Missouri has just over one month to get its Medicaid program back into compliance with federal regulations, and state officials said Friday they are optimistic they will meet that deadline despite the average wait time for Medicaid applications still hovering around double what is permitted.

The processing time for a Medicaid application, which averaged 100 days at the beginning of August, is now “about 90 days, 85 days,” Kim Evans, director of the state’s Family Support Division, said Friday. A mitigation plan approved last month by the Centers for Medicare and Medicaid Services (CMS) requires Missouri to get that wait time down to 45 days by Sept. 30.

“We are on target right now to do that,” Evans said.

Before Medicaid eligibility was expanded to include low-income adults last year, the average processing time was eight days. While wait times remain high, the backlog of pending applications has dropped to 23,804 as of Friday morning, down from 35,393 at the end of July.

The federal government formally requested the state produce a mitigation plan in May, after identifying “multiple issues related to Missouri’s timely processing of applications,” according to a letter obtained by The Independent.

CMS began working with Missouri officials in early 2022 to identify strategies the state could adopt to address the backlog. But by May, the federal government wasn’t satisfied with Missouri’s progress.

In July, CMS published a summary of Missouri’s shortcomings and signed off on strategies proposed by the state to help it come back into compliance with federal standards. The state’s Medicaid program, which is called MO HealthNet and administered by the Department of Social Services, has committed to those strategies.

Srare and national experts, along with longtime observers of Missouri’s Medicaid program said the decision by CMS to intervene was unusual and demonstrates how severe the application delays have become.

On Friday, during a briefing with reporters, Evans downplayed the significance of the federal intervention. 

“This is something that is normal,” Evans said. “It is not unique to Missouri and it’s not something we had to do because Missouri was just so far behind that we couldn’t save this.” 

If the state falls short of the plan laid out by CMS, the federal government could implement even more stringent compliance measures. Eventually, Missouri could face financial sanctions.

 ‘We’ve got crises’

Where the state stands regarding Medicaid wait lists was just one topic of a wide-ranging media briefing held on Friday by leaders of the Missouri Department of Social Services, or DSS. 

The agency’s leaders discussed a series of challenges that have plagued the department for years, most of which were intensified by the pandemic. 

The most-discussed challenge, which contributes to the Medicaid wait times and persistent issues across the agency, was staffing shortages.

Darrell Missey started in January as director of the Children’s Division  — which investigates child abuse and neglect and administers the foster care system.  He said when he took the job, “I walked in and discovered we’ve got crises going on.”

Despite a 5.5% pay increase for state workers, there are currently between 900 and 1,000 vacancies across DSS, according to data shared Friday. There are 6,630 full-time positions budgeted for, but only 5,760 full-time employees.

Staffing shortages impact almost every aspect of the department, including the level of care available for foster children and youth in the juvenile justice system.

“We’re creative in shifting resources to cover the caseload,” said Karen Meyer, human resources director for the department, who also emphasized ongoing mass hiring events.

In Family Support Division, Evans said, they are flexible enough to “move staff from one program to another when we are backlogged” because the “same folks that process Medicaid applications are dually trained to also take care of the SNAP benefits.” 

SNAP, the Supplemental Nutrition Assistance Program, is the program that provides federal food assistance. Missouri is currently facing a federal lawsuit over long hold times for required interviews to receive SNAP benefits.

Bringing on new staff takes time, and “sometimes folks get into this and decide this is not the job for them,” Evans said. “It is very complicated.” 

The turnover rate across the department currently stands at around 35%, meaning that over one third of all employees leave the department over the course of a year, Meyer, the HR director, said.  

In the Children’s Division, there might be as many as 200 open positions, said Patrick Luebbering, chief financial officer for DSS. There were 237 vacancies in the division in April.

The effect for workers is an increased “workload and frequency they have to be on-call,” Missey said.

The Division of Youth Services, which deals with treatment and rehabilitation for young people who are committed by juvenile courts in the state, is facing more young people in its custody but fewer staff to oversee them, said Scott Odum, the agency’s director.

According to Robert Knodell, acting director of DSS, a big part of the challenge is the state’s low rate of pay. The starting salary was $34,666 for DSS employees after the pay raise in April. 

“We have quite a bit of a way to go and making our pay more competitive and continuing to address that,” Knodell said.  

The other crisis Missey said he was faced with when he started his new position, in addition to staffing issues, was that the state has “too many kids in foster care” with nearly 14,000 children and only around 5,000 foster homes.

“There’s always a scramble to figure out where they should go,” he said.

Missey urged a prevention-centered approach that would reduce the need for more kids to come into state care, and would replace a “reactive” system “driven by fear of what might happen later,” which pushes more kids into foster care. 

In the shorter-term, “we need to work to stabilize the force” to prevent people from quitting and make caseloads tolerable, he said, and we “have to have a prevention force upfront that will help reduce the number of kids in care.”