Missouri’s health care challenges
Missouri Democrats are calling for legislative investigations to find out why 120,000 people have fallen off the state’s Medicaid rolls since January 2018.
Republican Gov. Mike Parson’s administration has given several possible reasons, including an improving economy and the end of the federal mandate that people carry health insurance or face a tax penalty.
But House minority leader Rep. Crystal Quade said those explanations aren’t sufficient, given that Missouri was third in the nation in Medicaid drop-off last year. In addition, 95,000 of the 120,000 now without coverage are children.
“The House of Representatives has more than enough resources and reasons to begin (investigative) proceedings,” Quade said in a letter to House Speaker Elijah Haahr. “We have no excuses not to, and at this point a failure to address this problem constitutes both a moral and procedural abdication of our oversight duties.”
Quade’s letter asks for a response by Wednesday. Haahr’s aides said they received it Monday morning and are reviewing it.
Todd Richardson, the director of Missouri Medicaid, or MO HealthNet, did not respond to a request for comment.
As of June, there were just short of 600,000 Missourians on Medicaid.
Quade and Sen. Scott Sifton, also a Democrat, had sent letters to Richardson in February requesting an explanation for Medicaid enrollment drops that at that point totaled about 80,000 people.
Patrick Luebbering, who works under Richardson, wrote back with three explanations: More people were accessing private insurance because of the improving job market, more people were going without insurance after Republicans scuttled the Affordable Care Act’s tax penalty and a new computer program was making it easier for the state to spot people who are no longer eligible.
“Over the past five years, the state has been developing this new technology to replace our outdated legacy system,” Luebbering wrote. “The new system, MEDES (Missouri Eligibility Determination and Enrollment System), brings significant new functionality to our state.”
But Quade and others now believe that same computer system may be kicking some qualified people off the rolls. When the software does its reviews, it doesn’t check income information submitted for other social welfare programs like food stamps, even though federal law says it’s supposed to.
She said other factors are keeping people from renewing their Medicaid. The state has failed to mail renewal notifications to enrollees in a timely way. And the state Medicaid call center has long hold times.
Kansas experienced similar issues after it switched its Medicaid eligibility software in 2015 and shuffled the state agencies that handle applications. But those problems mostly affected new applicants, not renewals.
Quade said that if an improving economy were truly the explanation, Missouri would be seeing similar enrollment declines in food stamps and welfare benefits, but those have remained fairly flat of late.
Meanwhile, Missouri’s decline in Medicaid enrollment is twice the national average, and accelerating.
A recent study by the liberal think tank Families USA found that Missouri, Tennessee and Arkansas had the largest percentage drops in Medicaid enrollment in 2018. Missouri was third at 7.2%, while the national average was 2.2 percent. In Kansas, enrollment was basically flat.
The report’s authors, Emmett Ruff and Eliot Fishman, blamed “outdated processes for verifying income and state residence that put an unnecessary burden on beneficiaries and create additional barriers to health insurance coverage.
“As a result, beneficiaries struggle to navigate their renewal processes and lose their Medicaid eligibility even though they may qualify,” they said.
Fiscal hawks in the Missouri legislature have little incentive to smooth the way, as the enrollment drops are projected to save the state more than $200 million a year.
Richardson, a former legislator, and other Republicans have been looking for ways to bend down the cost curve of Medicaid for years, as it has grown from about 17% of the state budget in 2009 to about 24% last year.
But in her letter to Haahr, Quade said legislators should fully examine whether cost reductions are coming at the expense of people who need health coverage and aren’t getting it — especially children.
“As parents, you and I can both appreciate how wrenching it must be for a mother or father to know their child needs medical attention and to learn they may not be able to get the care they need,” Quade said. “It is particularly cruel that the only means of access many children have to healthcare is through a government that seems increasingly content to purge as many of them from the system as possible.”