Missouri’s Medicaid enrollment has shrunk by around 200,000 people since last summer, as the state continues the process of undoing a COVID-era pause on eligibility checks.

The federal suspension on annual renewals expired last year and since then, states have been undergoing the process of re-verifying each participant’s eligibility.

From June to April, Missouri’s net enrollment in Medicaid — which is also called MO HealthNet — dropped by 197,525 people. 

Over half — 56% — of that net decline was among children, according to recent state data and analysis by the Center for Advancing Health Services, Policy & Economics Research at Washington University in St. Louis. There were 110,938 kids who lost coverage in that period.

The number of kids being removed has been a source of concern over the last few months among advocates. Although kids make up around half of the state’s caseload, they are also eligible at much higher household income level than adults.

As the state evaluates hundreds of thousands of current Medicaid recipients each month and processes their updated information, it continues to receive new applications. 

Federal data released earlier this month showed Missouri’s application processing times have been among the worst in the nation. 

Medicaid applications are generally required to be reviewed within 45 days. Nationwide, most applications were processed within 24 hours last year.

Missouri and New Mexico had the highest rates of late Medicaid determinations last year, according to the federal data, which covers October through December. 

In December, more than half of Missouri’s applications took longer than 45 days to process.

Long processing times can mean low-resource and low-income patients must delay or forego needed medical care and prescriptions.

And Missouri has struggled to meet that limit in the past: In summer 2022, the federal government initiated a mitigation plan with the state to get the wait time down.

At the quarterly MO HealthNet Oversight Committee meeting last week, chair Nick Pfannenstiel, a dentist, raised concerns about processing times. 

Pfannenstiel said as a provider, he has been told by state eligibility workers that the current average processing time is “60 to 90 days.” Though he knows the state is working to fix those delays, “that’s causing a lot of frustration, not necessarily from a provider standpoint only but from a patient standpoint.”

Todd Richardson, director of MO HealthNet, said that there are a “number of strategies and a lot of focus right now trying to bring that back down to the 45 day window” that is federally mandated.

Part of the issue is the agency is receiving a large number of applications, Richardson added.

From November to mid-January, during open enrollment season for the federal insurance marketplace, the state generally sees an uptick in Medicaid applications and then a decline and plateau, he said.

“We are not seeing that now,” Richardson said. “[Family Support Division] is continuing to experience a high number of daily new applications, and as a result, you can see that increase in the number of pending applications that we have.”

‘Perfect storm’: Missouri advocates decry Medicaid application delays, coverage losses

The number of pending applications reached nearly 53,000 in January and stands at just under 18,000 as of April.

“I know [Family Support Division] has been working exhaustively, trying to bring that number of pending applications down and I know they’ve had some success,” he said, “but there will continue to be kind of an intense review on the state’s part to make sure that we’re getting those applications as current as we possibly can.”

Baylee Watts, DSS’ communications director, said the division has “focused its staff and resources on processing applications that have exceeded 45 days” and continues training staff across several programs and “strategically reallocating staff to manage the workload effectively.”

There can be issues when a patient is on Medicaid but needs to change the category of coverage they qualify for, Pfannenstiel also noted, referring to a patient trying to convert to postpartum Medicaid as causing providers confusion as to whether the person is eligible for services.

A patient previously told the Independent she spent more than a month just trying to switch from adult Medicaid to Medicaid for Pregnant Women. In the meantime, she didn’t go to any doctor’s appointments.

Richardson said it is currently a “manual process” for state workers to move Medicaid participants into the postpartum category. Since last year, women can receive postpartum coverage for a full year rather than 60 days.

It is also a manual process for children to receive what’s called continuous eligibility, which went into effect this year after it was federally required. That policy allows kids to stay insured for the full year after they are renewed, rather than be potentially stripped of coverage between renewals, due to something like temporary changes in income.

There are system changes to automate those processes planned for June, Richardson said.