Missouri Medicaid recipients face cutoff over faulty address checks, advocates say

The letter was a shock.

It came to Heather Roberts from the Missouri Department of Social Services last month, explaining that officials had found out she and her family were living at an address in Washington state. As a result, her two children would be cut off from Missouri’s Medicaid coverage in 10 days.

But Roberts, a 37-year-old daycare worker, said she’s lived at the same Chesterfield, Mo. address for 11 years. She’s never even set foot in Washington.

She got the letter because Missouri is using a third-party records database to find and drop Medicaid recipients who have moved out-of-state. But the process has also wrongly flagged for removal some eligible residents.

Health care advocates are reporting many low-income clients who have recently received letters informing them they’ll be cut off from the health program because the database has identified them as living at an out-of-state address. They can remain enrolled, the letters state, if they provide proof of residency to DSS within 10 days.

Advocates are concerned that some eligible Missourians flagged at the wrong address by the database, LexisNexis, may never receive notice that their coverage is at risk. Or, that they may not be able to reach DSS, which is handling a high volume of pending Medicaid applications. Reported wait times for understaffed call centers have soared upwards of three hours in recent months. Application processing times are also on the rise.

“It’s putting the burden on the client to deal with inaccurate, stale, old data and just creating a lot of unnecessary havoc, is how it appears to us,” said Joel Ferber, director of advocacy at Legal Services of Eastern Missouri which has seen “several” clients receive letters with out-of-state addresses.

Roberts and her husband were holed up in their room, sick with COVID, when the letter arrived. By the time she checked the mail, there were only three days left to respond.

“You just feel helpless,” she said.

When she called DSS, the automated phone system told her there were hundreds of callers in line ahead of her. Eventually, she got through to Legal Services, which helped her contact the state with proof of residency.

She also ran some online searches herself. It appeared to be a case of mistaken identity: there was another Heather Roberts, who shared the same middle initial, apparently living in the same city as the Washington address.

“There’s probably a Heather Roberts in every state,” she said.

It’s not clear how many beneficiaries have been told they could lose coverage based on mistakes like those. DSS did not answer questions about it last week.

“It’s not just one or two or three people; it’s across the state,” said Iva Eggert-Shepherd, senior outreach program manager at the Missouri Primary Care Association. “I’m very, very concerned, all the way from young children, disabled individuals to working adults, that they’re going to lose their coverage and they should not be losing it because they are eligible.”

Eggert-Shepherd said she had a file of close to two dozen clients, all Missouri residents who have not lived outside the state for anywhere from seven to 20 years, she said.

‘What’s it going to cost me?’

Ruth Pera, a 39-year-old St. Louis woman, received a letter stating her five children’s coverage would end on Feb. 3 because the company had flagged the address of her mother-in-law’s home in Ohio. Pera’s husband grew up there, she said, but they had never lived there as a family.

“We stay there at Christmastime,” she said. “It’s never been our address of record.”

After five-and-a-half-hours on hold with DSS, Pera said the phone system dropped her call and she gave up. On Friday, she was headed to get one of her daughters’ essential prescriptions refilled.

“I don’t know what it’s going to cost me when I get to the pharmacy today,” she said.

Missouri began identifying Medicaid recipients to remove based on the LexisNexis address checks last month, according to a Dec. 6 memo that Kim Evans, DSS Family Support Division director, sent to staff.

Evans, whose office is responsible for verifying eligibility for social services, acknowledged in a Medicaid oversight committee meeting Thursday that some recipients have received termination letters based on incorrect information.

“When we started to hear that there was some conflicting information we went to LexisNexis and we took those cases back and said, ‘The data’s not correct,’” Evans said when asked about the situation by state Rep. Tracy McCreery, a St. Louis Democrat on the committee.

The company doesn’t reveal its exact sources, Evans said. Some recipients were linked to addresses where they used to live, she said, but, “We’ve had a couple that had never lived there before.”

The memo instructs workers to terminate recipients flagged for “out of state residency, death, and incarceration,” and to keep them on the program if they provide information “clarifying their eligibility.” There is a 90-day appeal window for anyone wrongly cut off from services, according to the letters.

It tells staff to direct recipients who have been falsely flagged for out-of-state addresses to contact LexisNexis themselves to fix the error, which advocates say is cumbersome for recipients.

Evans told the committee Thursday her division will still update the state’s own records when recipients contact them, but the state is encouraging recipients to contact LexisNexis directly to address potential “identity theft.”

Problems elsewhere

LexisNexis, commonly used for private-sector background checks, offers a database of Americans’ addresses and phone numbers amassed through public records, utility bills and other information. Government reliance on the company for social service checks has raised accuracy concerns in other states.

In 2017, advocates in the state of Washington voiced fears that the state’s apparent cutoff of health benefits from about 18,000 recipients, based on LexisNexis address checks, could have ensnared actual in-state residents such as those who are homeless or have unstable housing. In 2015, an Arkansas Medicaid official told a reporter many recipients flagged with an out-of-state address were “absolutely” eligible in-state residents.

In a statement Friday, LexisNexis spokesman Paul Eckloff did not address why the address checks in Missouri turned up some inaccurate matches, but said states can do further work to verify them.

“LexisNexis Risk Solutions works with many states to provide services that allow the state agencies to better serve their citizens,” Eckloff wrote. “Eligibility decisions are made by each state based on their own investigations. Those important decisions are made by agencies after independent investigations that they perform.”

The residency checks were conducted as Missouri prepares to use other third-party services to check the income of nearly all its Medicaid recipients.

For the past two years, the state has been prohibited from cutting anyone off coverage during the federal COVID emergency. Moving out of state is one of the few reasons a state is still allowed to cut off benefits during the emergency.

The emergency is set to end April 16, though it has been extended several times before. After that, the state will begin dropping those who now make too much to qualify for the program.

In preparing for the re-evaluation, DSS is hoping to avoid repeating issues that arose in 2019 when more than 90,000 children were removed from the Medicaid rolls. Part of the reason then, advocates said, was that many families never received renewal notices.

This story was originally published February 7, 2022 at 5:00 AM.