ST. LOUIS — More than 100 days.
That's how long application wait times are right now for Medicaid in Missouri.
By federal standards, it should be no longer than 45 days.
Now, the federal government is stepping in to fix the backlog.
How we got here
Medicaid expansion is called MO HealthNet in Missouri and it took a lawsuit to make it happen in the Show-Me State.
Last August, a judge ordered the state to make this available.
Since then, the state has been enrolling applicants, but the process has been a slow and cumbersome one.
The problems
Missouri Foundation for Health is one of several organizations helping 275,000 low-income Missourians get their hands on Medicaid.
"Folks who make $1,500 a month as an individual or $3,200 a month for a family of four are now eligible for Medicaid. What the expansion did was it increased income levels for people to qualify," VP of Health Policy Sheldon Weisgrau said.
Expanding eligibility for Missourians like Amber Kuehn from Jackson.
"I have to see an eye specialist on a regular basis. I was driving two hours twice a month to see one. Having someone to help me with it was the biggest thing," Kuehn said.
She's one of the 258,000 people who submitted applications to the state.
"After a year, most states had enrolled everybody they thought would be eligible and we are not at that pace," Weisgrau said.
There are several setbacks the Missouri Department of Social Services faced, from insufficient staffing, hiring and retention hurdles, computer issues and problems with the call center.
This resulted in sizable backlogs and pending applications.
The nonprofit Legal Services of Eastern Missouri helps with the process and the director of Advocacy Joel Ferber says, wait approval times should be 45 days.
At the end of June, Medicaid applicants were waiting an average of 115 days, up from an average of 106 days in May.
A plan the Missouri Department of Social Services shared with the federal government showed several findings:
- As of June 26, 2022, Missouri has more than 51,381 total pending applications
- The state went from making 1% of Modified Adjusted Gross Income (MAGI) determination in 45 days in April 2021 to 42% in October
- That number jumped up 82% in April 2022
The changes
On July 11, Centers of Medicaid and Medicaid Services (CMS) approved Missouri’s Eligibility and Enrollment Mitigation plan.
- It will de-duplicate applications, there are about 10,000-11,000 duplicate applications and it’s been reduced to 2,868
- Transition of Gateway to Better Health Demonstration to adult expansion group
- Enrolling parents into Medicaid based on children’s income eligibility
- Targeted enrollment SNAP strategy
- Pilot project with Truman Medical Center to assist with eligibility application – hospital staff gathering information to complete and submit applications through an online portal, not making eligibility determinations
- Treat assessments as determinations – Missouri is requesting temporary determination status with Federally Facilitated Marketplace May 1, 2022 to 12/31/2022
- Processing changes in circumstance, new method for processing renewals called first touch resolution
- Ex-parte renewals for pregnant individuals hose postpartum period has ended
- Renew child’s eligibility based on updated information used to enroll parent
- Processing of non-MAGI determinations
- Enhance eligibility and enrollment operations – received funding to support systems and staff to facilitate process applications
- Evaluate staffing plan
- Use of contractor services for assistance in processing applications and renewals
Weisgrau said he's already felt some relief.
"The backlog of applications is really going down and we hope that continues and even get better," he shares.
Already, the state has dwindled down to 43,475 pending applications as of June 18th versus 51,381 when the plan was submitted.
This is giving a chance to more folks like Kuehn.
She was finally able to get Medicaid with the help of Legal Services of Eastern Missouri and found a cure to many of her coverage problems.
"It's been a lot simpler than I expected it to be. It's been a blessing," Kuehn adds.
As far as what's next, the state has committed to meeting the wait time requirement of 45 days by the end of September.
Assistance
If you need our assistance, you can call the Legal Services of Missouri intake department from 8:30 AM to 5:00 PM, Monday through Friday at 314-534-4200 or toll free at 800-444-0514.
You can also go to the Cover Missouri website here or call 1-800-466-3213 for assistance.