SB 0905 - Fiscal Note

Fiscal Note - SB 0905 - Creates the Missouri Universal Health Assurance program

COMMITTEE ON LEGISLATIVE RESEARCH

OVERSIGHT DIVISION

FISCAL NOTE

L.R. NO. 3817-01

BILL NO. SB 905

SUBJECT: Creates the Missouri Universal Health Assurance Program

TYPE: Original

DATE: February 23, 1998

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FISCAL SUMMARY

ESTIMATED NET EFFECT ON STATE FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
General Revenue	($2,977,367)	($237,854,556 to Unknown)	($388,421,045 to Unknown)
Conservation	$0	($1,442,000)	($3,190,126)
Highway	$0	($4,599,081)	($9,164,599)
County Insurance	$0	$0	($20,000,000)
General Revenue Reimbursement	$0	($43,683,546)	($43,683,546)
Health Professional Education & Training	$0	$0	$0
Health Care Trust	$0	(Unknown)	(Unknown)
Total Estimated Net Effect on All State Funds*	($2,977,367)	($287,579,183 to Unknown)	($464,459,316 to Unknown)

*Does not include possible income and/or costs for Medicaid reimbursements.

Numbers within parentheses: ( ) indicate costs or losses

This fiscal note contains 15 pages.

FISCAL SUMMARY (continued)

ESTIMATED NET EFFECT ON FEDERAL FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
Medicaid	Unknown	Unknown	Unknown
Total Estimated Net Effect on All Federal Funds	Unknown	Unknown	Unknown

ESTIMATED NET EFFECT ON LOCAL FUNDS
FUND AFFECTED	FY 1999	FY 2000	FY 2001
Local Government	(Unknown)	(Unknown)	(Unknown)

Numbers within parentheses: ( ) indicate costs or losses

FISCAL ANALYSIS

ASSUMPTION

This proposal would become effective if approved by the voters in the general election to be held on the Tuesday following the first Monday in November, 1998. Sections 1 through 16 would become effective April first of the year following notice to the revisor of statutes that a waiver had been obtained from the Secretary of the Department of Health and Human Services. The health premium surcharge and the income tax surcharge would apply to all tax years beginning on or after January first of the year following receipt of notice that appropriate waivers had been obtained. The small employer tax credits would apply to five consecutive tax years beginning on or after January first of the first year following notice by the revisor of statutes that appropriate waivers had been obtained.

Officials from the Office of Governor, Office of Lieutenant Governor, Office of Attorney General, Office of State Treasurer, House of Representatives, Missouri Senate, , Department of Corrections, Department of Economic Development Department of Higher Education, Department of Health, Office of State Courts Administrator, and Harris-Stowe State College assume this proposal would not fiscally impact their agencies.

ASSUMPTION (continued)

Officials of the Office of Secretary of State (SOS) note the state would be responsible for paying the publication costs of approximately $678,300. These costs would be paid from the General Revenue Fund.

Officials from the Office of State Auditor (SAU), assumes the Board of Governors would contract with an auditing firm for any audits of the program. The SAU assumes that their office would be involved at a minimum for reviewing the audit firms working papers. Oversight assumes the SAU could perform this work with existing resources.

Officials of the Office of Administration (COA) have projected the income which would result from the imposition of a surcharge on each individual's adjusted gross income using an Individual Tax Simulator. The estimate of the tax base for the health insurance premium surcharge was based on wage and salary data provided by the U.S. Department of Commerce, Bureau of Economic Analysis (Annualized 1994 second quarter).

COA estimates the premium tax on employers would generate revenues of $5,685,000,000 for the Health Care Trust Fund. In addition, COA estimates the surcharge tax on individuals would generate $690,000,000 in revenues for the Health Care Trust Fund.

Officials from COA - Division of Accounting note that the gross wages paid to all state employees in FY95 equalled $1,767,502,198. The 12.0% surcharge on that amount would accrue to various funds and would have been $212,100,263 in FY95. This figure includes wages paid to employees of all state agencies and would accrue to various state funds. Oversight, will present the 12% surcharge for Department of Conservation and Department of Transportation employees separately from the rest of the state government employees. Oversight will also inflate the FY 95 amount by 2.5% annually for FY00 and FY 01 amounts of fringe benefit calculation.

Officials from COA note that the employer premium tax on wages would have a direct effect on business and corporate income taxes by increasing operating expenses. COA is not able to determine what the amount of lost business and corporate income taxes would be.

Officials from the Department of Elementary and Secondary Education (DES) assume that salaries which would be paid in FY 99 would be $65,496,639 resulting in an employer surcharge of $7,859,597 to DES. Oversight assumes the Office of Administration will calculate the increased benefit costs for all state employees.

Officials from the Department of Labor and Industrial Relations (DOL) assume that salaries which would be paid in FY 97 would be $52,469,646 resulting in an employer surcharge of $6,296,358 to DOL. The FY 97 employee benefit rate of $150 per month for each full-time

ASSUMPTION (continued)

employee would total $3,223,800 for the DOL. This results in a net increase in costs totaling $3,072,558. Oversight assumes the Office of Administration will calculate the increased benefit costs for all state employees.

The Department of Conservation (MDC) officials assume that salaries which would be paid in FY 99 would result in an employer surcharge of approximately $6,900,000 to the Conservation Commission Fund.

MDC officials note that for FY 99, their agency has budgeted $4,100,000 for health care benefits for their employees which would be provided by a non-HCP provider. This results in a net charge of approximately $2,800,000. With an effective date of January 1, 1999, costs would be $1,400,000 in FY 99. Costs and savings for FY 00 were prorated to 6 months.

The Department of Insurance (INS) officials estimate that the General Revenue Fund and the various County Insurance Tax Funds would lose funds annually due to the loss of the 2 % premium taxes on accident and health policies. The loss would be shared on a fifty-fifty basis between the General Revenue and the various county insurance funds. Based on calendar year 1995, INS estimates approximately $40,000,000 would be lost. The INS also assumes an unknown rate increase in license fees will be required to maintain a positive fund balance in the Insurance Dedicated Fund.

Officials of the Department of Mental Health (DMH) assume that DMH reimbursement funds would be deposited to the Missouri Health Care Trust Fund (Trust). DMH projects the amount of reimbursements that would be deposited into the General Revenue Reimbursement Fund in FY99 to be $43,683,546. In addition, this proposal would decrease funds that are currently being used to provide behavioral health services. It does not, however, represent a loss of funds to the state. These funds would be used to provide medical services to persons through the Missouri Health Care Trust Fund. DMH assumes the Trust would pay for medical expenses incurred by DMH clients presumably in the same manner as DMH currently pays for these services. DMH staff that are currently being used for these functions could also be lost. DMH estimates the General Revenue Fund loss that would be transferred to the Trust to be $155,356,313 annually.

Officials of the Department of Revenue (DOR) assume they would need the following expense and equipment items, additional FTE within the Division of Taxation and Collection, and outside contractors to implement this proposal:

Central Processing Bureau

Fourteen (14) Clerk I - These employees would be responsible for the mail extraction and pre-sort

ASSUMPTION (continued)

of 1.3 million employers forms and 2.4 million returns.

Two (2) Clerk I - These employees would be operate 2 new remittance processors which cost $5,500 each.

Tax Administration Bureau

Six (6) Tax Processing Technician I - These employees would work with withholding errors.

Twelve (12) Tax Processing Technician - These employees would work with Individual return type errors for the expected 20% error rate.

Collections Bureau

Eighteen (18) Tax Processing Technician I - These employees would be responsible for processing correspondence, bankruptcy claims, petitions, handling incoming and outgoing telephone calls associated with billings and non-filer notices.

Four (4) Clerk I - These employees will support the above Tax Processing Technicians

Eight (8) Tax Service Representative I - These employees would be responsible for pursuing delinquent and non-filer employers. They would be located in the six area offices.

One (1) Clerk I - This employee would support the 8 Tax Service Representatives noted above.

Information Systems Division

Three (3) Programmer Analyst II's - These employees would be responsible for new programming and maintenance of programs.

One (1) Senior System Analyst - This employee would supervise the Programmer Analysts and contract programmers.

Contract programmers will be needed for 550 hours in FY 99, 22,000 hours in FY 00. State Data Center costs are anticipated as $19,822 in FY 99 and $122,223 in FY 00, and $$40,578 in FY 01.

Officials of the Department of Highways and Transportation (DHT) assume they would be liable for the 12.0% employer surcharge on gross total wages of $203, 053,692, based on FY97 payroll. Further, they assume it would be unnecessary to continue the Missouri Highway and Transportation Department and Missouri Highway Patrol Medical and Life Insurance Plan. The DHT estimates that the proposal will fiscally affect the General Revenue Fund, Highway and

Transportation Fund, Federal Fund, and the Road Fund. Oversight has presented fiscal impact for the Highway and Transportation Fund only as the impact on the General Revenue, Federal, ASSUMPTION (continued)

and Road funds were minimal.

Officials from the Department of Social Services(DSS) - Division of Medical Services (DMS) assume that the population (Medicaid) would be the same, whether they were served by the new entity or contracted to DMS to administer. DMS assumes that institutional care would

remain constant regardless of the administering agency. To the contrary, independent providers shall be reimbursed on a fee-for-service schedule that is anticipated to represent usual and customary charges (UCR). As current Medicaid reimbursement for non-institutional providers, in

many cases, represent less than UCR, costs are expected to increase. Dental, ambulance and physician reimbursement is currently paid at less than UCR. If the negotiated reimbursement were to reflect 100 % of UCR, it is anticipated that additional costs of $321,000,000 would be realized. The following differences were developed for either the FY 98 and FY 99 budget in which procedures identified by current Medicaid reimbursement and UCR:

Additional Cost to Bring

Provider Fees Up to UCR Rates

Physicians $ 299,000,000

Dental Programs $ 16,000,000

Ambulance $ 6,000,000

Total $ 321,000,000

The loss of the advantage of competitively bidding managed care contracts would result in additional cost of over $16,000,000 or five percent of current Missouri Care Plus (MC+) payments. The DMS cannot arrive at an actual dollar increase to Medicaid, they believe there will definitely be an increase exceeding $100,000 annually. No impact for FY 99 is anticipated due to the time frames involved in waiver applications and implementations. No cost to DSS is associated with the DSS director serving on the Board of Governors as all expenses would be paid from the Health Care Trust Fund.

Oversight notes that based on DOS FY 95 budget for the provision of medical services through the Medicaid program ($2,595,809,000), a base figure of $1,038,323,600 would be used to estimate federal matching funds which would be deposited in the General Revenue Fund annually for appropriation to the plan after the required waiver would be obtained. Oversight for purposes of this fiscal note has represented unknown costs associated with personal services and expense and equipment in the DOS - Division of Medical Services (DMS) as being saved by the state because the state's Medicaid program as it now exists would no longer be in place.

Depending on the provisions of the waivers, if obtained, some of the functions of the DMS could be required to be performed by the Missouri Universal Health Assurance Program.

ASSUMPTION (continued)

Officials from the Department of Natural Resources (DNR) assume that salaries which would be paid in FY 98 would be $55,329,460 resulting in an employer surcharge of $6,639,535 to DNR. DNR officials estimate this would result in an increased cost of $2,936,068 to the

department and related funds.

Missouri Consolidated Health Care Plan (HCP) officials state the proposal would require employers with more than 450 employees to pay 12% of payroll into the insurance fund. The state's contribution for employee health care would fall into this category. The HCP estimates that the first year cost of this program would be $67,348,213 more than the cost of the current medical plan options. HCP assumes a six percent inflation factor in future fiscal years. The HCP also estimates the first year cost of this program for public entities would be $5,007,699 more than the cost of the current medical plan options.

Southwest Missouri State University (SMSU) officials estimate they would expect to incur a cost of $9,420,352 for the health care surcharge. SMSU currently pays $3,238,182 to cover its employees health care insurance. This would be an increased cost of $6,182,170 annually.

Officials from Central Missouri State University (CMSU) would expect to incur health surcharge costs of approximately $5,700,000. Current health benefits cost approximately

$2,200,000 annually. This would result in an increased cost of approximately $3,500,000 annually.

Officials of the University of Missouri (UM) expect to incur an additional cost of $54,600,000 for the health care coverage for its employees.

Officials from Missouri Western State College (MWSC) estimate that the surcharge would cost the MWSC $1,408,750, $1741,200, and $1,793,540 for FY 99, FY 00, and FY 01, respectively.

Officials from Truman State University (TSU) report that the 12% surcharge would result in costs of $3,592,955 annually. The cost of its current plan is $1,706,155 for an increased cost of $1,886,800.

Northwest Missouri State University (NWMSU) did not respond but under a similar proposal last year officials reported the 12% health premium would cost $1,665,159 annually. Their current health plan costs $852,913 per year for an increased cost of $812,246.

Southeast Missouri State University (SEMU) did not respond but under a similar proposal last year officials reported the 12% surcharge would result in costs of approximately $3,600,000 annually. The cost of its current plan is approximately $1,860,000 for an estimated increased ASSUMPTION (continued)

cost of a $1,750,000.

Officials from Missouri Southern State College (MSSC) did not respond but under a similar

proposal last year officials expected to incur costs of approximately $750,000 per year for the health premium surcharge .

Lincoln University did not respond but under a similar proposal last year officials stated they would expect to incur a net cost of $500,000 more per year for the health premium surcharge

versus their current health benefit program.

Oversight assumes for purposes of this fiscal note:

1) Should the proposal be approved by the voters in a general election in November, 1998, the health premium surcharge on employers and the individual income tax surcharge

would be levied on the wages paid or received in the taxable year beginning January 1, 1999.

2) In accordance with projections made by DOS officials, the waiver which would be required by this proposal would become effective prior to January, 2000, and the federal financial participation for Medicaid and Medicare would begin to accrue to the plan at that time.

3) In accordance with the provisions of this proposal, the Missouri Universal Health Care Plan would become effective on April 1, 2000.

4) The state would pay both the surcharge and premiums for health care coverage for employees from January 1, 2000, to April 1, 2000. Further, all state-financed insurance plans would be dropped as of April 1, 2000.

5) Expenditures for health care in Missouri are in line with those across the United States. The Health Care Financing Administration states that the per capita expenditure for health care in the United States was $3,509 in 1995 and can be used as a basis for projecting statewide costs. The 1990 census of Missouri's population was 5,117,073. Further, increases in health care costs since 1993 have been approximately 5% annually

6) Health care costs which would be covered by the plan and are currently paid by state agencies from a number of funds which would accrue to the Missouri Health Care Trust Fund and be saved by the current fund. Further, these costs would be included in projections made based on per capita cost of health care. Agencies affected would include the Department of Elementary and Secondary Education, Department of Corrections, ASSUMPTION (continued)

Department of Labor and Industrial Relations, Department of Health, Department of Mental Health, etc. The 12 % employer surcharge tax for health care premiums for the Departments of Conservation and Transportation will be presented separately. The 12% surcharge for the rest of the state employees will be presented under the Office of Administration.

7) After April 1, 1999, growth in health care expenditures would be limited to "2% above the total percentage increase in the state's gross domestic product for the previous year".

FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
		(6 Mo.)
	GENERAL REVENUE FUND
Income - Department of Social Services
Medicaid Reimbursements	$0	Unknown	Unknown
Savings - Department of Social Services
Possible Elimination or Cutback in
Division of Medical Services	$0	Unknown	Unknown
Costs - Department of Revenue
Personal service (69 FTE)	($1,133,080)	($3,8485,973)	($1,351,562)
Fringe benefits	($317,262)	($1,077,607)	($378,437)
Expense and equipment	($848,725)	($415,247)	($338,374)
Total Costs - Department of Revenue	($2,299,067)	($5,341,451)	($2,068,373)
Loss - Department of Insurance
Insurance Premium Tax	$0	$0	($20,000,000)
Costs - Secretary of State
Election Costs	($678,300)	$0	$0
Costs - Office of Administration
Fringe Benefit Surcharge for State Employees
Other than DOC and DHT Employees $0		($103,049,511)	($210,996,359)
Cost - Department of Mental Health
Medicaid Reimbursements $0		($129,463,594)	($155,356,313)
FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
(continued)		(6 Mo.)
		($237,854,556)	($388,421,045)
ESTIMATED NET EFFECT ON		TO	TO
GENERAL REVENUE FUND*	($2,977,367)	(Unknown)	(Unknown)
* Does not include possible income and /or cost for Medicaid reimbursements from the DSS-DMS.
COUNTY INSURANCE
TAX FUND
Loss - Department of Insurance
Insurance Premium Tax	$0	$0	($20,000,000)
ESTIMATED NET EFFECT ON
COUNTY INSURANCE FUND	$0	$0	($20,000,000)
GENERAL REVENUE
REIMBURSEMENT FUND
Loss - Department of Mental Health
Medicaid Funding	$0	($43,683,546)	($43,683,546)
ESTIMATED NET EFFECT ON
GENERAL REVENUE
REIMBURSEMENT FUND	$0	($43,683,546)	($43,683,546)
CONSERVATION FUND
Savings - Department of Conservation
Conservation Medical Plan Expenditures	$0	$2,111,500	$4,349,690
Costs - Department of Conservation
Fringe Benefit Surcharge for Employees	$0	($3,553,500)	($7,539,816)
ESTIMATED NET EFFECT ON
CONSERVATION FUND	$0	($1,442,000)	($3,190,126)
FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
(continued)		(6 Mo.)
HIGHWAY FUND
Savings - Department of Transportation
Highway and Patrol Medical Plan Expenditures	$0	$8,783,897	$18,270,506
Costs - Department of Highways and Transportation
Fringe Benefit Surcharge for Employees	$0	($13,382,978)	($27,435,105)
ESTIMATED NET EFFECT ON
HIGHWAY FUND	$0	($4,599,081)	($9,164,599)
MISSOURI HEALTH CARE TRUST FUND
Income - Office of Administration
Employer premium tax* $0		$2,842,500,000	$5,685,000,000
Individual surcharge tax $0		$ 345,000,000	$ 690,000,000
Total Income - Office of Administration $0		$3,187,500,000	$6,375,000,000
*Includes premium tax paid by the state for all state employees.
Costs - Missouri Health Care Trust Fund
The plan could become effective on April 1, 1999, at which time costs to administer the plan (staff, Board of Governor's expenses, Regional Advisory Council expenses, etc.) and to provide health care benefits at costs which would be negotiated by the Board of Governors, as specified
in the proposal would be borne by the Fund. Using HCFA per capita data, 1990 census figures for Missouri and 5% annual increases in health care costs, it is projected that expenditures from the Fund for benefits would equal $6,284,533,205 for four months in FY00. Administrative costs
would be capped at four percent of the income generated from the various sources. A reserve equal to expenditures in the preceding three months would be required.
ESTIMATED NET EFFECT ON MISSOURI
HEALTH CARE TRUST FUND*	$0	(Unknown)	(Unknown)
*Does not include possible income and\or costs for Medicaid reimbursements from the DSS-DMS.
FISCAL IMPACT - State Government	FY 1999	FY 2000	FY 2001
(continued)		(6 Mo.)
HEALTH PROFESSIONAL EDUCATION
AND TRAINING FUND
Income
Federal Government and Other	$0	Unknown	Unknown
Costs
Personal Service, Expense and Equipment	$0	(Unknown)	(Unknown)
ESTIMATED NET EFFECT ON HEALTH
PROFESSIONAL EDUCATION
AND TRAINING FUND	$0	$0	$0
FEDERAL FUNDS
Savings - Department of Social Services
Possible Elimination or Cutback in
Division of Medical Services	$0	Unknown	Unknown
Loss - Department of Social Services
Medicaid Funding	$0	(Unknown)	(Unknown)
ESTIMATED NET EFFECT ON
FEDERAL FUNDS	$0	Unknown	Unknown
FISCAL IMPACT - Local Government	FY 1999	FY 2000	FY 2001
	(10 Mo.)
ALL LOCAL GOVERNMENTS
Savings-All Local Governments
Health Insurance Programs	Unknown	Unknown	Unknown
Costs - All Local Governments
Fringe Benefits	(Unknown)	(Unknown)	(Unknown)
ESTIMATED NET EFFECT ON
ALL LOCAL GOVERNMENTS	(Unknown)	(Unknown)	(Unknown)
FISCAL IMPACT - Small Business

Small businesses would expected to be fiscally impacted to the extent that they would incur additional administrative costs and additional payroll tax expense due to the requirements of this proposal.

DESCRIPTION

This proposal would create a Missouri Universal Health Assurance Program to provide health insurance coverage for all Missouri residents and for nonresidents who work in Missouri who

pay the appropriate taxes. The program would be governed by a 22-member board of directors comprised of gubernatorial appointees, representatives of regional health policy development districts, and state officials. The board would reflect the racial and ethnic diversity of the state and would include at least two disabled members. The Governor would also appoint an advisory council in each of six regional health policy development districts. Each advisory council would assist the board in its planning activities and develop a transportation plan to provide the indigent, elderly, and disabled with access to nonemergency health care services. The various specific powers, duties, and procedures of the board in administering the program are described. The board may contract with a not-for-profit organization to administer the program or the separate trust fund created by this proposal, or both. The board would develop an annual comprehensive state health plan in conjunction with the regional district advisory councils. It would provide for budgetary and capital expenditure allocations, evaluation of health care needs, and goals for various aspects of the health care delivery system. Limits would be placed on budget requests and administrative expenditures for the program. Funding for the program would be placed in a separate trust fund. It would be used to establish disease prevention programs, pay health care providers for their services, make grants for health care and medical research, and develop and maintain health care institutions. Federal funding for health professional training would be placed in a separate account and used by the board to train health care providers. For up to 6 years after the effective date, state expenditures for training of health care providers would not fall below 1998 levels. The program's payment for a covered service would constitute full payment for the service; the patient may not be charged an additional amount. Coverage would include but not be limited to those services provided under Medicaid, except that certain other types of services are specifically excluded from coverage. Nonmedical residential care services would not be covered, nor would nursing home care for those not eligible for Medicaid, except as provided under Medicare. Insurers, employers, and other health care coverage plans may offer benefits that do not duplicate coverage offered under the program. The program would pay the expenses of institutional providers from budgets which would be negotiated annually and would provide for a reasonable margin above operating expenses for capital depreciation and other long-term institutional needs. It would reimburse independent providers based upon fee schedules negotiated with appropriate professional associations elected by the health care providers. Fee schedules set after unsuccessful negotiations may be appealed to the Cole County circuit court. The program would be partially funded by a tax levied upon DESCRIPTION (continued)

employers of nine percent of total wages paid. The employer tax would also be paid by self-employed persons and independent contractors. When an employer has contracted with an insurer to provide benefits as of the effective date, the employer would receive a credit for the amount of tax and the tax would be paid by a premium tax assessment levied on the insurer. Collection procedures are described. Tax withholdings which exceed tax liabilities would be refunded. The proposal would also imposes an income tax surcharge on adjusted gross income above $5,000. The rate of taxation varies with income. The taxes would be levied for all tax years beginning on or after January 1 of the year following federal approval for funding of this program. The proposal would establish an income tax credit of $25 per month per full-time employee for employers of 25 or fewer. The tax credit would be offered for five tax years beginning on or after January 1st after the waiver of federal requirements has been received, with the maximum amount of tax credit decreasing annually during the last four years that the credit is available. The tax credit would be prorated for part-time employees and would not exceed the employer's tax liability. After this proposal becomes effective, the Department of Insurance would reduce workers compensation insurance rates to reflect a reduction in employers' liability for medical expenses. The Department of Social Services would apply for waivers of federal requirements to allow federal Medicaid and Medicare funding to be routed into the program's trust fund and to allow Missouri residents who are federal employees or retirees to participate. The portion of the proposal which establishes the new program would go into effect on April 1st of the year following federal approval for funding of this program.

The entire proposal is subject to referendum at the November, 1998 general election.

This legislation is not federally mandated, would not duplicate any other program and would require additional capital improvements or rental space.

SOURCES OF INFORMATION

Office of Administration

Department of Conservation

Department of Corrections

Department of Economic Development

Department of Elementary and Secondary Education

Department of Health

Department of Higher Education

Department of Transportation

Department of Insurance

Department of Labor and Industrial Relations

Department of Mental Health

Department of Natural Resources

SOURCES OF INFORMATION (continued)

Department of Revenue

Department of Social Services

Office of State Courts Administrator

House of Representatives

Missouri Senate

Office of State Auditor

Office of Attorney General

Office of Governor

Office of Lieutenant Governor

Office of Secretary of State

Office of State Treasurer

Missouri Consolidated Health Care Plan

Central Missouri State University

Harris-Stowe State College

Missouri Western State College

Missouri Southern State College

Truman State University

Northwest Missouri State University

Southeast Missouri State University

Southwest Missouri State University

NOT RESPONDING: Department of Public Safety, Missouri State Lottery Commission, and State Fair Community College

Jeanne Jarrett, CPA

Director

February 23, 1998