Aneka French applied for Medicaid in October, shortly after Missouri became the 38th state to expand eligibility for the program.
But her application, along with tens of thousands of others, has been backlogged for months. While waiting, French, 45, an uninsured medical technician from St. Louis, paid out of pocket when she was treated at a health clinic last fall for a knee injury.
For nearly a decade, Republican political leaders in Missouri have resisted expanding eligibility for Medicaid, the state’s federal health insurance program for low-income people. It goes into effect in the summer of 2021, following the passage of a voter ballot initiative in 2020. Missouri’s MO HealthNet (the name of the state’s Medicaid program) now has more pending applications than enrolling through expansion. While 64,210 people have been approved as part of the expansion, nearly 73,000 applications were still pending as of early February.
most in the state recent reportwhich says it takes an average of 70 days to process a typical application—more than the 45 days allowed by federal law.
“This means that in the midst of a raging pandemic, people who are ultimately able to get health insurance are left out of the system and left to wait and wait,” said Melissa Burroughs, associate director of strategic partnerships at consumer advocacy group Families USA. “It’s totally unfair to those who have been hit financially and healthily by the pandemic.”
By contrast, most other states process Medicaid applications within a week, and many cases take less than a day, according to federal data for 2021.
Kim Evans, director of the Missouri Department of Social Services’ Division of Family Support, told the MO HealthNet Oversight Board in February that the delays were due to a shortage of workers exacerbated by the pandemic. She also said the agency had to process applications in the fall during the open enrollment period for the Affordable Care Act marketplace, where people sign up for private insurance but can be redirected to Medicaid if they qualify.
Before the expansion, Missouri’s Medicaid program did not cover adults without children. Medicaid is now available to all Missourians with incomes below 138% of the federal poverty level, or about $18,800 per year for individuals. Those whose applications are approved will be eligible for coverage retroactive to the month they applied, and possibly up to three months before then.
but Tricia BrooksPeople waiting for applications to be approved often continue to act as if they don’t have insurance, delaying needed care and avoiding preventive services like health checks, said a research professor at Georgetown University’s Center for Children and Families. If they do seek care, they face huge medical bills if their application is later denied.
France, a 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 ER with a knee injury, but didn’t do so for fear of being stuck with a large bill. Instead, she went to a community health center that billed uninsured patients on a variable rate based on their income.
Missouri is not the first state to experience such delays. When 26 states expanded Medicaid under the ACA in 2014, many struggled to keep up with the demand for applications. For example, California had a backlog of 900,000 applications in June 2014, file a lawsuit By health advocates.
Patient advocates say Missouri has years to prepare to expand Medicaid. And, they note, delays in processing applications in Missouri have been an ongoing problem that worsened after the expansion.
“At the very least, they lack resources, and at worst, they do it on purpose,” Burroughs said.
Missouri has consistently taken more than 45 days to process applications, Brooks said. In 2018, more than 40 percent of applications took more than 45 days to process, and that number rose to more than 50 percent in 2019 and 60 percent in 2020, she said.
“Where is the accountability and federal oversight when there is this historical evidence that eligible businesses in Missouri are clearly not meeting federal standards?” Brooks asked. “The situation has worsened, not improved.”
Beth Lynk, a spokeswoman for the Centers for Medicare and Medicaid Services, said the agency is aware of the problem and is working with Missouri to bring it into compliance.
Delays in Missouri were also prominent due to the state’s longstanding resistance to expansion.
Republican-controlled state legislatures even after voters approve ballot initiative in 2020 refuse funding Expansion, the state withdrew its plans. In August, a judge order The state began accepting applications from newly eligible adults.Missouri didn’t start processing them until October 1 because Computer update required.
Oklahoma expanded Medicaid in much the same way as Missouri: Voters approved it in 2020, starting July 1, 2021.But Oklahoma is far Register faster Enrollment in its expansion program – As of December 2021, more than 230,000 people had signed up, nearly four times the number of people enrolled in Missouri as of early February. Oklahoma replied to them as soon as they filed their applications.
Health Economist at the University of Washington Timothy McBride Said the patchwork computer system used by Missouri Medicaid was very outdated and caused problems for years.
Adding to the challenge, Missouri is reviewing the eligibility of tens of thousands of applications submitted through the federal marketplace during open enrollment.But some states that have recently expanded Medicaid, such as Virginia and Louisiana, Leverage federal determination to process the growing number of applications and get people to register faster.
Beginning in September, Moshe Biron, 33, from suburban St. Louis, called the Missouri Medicaid helpline at least 20 times and spent more than 15 hours trying to figure out if his five children were still eligible after he started working full-time Get insurance. as a teacher. Through his state senator’s office, he learned in December that his children were still eligible, but he and his wife were not.
Department of Social Services spokeswoman Heather Dolce said Family Support was “actively addressing” the backlog, providing overtime for staff and prioritizing the oldest applications.
But health advocates have criticized the agency for hiring third-party vendors to check income and address information, which sometimes leads to bad data that department workers must fix.For example, some Medicaid recipients are error flag As residing out of state, the removal and appeal process was triggered.country has Suspended residency inspection At least until February.
Brooks says Missouri application processing times may Even worse, when coronavirus disease public health emergency over – Now scheduled for mid-April. Since March 2020, federal regulations enacted during the pandemic have barred states from canceling Medicaid recipients who no longer qualify because of income status.
But the state will soon have to review each enrollee’s eligibility status, adding to the workload for thousands of cases. Missouri had nearly 1.2 million Medicaid enrollees in December, up from about 861,000 in March 2020.
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