Missouri takes months to process Medicaid applications – longer than the law allows
Aneka French applied for Medicaid in October, shortly after Missouri became the 38th state to expand eligibility for the program.
But his candidacy remained for months in a backlog along with tens of thousands of others. While she waited, French, 45, an uninsured medical technician from St. Louis, paid out of pocket when she was treated at a health clinic for a knee injury last fall.
For nearly a decade, Republican political leaders in Missouri have resisted expanding eligibility for Medicaid, the federal health insurance program for low-income people. It went into effect in the summer of 2021 after a 2020 voter ballot initiative passed. Now, Missouri has more pending applications for MO HealthNet — the name of the state’s Medicaid program — than people enrolled as part of the expansion. While 64,210 people were approved under the expansion, nearly 73,000 applications were pending at the start of February.
In the state’s most recent report, it said it takes an average of 70 days to process typical requests — longer than the 45 days allowed by federal law.
“It means that in the midst of a raging pandemic, people who are finally able to get health coverage are being shut out of the system and left waiting and waiting,” said Melissa Burroughs, associate director of strategic partnerships at Families USA, a consumer advocacy group. “It is a complete injustice to those who have been hit hard financially and health wise by the pandemic.”
By contrast, most other states process Medicaid applications within a week, with many cases taking less than a day, according to 2021 federal data.
Kim Evans, director of the Family Support Division of the Missouri Department of Social Services, told the MO HealthNet Oversight Committee in February that the delay was due to a worker shortage that has worsened due to the pandemic. She also said the agency was stretched in the fall when it had to deal with applications submitted during the Affordable Care Act open market enrollment, where people sign up for private coverage but may be redirected to Medicaid if eligible.
Prior to the expansion, Missouri’s Medicaid program did not cover adults without children. Now, Medicaid is available to all Missouri residents whose income is below 138% of the federal poverty level, or about $18,800 per year for an individual. Those whose claims are approved will be eligible for coverage retroactive to the month of their claim, and possibly up to three months prior to that date.
But Tricia Brooks, a research professor at Georgetown University’s Center for Children and Families, said people who wait for their application to be approved usually continue to act as if they are uninsured, delaying claims. necessary care and avoiding preventive services such as health examinations. If they seek care, they will face large medical bills if their request is later denied.
French, the St. Louis medical technician, was notified in January — three months after she applied — that her Medicaid application had been approved. She said if she had been approved sooner she might have gone to the emergency room for her knee injury, but didn’t because she was worried she would end up with a big bill. Instead, she went to a community health center that charges uninsured patients on a sliding scale based on their income.
Missouri is not the first state to experience such delays. When 26 states expanded Medicaid in 2014 as part of the ACA, many struggled to meet application demands. For example, in June 2014, California had a backlog of 900,000 claims, which prompted a lawsuit by health advocates.
Patient advocates say Missouri has had years to prepare to expand Medicaid. And, they note, Missouri’s delays in processing applications have been an ongoing problem that worsened after the expansion.
“At the very least, they’re under-resourced, and at worst, they’re doing it on purpose,” Burroughs said.
Brooks said Missouri has consistently taken longer than 45 days to process requests. She said more than 40% of requests in 2018 took longer than 45 days to process and the number had risen above 50% in 2019 and 60% in 2020.
“Where is the federal accountability and oversight when there is this kind of historical evidence that Missouri’s eligibility business is grossly non-compliant with federal standards?” Brooks asked. “The situation has gotten worse, not better.”
Centers for Medicare & Medicaid Services spokeswoman Beth Lynk said the agency is aware of the issue and is working with Missouri to bring it into compliance.
The delays in Missouri are also notable for the state’s long resistance to expansion.
Even after voters approved the 2020 ballot initiative, the Republican-controlled state legislature refused to fund the expansion and the state withdrew its plan. In August, a judge ordered the state to begin accepting applications from newly eligible adults. Missouri did not begin processing them until October 1 due to a need for computer updates.
Oklahoma expanded Medicaid much the same way as Missouri: voters approved it in 2020, starting July 1, 2021. But Oklahoma was much quicker to enroll people in its program. expansion – more than 230,000 had been enrolled through December 2021, nearly four times as many as Missouri had enrolled through early February. Oklahoma gives people a response as soon as they submit their application.
University of Washington health economist Timothy McBride said the disparate computer systems used by Missouri’s Medicaid program are extremely outdated and have caused problems for years.
To add to the challenge, Missouri reviews the eligibility of tens of thousands of applications submitted through the federal marketplace during open enrollment. But because the market assesses eligibility, some states that have recently expanded Medicaid, such as Virginia and Louisiana, are using that federal determination to handle the increased volume of claims and enroll people faster.
Beginning in September, Moshe Biron, 33, of suburban St. Louis, called the Missouri Medicaid helpline at least 20 times, spending more than 15 hours on hold trying to determine if his five children were still eligible for coverage after starting full-time work. like a teacher. Through his state senator’s office, he learned in December that his children remained eligible, but he and his wife were not.
Department of Social Services spokeswoman Heather Dolce said the Family Support Division is “aggressively tackling” the backlog by offering employees overtime and prioritizing the most urgent requests. older.
But health advocates have criticized the agency for hiring third-party vendors to verify income and address information, sometimes resulting in bad data that department staff have to correct. For example, some Medicaid recipients have been incorrectly flagged as living out of state, triggering a referral and appeal process. The state has suspended residency checks until at least February.
Brooks said Missouri’s application processing time could get worse when the covid public health emergency ends – now scheduled for mid-April. Federal rules in place during the pandemic have prohibited states from withdrawing Medicaid beneficiaries who are no longer eligible due to their income status since March 2020.
But the state will soon have to review each enrollee’s eligibility status, adding thousands of cases to the caseload. As of December, Missouri had nearly 1.2 million Medicaid enrollees, up from about 861,000 in March 2020.
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