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Critics Cry Foul As Missouri Medicaid Enrollment Hits 5-Year Low

Dierdre Wortham relaxes while members of her family play around her. Her son, Aiden (second from left) had to forgo treatment after the state removed them from Missouri's Medicaid program.
Sarah Fentem | St. Louis Public Radio
In this file photo, Dierdre Wortham relaxes while members of her family play around her. Her son Aiden (second from left) had to forgo treatment after the state removed them from Missouri's Medicaid program.

The number of people enrolled in the state’s Medicaid program reached a five-year low in December, falling to 846,554. That’s 130,000 fewer people — including 100,000 children — on the rolls since January 2018.

Democratic lawmakers and other critics said the large drop in enrollment is a sign that the state agency in charge of administering the program is culling people unfairly and leaving them without needed medical services.

“We are setting the pace in the nation at how many children have dropped off,” said state Rep. Deb Lavender, D-Kirkwood. “That indicates that there’s something not right, that should not just justify but call for an investigation, that we truly can start understanding this problem.”

In the past two years, the number of Missourians covered by Mo HealthNet has decreased 13%.

But Democrats in the Missouri Legislature and the administration of Republican Gov. Mike Parson are split on whether the development is a positive or negative.

State officials said that because of an improved economy, more people can now afford their own insurance, and others are not enrolled because the state is removing those who don’t meet the income requirements for the program. They said that for years people were able to use the program without needing it, and a new verification process is systematically weeding them out – and saving Missourians money.

Parson touted the savings to the state’s Medicaid program earlier this week in his annual State of the State address. In his speech, he noted Medicaid savings totaled $84 million in 2019.

Those savings came were the result of increased “accountability” and “efficiency” on behalf of the Department of Social Services, Parson said.

“While some in the press are eager to criticize this improved efficiency, or outright misrepresent it, the truth is that this system has been broken for many years and unproductively serving every Missourian who is paying for it,” he said.

Parson characterized Democrats' concern as political game-playing and shrugged it off during an interview Thursday.

“I think the spin the Democrats put on that is a political spin,” he said. “They keep throwing out those numbers, but they have from day one.”

Lavender said that’s not true. She’s heard from several people whom the state removed from the program without notice, even though they’re eligible. Legal Services of Eastern Missouri has re-enrolled hundreds of people in Medicaid after they were removed, she said.

The legal nonprofit found that only one person in the cases the lawyers reviewed was above the income threshold for eligibility.

Others point to an increase in Missourians’ Medicaid applications as a case against the state’s argument that people don’t need the program anymore.

“What’s perplexing about it is it’s happening the same time we’re seeing a 25% increase in applications for the program, in August through November,” said Tim McBride, a Washington University professor and former chair of the Missouri Medicaid Oversight Committee.

“You have to wonder at what point — there’s been a lot of complaining about this, but at what point is it going to matter? They’ve been pretty resistant saying, ‘There’s no problem here,’” he said, adding the 13% drop in enrollment is the largest in the country.

McBride and Lavender think the enrollment drop could play into the push for expanding Medicaid. Missouri is one of the 14 states that have not elected to expand coverage to people making up to $18,000 a year. A grassroots effort has collected half of the more than 170,000 necessary signatures to place the expansion before Missouri voters. If the petition receives the signatures before the May deadline, the expansion will appear on the November 2020 ballot. 

The enrollment plunge could “draw a beam” to the issue of health care access, Lavender said. 

“People across the state are losing access to health care, and they’re realizing how important expanding access to Medicaid is for our state,” she said.

Follow Sarah on Twitter: @petit_smudge

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Sarah is the health reporter at St. Louis Public Radio.

Send questions and comments about this story to feedback@stlpublicradio.org.