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Health, Science, Environment

'I'm not exactly sure what took so long': Missouri struggles with Medicaid applications

Filing an application for presumptive eligibility is the starting point in applying for Medicaid coverage.
Sebastián Martínez Valdivia
/
KBIA
Filing an application for presumptive eligibility is the starting point in applying for Medicaid coverage.

Missourians who apply for Medicaid are now waiting nearly four months on average to get those applications processed.

Since the state implemented Medicaid expansion in October — opening the door for most Missourians making less than 138% of the federal poverty level — wait times have ballooned.

As of February, Missourians were waiting more than two and a half times the 45 days the federal government says states should take to determine if someone is eligible.

Washington University Professor Timothy McBride spoke with KBIA reporter Sebastián Martínez Valdivia about state's predicament. McBride studies health policy, and served as chair of the oversight committee for MO HealthNet — Missouri’s Medicaid program — from 2012 until 2019.


Sebastián Martínez Valdivia: How unusual are the wait times Medicaid applicants in Missouri are facing right now?

Timothy McBride: Very unusual. In fact, I've been tracking this for probably almost a decade and this is the highest number of days pending I've ever seen. There was a time when I was chair of the Medicaid oversight committee when the number of days pending was like 90, and we thought that was pretty high then.

Martínez Valdivia: And what are the biggest factors you think are contributing to the steep increase in wait times?

McBride: Multiple factors unfortunately. I think when I looked at it there were probably 150,000 applicants in about a four month period and a lot of those came from the federal marketplace.

So if people end up applying through the marketplace and then it tells them, 'Well you actually are eligible for Medicaid.' Then when the applicants come in there are probably three or four problems that we're facing at the state level. They're short-staffed because they have a lot of turnover in the staff, and that's probably because of pay issues and other issues. Then actually some people have been out a lot because of COVID, so that's another problem.

Martínez Valdivia: The state says staffing turnover is a big contributor to the difficulties they’re having. You chaired the MO HealthNet oversight committee for many years: is this a new problem for the Department of Social Services?

McBride: I think it's more acute now than it's ever been that I've seen — you know, I'm not there every day but from what I've heard. And I think we've historically paid our state employees about the lowest in the country and it just hasn't grown very much and that problem is going to perpetuate itself. And obviously that was a discussion the legislature was having too after the governor proposed raising pay. So I think it's always been an issue and I remember hearing about it but I think it's become more problematic now especially as we come out of the pandemic.

Martínez Valdivia: Are there any immediate changes Missouri could make to speed up the process for applicants?

McBride: Well there are several things that I think people have been proposing for a while. And I think we actually saw this week— every week the state puts out a number of how many people are enrolled in the Medicaid expansion and it went up about 18,000 this week to over 100,000 enrolled now.

So what it appears is happening is that the state is now looking at people in a couple categories including the pregnant women category and the MO Healthnet for families category, and if they are eligible for the expansion, they're moving them over. Frankly I think that could've been done a long time ago, closer to October, and I'm not exactly what took so long.

So in answer to your question, I think there are well-known ways of dealing with this that other states have used that I'm not sure our state is using.
This story was originally published by St. Louis Public Radio's colleagues at KBIA in Columbia, Missouri.

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