State health officials faced tough questions Wednesday from the board overseeing Missouri’s Medicaid program — with a focus on the persistently long wait times for applicants and heightened federal scrutiny of the program.

Kim Evans, director of the Department of Social Services’ family support division, told the MO HealthNet Oversight Committee that Missouri is “well on our way” to getting wait times for applicants below 45 days by Sept. 30.

That deadline was established in a mitigation plan approved last month by the federal agency Centers for Medicare and Medicaid Services, in response to wait times violating federal standards for nearly a year.

Some members of the committee were skeptical the state will meet its deadline. As of Wednesday the average processing time for an application remained around 100 days. 

“I’m really concerned about the people who are waiting over three months to figure out if they have been accepted into the program,” said state Sen. Jill Schupp, a Democrat who serves on the oversight committee.

Board members also expressed concern that if the state can’t get wait times under the 45 day limit, the federal government could impose financial sanctions. 

“We don’t want sanctions, ” Schupp said, “we don’t want to lose money because we’re not able to fulfill the applications in the 45 day period.”

Evans said that before any financial penalties, the federal government would first implement more stringent compliance measures in a corrective action plan to try to help the state comply. 

“Our plan is never to get to the corrective action plan,” Evans said. “Our staff are working very hard right now.”

Federal scrutiny intensifies 

Wednesday was the first oversight meeting since the state began operating under a federal mitigation plan to curb Missouri’s delays and backlog.

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 the letter obtained Wednesday by The Independent.

CMS had begun working with the state 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 the May letter, CMS said Missouri will “need to do more” to achieve compliance, and to avoid erroneously stripping applicants of coverage in the longer-term.

Right now, under the federal public health emergency, the state is not allowed to remove anyone from its rolls. Experts worry that once the state has to begin recertifications again, possibly early next year, the process could strain an already overburdened system. 

“We have communicated our concerns to the state on multiple calls,” the May letter says, adding that if wait times don’t get down under federal standards Missouri may have to submit a corrective action plan. 

If the state continues to fall short, federal financial participation in the program “may be at risk,” the letter says.

Evans, asked about those repercussions in the meeting, said the state is doing all it can to avoid them, including “throwing as many staff at this as we can” at processing applications.

The mitigation plan, designed to help the state process applications more quickly, includes temporary measures such as enrolling parents based on children’s verified eligibility, allowing the agency to use verified income from applicants already enrolled in federal food benefits, and allowing the agency to accept verification from the federal marketplace. 

Waiting over three months 

According to numbers Evans presented to the committee Wednesday, the current wait time is around 100 days — down from 115 days in June but still double what is federally allowed. 

The backlog of applications also has dropped to 34,060 from close to 50,000 in late June. 

At the last meeting, Evans predicted they’d be at 30 days by late August, Schupp pointed out. 

“Obviously, we’re not there,” Schupp added.

Medicaid isn’t the only benefits program struggling with delays. 

Evans testified Wednesday that Missourians are also facing long hold times waiting for required interviews to receive federal food assistance through the Supplemental Nutrition Assistance Program, or SNAP.

“The same staff that process Medicaid also process SNAP,” Evans said, explaining that DSS moves staff around depending on need. 

Lately, Evans said there has been an influx in SNAP applicants that she attributed in part to the worsening economy.  

“I know it has crept up to a couple of hours the last couple weeks,” Evans said about the average SNAP call wait time. 

Missouri’s SNAP call times are the subject of a federal lawsuit. 

Last month a judge said just one hour, which was the state’s May average, is “still unacceptably long and particularly burdensome for financially struggling Missouri citizens in need of SNAP benefits.”

‘You just leave a person in limbo’

For the Missourians with pending applications, each additional day waiting is a day worrying about prescription prices, delaying needed care, and, often, devoting hours they can’t spare to try to navigate the system, experts say. 

Melanie Jefferson, a 59 year old in St. Louis, said she applied on April 15 for Medicaid.  

As of this week, she still hadn’t heard back. 

Jefferson is a Type II diabetic and without Medicaid has to pay almost $100 for each Epipen. She is delaying other care, including visiting the neurologist and dentist. When she recently went to the optometrist for her annual eye exam, they told her it’d cost $400 without insurance. She walked out of the office without an exam. 

As the weeks stretched on without hearing back about her application, Jefferson felt completely in the dark. 

“I never got any information: nothing in the mail, no email, nothing to keep up with the status of my application,” Jefferson said, later adding “You just leave a person in limbo and it’s kind of crazy to me.”

When she called the Medicaid call center in late June, a staff member initially had trouble locating her in the system, Jefferson said. When they located her application, the staff member told Jefferson her information hadn’t been appearing because no one had begun processing the application yet. 

“I have enough going on,” said Jefferson. “This is unnecessary stuff.”