require premiums for those making between 50 percent and 100 percent of the federal poverty level.

For those between 100 percent and 138 percent of the federal poverty level (the minimum that is required to be covered by Medicaid expansion according to the federal health care law), the plan would provide premium assistance for individuals to purchase insurance plans in the federal health care marketplace.

The plan, like Torpey’s, includes a provision that would seek a waiver from the Centers for Medicare and Medicaid to encourage workforce participation in order to be eligible for Medicaid under the expanded law. The plan would repeal itself if the federal government were to fail to meet its promise to fund the program in 90 percent by 2021.

Silvey’s plan would include price transparency components to allow beneficiaries to seek care at the lowest possible costs and require hospitals to report the process for the most common procedures.

The plan includes willing provider language sought by conservatives that would prevent managed care companies from refusing to contract with any licensed medical doctor or medical professional within the coverage area of the state’s Medicaid program and is credentialed.

Silvey’s plan would also establish the “Show-Me Healthy Babies Program,” which would allow for a separate children’s health insurance program for any low-income unborn child, and establish a joint legislative committee on MO HealthNet to review the efficiency of the state’s Medicaid program.