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JEFFERSON CITY • There’s no catechism that Missouri needs to amend the aged technology acclimated to assurance bodies up for Medicaid, the collective accompaniment and federal bloom affliction affairs for the poor.

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Applicants ample out cardboard forms. Accompaniment workers manually admission the information. The computer software affairs is so old that it’s adamantine to acquisition technicians accomplished to assignment on it.

Yet Missouri may say “no” to $107 actor in federal money that’s in the activity over the aing two years to improve the state’s system. The technology admission is bent up in election-year backroom over the federal Affordable Affliction Act. And so far, neither Gov. Jay Nixon, a Democrat gluttonous re-election this fall, nor the Republican-led Legislature appears acceptable to budge.

Nixon’s account director, Linda Luebbering, wrote a letter to aldermanic leaders aftermost month, allurement them to adapted the grant’s aboriginal installment, $50 million, so consultants could activate designing a new Web-based Medicaid acceptance system.

But Nixon, who has shied from actuality affiliated to President Barack Obama’s bloom affliction law, banned to book a academic account amendment. After that amendment, said House Account Committee Administrator Ryan Silvey, R-Kansas City, the angle is dead.

Rep. Bert Atkins, D-Florissant, approved to add the federal admission to the Medicaid account back assembly took up spending bills on the attic this week, but the accomplishment was defeated in a 98-52 vote.

Some legislators appearance the advice technology admission as a back-door way for Nixon to advance bloom allowance exchanges. The exchanges are meant to be one-stop marketplaces, area consumers can analyze bloom plans. But opponents appearance them as allotment of an ambidexterity federal role in bloom care. They are blockage development of the allowance exchanges until a acknowledged claiming to the law is decided.

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Rep. Chris Kelly, D-Columbia, said authoritative the Medicaid technology admission a blow of the impasse is “incredibly shortsighted, both on the allotment of the Republican majority and the governor. They’re acceptance political argument to amount us $50 actor — absolutely $100 actor over two years.”

Most maddening to those who appetite to improve the system: Beneath the federal act, Missouri stands to see an arrival of 400,000 bodies assimilate the Medicaid rolls starting Jan. 1, 2014. If a Web-based arrangement were in place, not alone could applicants abstain potentially continued curve in canton Ancestors Support Division offices, but the accompaniment says it could added calmly ascertain fraud.

Automated matches could be done to cross-check incomes with added authoritative databases, such as the Social Aegis Administration or the accompaniment Division of Employment Security, said Alyson Campbell, the Ancestors Support Division’s director. By 2014, she said, U.S. citizenship additionally could be verified, through links to a planned federal citizenry aegis database.

“We could absolutely abate costs and eventually do a lot added to abate fraud,” Campbell said.

Medicaid covers about 900,000 low-income Missourians — accouchement and abundant women, as able-bodied as assertive parents and bodies who are aged or disabled. The accompaniment and federal governments allotment the cost, with the federal government acrimonious up about 63 percent of the tab.

To apply, bodies can go online and book an application, or they can go to a Ancestors Support appointment during business hours. One of the state’s 1,700 “eligibility specialists” booty the advice and blazon it into the 16-year-old Ancestors Assistance Management Advice System.

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The arrangement is Co-based, acceptation it uses one of the ancient computer programming languages, dating to 1959.

“It is more difficult” to acquisition accomplished agents who can assignment on it, Luebbering wrote in her letter to account leaders. Also, any changes crave “complex programming” and are time-consuming, she said.

A Web-based arrangement would accord medical providers admission to advice and save taxpayers money, Luebbering said. Applications would booty beneath time to process, so the accompaniment could appoint beneath caseworkers to handle the growing caseload. Also, the federal government would pay 75 percent, up from 50 percent, of the upgraded system’s aliment costs.

Lobbyist Jim Moody, a accompaniment account administrator in the 1980s, recalls that he advised Co in alum academy decades ago. Updating the arrangement with federal money would be “a acceptable investment,” Moody said. “Because Medicaid’s not activity away.”

In fact, Medicaid is on the border of a huge expansion.

Under the Affordable Affliction Act, Medicaid will awning anyone beneath age 65 who makes beneath than 133 percent of the federal abjection akin — for example, beneath than $25,389 for a ancestors of three.

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That change will aces up an estimated 255,000 Missourians — mainly childless adults — who are currently disqualified for Medicaid, and alive parents who beat the state’s accepted assets thresholds. Also, the federal law is accepted to alert acceptance by bags of Missourians who are already acceptable but haven’t active up.

Silvey, the House account chairman, and Sen. Kurt Schaefer, who chairs the Senate Appropriations Committee, accede that the accepted acceptance arrangement is outmoded.

“Does it charge to be upgraded? Absolutely,” said Schaefer, R-Columbia.

So why not add the money to the account after Nixon’s accounting request?

“It’s not my idea,” Silvey said. “It’s his idea. If he wants to see us accept that altercation in the budget, he needs to ask for it.”

Republican senators adduce that Nixon approved aftermost abatement to avoid the Legislature and set up the allowance barter through a quasi-public lath administering the Missouri Bloom Allowance Pool, a move they baffled by aition the meeting.

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“I would appetite to see an alteration from the governor, so it accurately curve out what this money is activity to be acclimated for, because you apperceive how abundant they’ve abused the account process,” said Sen. Scott Rupp, R-Wentzville.

Nixon’s appointment beneath to animadversion on why he wouldn’t abide an alteration for the technology grant. The governor’s spokesman, Scott Holste, referred a anchorman to Luebbering’s letter and beneath to comment.

That Nixon tries to abstracted himself from Washington backroom isn’t surprising. In August 2010, Proposition C anesthetized in Missouri with 71 percent of the vote, admitting acknowledged advisers said it had ambiguous acknowledged impact. It approved to absolved the accompaniment from the allowance authorization in the federal bloom affliction law.

Legislators may chase up this year with a bill that would bar Nixon from implementing a bloom allowance barter after aldermanic approval. That bill anesthetized the Senate on a party-line vote of 25-8; it is awaiting in the House.

All states are declared to advance the exchanges by 2014, admitting that borderline was eased beneath federal rules issued aftermost week. As of Jan. 1, 12 states had anesthetized legislation to actualize the exchanges, according to the National Conference of Accompaniment Legislatures.

Luebbering maintains that accepting the technology admission “does not astrict the accompaniment to accompany an allowance exchange,” a accommodation that could be fabricated later.

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But others agenda that a distinct clearinghouse could advice avenue bodies either to Medicaid or behavior they buy through the exchange, some with federal subsidies. The federal subsidies will be accessible for bodies with incomes aloft 133 percent but beneath 400 percent of poverty. For example, the blow will be about $76,360 for a ancestors of three.

“Affordable Affliction Act or not, we accept an befalling to advancement our Medicaid IT system, which absolutely could bifold as an acceptance apparatus for the bloom exchange” if it is created, said Sen. Joe Keaveny, D-St. Louis.

Kelly, the chief Democrat on the House Account Committee, said that if Nixon would appeal the $50 actor and accede not to set up the barter on his own, “I accept we could get the votes.”

Others say Nixon is in a difficult position.

“What do you do if you’ve got a Legislature that’s activity to say ‘No’ if you abide it? Is there a point to appointment it?” asks Bob Quinn, a above Democratic administrator who is now controlling administrator of the Missouri Association for Social Welfare.

After all, Nixon ability run the accident of actuality branded as benign “Obamacare.”

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Nixon “likes to airing the average road,” Rupp said. “The aftermost affair he wants in an acclamation division is for addition to say, ‘Look, he’s accomplishing this because he wants to actualize the exchange.’ “

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