Missourians for Healthy Families and Fair Wages prepare for a press conference in May, 2024 (Annelise Hanshaw/Missouri Independent).

A measure that would guarantee paid sick leave for over 700,000 Missouri workers who currently lack it, as well as gradually raise the minimum wage to $15 per hour, will appear on voters’ ballots next month.

The ballot initiative, called Proposition A, has been backed by various unions and workers’ advocacy groups, social justice and civil rights organizations, over 500 state business owners and others. 

Some business groups, including the state Chamber of Commerce, have opposed it, especially the guaranteed sick leave portion. But thus far there hasn’t been a coordinated opposition campaign. 

The campaign in favor of the measure, called Missourians for Healthy Families and Fair Wages, has raised over $5 million — including from out-of-state groups that don’t disclose their donors— and collected 210,000 signatures to have the issue placed on the statewide ballot.

Most expect the ballot measure to succeed, given polling, national trends with similar ballot measures and the lack of coordinated opposition. Missourians have approved minimum wage increases on the ballot twice before by wide margins. 

“We believe full-time work deserves better than poverty,” said Richard Von Glahn, campaign manager for Missourians for Healthy Families and Fair Wages, “but current minimum wage — that’s what it leads to.” 

The current minimum wage in Missouri is $12.30, which is equivalent to $492 per week, before taxes.

And without sick leave, proponents argue, workers have to choose between their financial and physical wellbeing — going into work sick or losing out on a needed paycheck.

“Everybody gets sick. Everybody has a child or someone they care for that gets sick,” Von Glahn said, “But when there’s an unequal ability to care for yourself or care for your family, that is unjust.”

Businesses would be required to provide one hour of paid sick time for every 30 hours worked, up to five days per year for small businesses and seven days per year for larger businesses. Small businesses are those with fewer than 15 employees.

Some business groups have said the proposal constitutes government overreach in what should be the decisions of business owners.

“A business owner’s ability to set their own workplace policies and procedures is really the bedrock on which our free enterprise system is built,” said Kara Corches, interim president and CEO of the Missouri Chamber of Commerce and Industry. “So this is creating a new mandate for employers in terms of wage as well as paid leave policy, that is really against that principle of ‘let business decide.”

“…We want to make sure that Missouri is the most business friendly state in the nation, and we don’t think that this proposition is sending that message,” Corches added.

Sick leave

The ballot measure would make sick leave guaranteed for 728,000 workers who currently lack it statewide, or over 1 in 3 Missouri workers, according to an analysis from the progressive nonprofit the Missouri Budget Project.

Many of those who lack paid sick leave are the lowest earners.

“Sick days are very common amongst the highest paid workers, you know, executives, those types of positions,” Von Glahn said, “but particularly in some of the lower wage industries — the industries that we’ve been calling essential for a number of years now — construction, retail, food service, nursing home, childcare workers, they lack access to this.”

Employees would be allowed to take the time for mental or physical illness, to take care of a family member, or due to a domestic violence situation, according to the proposition.

Employers could require documentation when a worker takes three or more days off in a row, such as a doctor’s note, but wouldn’t be allowed to require disclosure of detailed health information.

Corches said the paid sick leave part of the measure is what “gives us a little more heartburn, just because it’s so nebulous,” and open to interpretation. She pointed specifically to confusion around provisions that would give employees a civil cause of action to sue if employers break the law, and another provision that prohibits employers from retaliation when workers take leave. 

“Business owners have enough on their plates, just trying to, you know, keep their businesses open, retain and recruit employees, and this nine page new proposition is very complicated and is going to make compliance quite challenging,” Corches said.

If the measure passes in Missouri, the paid sick time provision will kick in on May 1, 2025.

Ray McCarty, CEO of Associated Industries of Missouri, a business advocacy organization, raised concerns that “you will have people that abuse the system,” meaning those who take sick leave who don’t qualify. McCarty said in some cases employers may need proof of the legitimate absence earlier than three days in, or need to ask for more detailed information.

Missouri would join 15 states that require employers to provide paid sick leave. The United States, unlike nearly every other country, lacks federal paid sick leave, so states, as well as cities, have taken the lead. 

In states that have adopted sick leave mandates, employees take, on average, two more sick days a year than prior to the law going into effect, a National Bureau of Economic Research report found.

Studies have found that offering paid sick time can increase workers’ productivity and reduce illness, and generally adds little or nothing to business expenses.

Nebraska and Alaska also have paid sick leave on the ballot this year.

Minimum wage

The ballot measure also would raise the state’s minimum wage to $13.75 next year and $15 in Jan. 2026. 

The increase would affect over 562,000 workers in the state, according to the Missouri Budget Project, or nearly one in every four workers. The minimum wage would be adjusted based on inflation every year after 2026.

McCarty said most members in Associated Industries of Missouri already pay at least $15 hourly, though they may not realize the “whole wage scale will slide up,” meaning raising the minimum wage could have spillover effects on other wages, for businesses to remain competitive. 

He said some employers could go over to Kansas and pay less, so may choose to be based in neighboring states. 

The states neighboring Missouri already have lower minimum wages, except for Illinois, which is $14 per hour. 

A coalition of hundreds of businesspeople in the state have signed on to support the ballot measure, arguing the policies help their bottom line, causing lower employee turnover, increased productivity and better health and safety conditions.

Ballot initiatives to raise the minimum wage are generally likely to succeed, and have previously succeeded in Missouri, amidst legislative inaction or opposition.

Voters approved a minimum-wage hike in 2006, with 75% of the vote, and again in 2018, with 62% of the vote.

Advocates have had success with ballot measures as, for years, Republicans in the legislature have voted against or failed to hear proposals to increase the minimum wage, Von Glahn said. In 2017 the legislature passed a law prohibiting cities from raising the minimum wage beyond that of the state’s, after St. Louis city passed an ordinance to raise the city’s minimum wage.

The federal minimum wage has been stagnant, at $7.25, since 2009. Thirty states, including Missouri, have a minimum wage higher than the federal one.

‘Confident it will pass’

Missourians for Healthy Families and Fair Wages has so far raised over $5 million, according to campaign filings. 

That includes two $1.2 million donations from the D.C.-based Sixteen Thirty Fund, in August and October, a progressive nonprofit that is not required to disclose its donors. Other large donors include Missouri Jobs with Justice Voter Action and the D.C.-based The Fairness Project.

The campaign has purchased over $1.4 million in television ads, slated to begin airing next week, according to Federal Communications Commission filings.

The ballot measure would change the state law but not the constitution, meaning the legislature could overturn it, but that is unlikely, McCarty said. 

“I don’t see any politician in their right mind — if this passes with a high percentage of votes, which we expect it will — I don’t see any politician in their right mind completely repealing the entire law,” he said, citing potential concerns about overturning the will of voters.

Corches said the Chamber is focused on the election and would only “start looking at, is it possible to modify this in the Capitol” if it passes.  

Von Glahn said Prop A will be a test of whether or not the legislature “respects the will of voters.”

The St. Louis University/YouGov poll conducted in August found the ballot measure had a strong backing, with 57% of those surveyed supporting it.

“We feel confident that it will pass next month, but we’re also doing the work,” Von Glahn said. “I mean, we’ve got people out canvassing every day, talking to voters about it.”

Advocates are raising alarm that certain people who still need services will lose them, causing their health to decline or forcing them into institutional settings like nursing homes (Scott Olson/Getty Images)..

Nearly 8,000 seniors and Missourians with disabilities could lose at-home care over the next year after a new eligibility algorithm went into effect this week, a spokesperson for the state health department told The Independent.

Starting Oct. 1, Missouri’s Department of Health and Senior Services implemented a change in the scoring algorithm they use to determine eligibility during annual reviews and enrollment for those receiving help with everyday tasks like going to the bathroom, getting dressed and taking their prescriptions. The assistance is part of a Medicaid-funded program called home and community based services designed to provide an alternative to those who would otherwise need to receive institutional care. 

That change, according to the department, is designed to help ensure those who truly need the services receive them, and those who don’t — for instance, because their conditions have improved or they’re not severe enough to qualify — are removed.

“We want to ensure those with higher acuity needs are receiving the care they need,” said DHSS spokesperson Lisa Cox. “That is what this transformation is about—to ensure we are providing the right services, in the right setting, at the right time to those who would go into a facility placement if not for [home and community based services].”    

But advocates are raising alarm that certain people who still need services will lose them, causing their health to decline or forcing them into institutional settings like nursing homes. 

Jennifer Gundy, who runs a center for independent living in southwest Missouri, which provides in-home care support for 370 people, estimates 18% of her clients will fall off the rolls.

And most of them will still be in need of services, she said, including cases of those with severe diabetes, mobility issues, complicated medication regimes and other issues that are eased by current assistance but will worsen without it.

“So that’s our concern,” she said. “And we’ve been voicing that concern with the state for probably the last two years,” she said.

Joel Ferber, director of advocacy at Legal Services of Eastern Missouri, said there are “truly needy folks who are going to lose services.” 

Legal Services of Eastern Missouri has been working with national advocacy groups to analyze the new algorithm and its effects, and provide guidance. One client they identified, a 70-year-old woman who receives 40 hours of weekly paid help, won’t be eligible after her review, according to LSEM. She weighs under 100 pounds and has had a stroke.

Without a caretaker, she won’t be able to make herself meals or bathe, and has no family in the area. She may have to be hospitalized or go to a nursing home.

State Rep. Deb Lavender, a Democrat of Manchester, said thousands will lose services, “without any support from the state” to fill in the gap.

“They’re going to be people who have received services for years,” she said, “and we have provided that for them — to then drop them because they don’t meet the new algorithm doesn’t seem right.”

Cox said 7,818 people are at risk of losing services, but she didn’t provide an estimate of any possible net change, saying the program will “continue to add more participants every month due to the increase in needs of our population.” New people will also qualify based on the new algorithm, adding to the population, she said.

From 2021 to last month, the department used both the new and old algorithm, so that anyone who qualified on either basis could qualify for the program. Cox said thousands of people have gained access to services under the new algorithm who wouldn’t have qualified on the old calculation: She said 7,708 people have gained eligibility under the new algorithm since it was introduced in Nov. 2021.

There were around 68,000 people monthly on the program last fiscal year, Cox said.

The new algorithm has been years in the making. 

The legislature in 2017 grew concerned with the home and community based services program “just blossoming” in participation and cost, said Jessica Schaefer, program director for home and community based services in a recent training. 

To cut the budget, the legislature in 2017 raised the threshold for eligibility. It also capped costs for services at a lower level. 

The program is jointly funded by the state and federal government, and states vary widely in how they run the programs.

The department found those changes weren’t entirely effective, Schafer said — that some people who needed services most didn’t qualify anymore — so they launched a “transformation” of the eligibility criteria. It was designed to be more accurate at directing limited services to the correct people.

The “transformation is about ensuring those most in need of care receive the services needed to remain independent in their community,” Cox said.

There have been several delays in implementing the new algorithm — most recently because of federal rules tied to accepting American Rescue Plan Act funds. 

The state has generally characterized those who will lose coverage as people who don’t have needs significant enough to qualify in the first place.

In a slideshow for providers during a recent training, the state recommended when delivering the news of ineligibility to individuals, that they “exude confidence” and “put a positive spin on ineligibility,” along with connecting them to other resources and expressing sympathy.

Because the department has been providing two scores, advocates can see which clients will not qualify under the new algorithm and have been able to track it.

Advocates say they’ve repeatedly brought up concerns with the state based on clients they see are desperately in need of services who will no longer qualify.

“The only thing that we can do is just go ahead and allow them to do this, and then if there’s enough people that fall off the services and end up going to the nursing home, going in the hospital, having lots of problems because they’re not getting the services, then we can look at doing a class action lawsuit,” said Gundy, the southwest Missouri advocate.

“Which is really sad, because those people have to get hurt or have really bad health problems for something to get done.”

States across the country have made similar cuts to the program, based on automated decisions, including in Arkansas, where the algorithm was successfully challenged in court.

Legal Services of Eastern Missouri and a group of national advocates published a toolkit for providers and participants to understand the changes and track those who lose services.

Emily Paul, project director at Upturn, a national organization that advocates for equity and justice in technology, has been involved in that analysis.

“What we understand in general is that automation is a tool that states are using to deal with inadequate funding for these programs, and to create a rationale for who doesn’t get services,” Paul said.

“Underfunding really drives the need to have this whole rationale for trying to distribute the resources and trying to make claims to fairness and objectivity within a system that is not really set up to actually meet people’s needs,” she said. “And so that’s the fundamental issue. States can still try to make better or worse choices about how they allocate the resources.”

This story was updated at 9:10 A.M. with additional comment from the Department of Health and Senior Services.

(Getty Images).

Missouri has begun distributing summer food benefits for children and aims to finish by the end of the year, a spokesperson for the Department of Social Services told The Independent this week.

The aid was intended to be distributed during summer break, to help vulnerable kids avoid a drop-off in nutrition while they were out of school.

Missouri didn’t begin issuing the benefits until Sept. 19.

That’s faster than the state issued summer 2022 emergency benefits that were tied to the COVID-19 pandemic — those were not distributed until the following summer. And in 2023, Missouri did not accept federal pandemic summer food aid for children.

This year’s benefits are part of a federal program in its first year called Summer Electronic Benefits Transfer, or SUN Bucks, which is administered by states.

Each eligible child receives a one-time benefit of $120, loaded onto a card that can be used like a debit card to buy groceries.

Thirteen Republican-led states, but not Missouri, opted out of participating in the program.

Benefits for the program have so far been issued to 9,500 Missouri kids, out of the 490,000 kids estimated to receive benefits that amount to $58.8 million.

“[The Family Support Division] remains committed to disbursing benefits as swiftly and accurately as possible,” DSS spokesperson Chelsea Blair said, “with the goal of completing all disbursements by the end of the year.”

State officials said they dealt with technical issues that delayed federal approval and hindered earlier launch of the program. 

One issue is that “much of the data collection process for children enrolled in the National School Lunch Program is still manual at this time,” another DSS spokesperson, Baylee Watts, said — the department needs schools to submit data before they can determine eligibility for many of the kids.

The children who will be automatically eligible for the program are:

• Students who are eligible for free or reduced-price lunch during the school year;
• Households already enrolled in Supplemental Nutrition Assistance Program (SNAP) or temporary assistance; and
• Students who are in foster care, are experiencing homelessness or are migrants.

Missouri has so far issued benefits to foster kids, Watts said, and is next turning to kids whose families are already on SNAP or temporary assistance.

It won’t be until after Oct. 10 that the benefits for kids on free or reduced-price lunch will begin to be issued, she said, because that’s the deadline for schools to submit eligibility data to the department.

Benefits will be issued on an existing card if the family is enrolled in SNAP benefits or temporary assistance, or on a new mailed card if they are not. Families who need a new EBT card can request one by phone or the ebtEDGE mobile app.

SUN Bucks benefits will expire 122 days after they are issued, regardless of usage, so families must act quickly once the benefits are distributed. They should also keep the cards for next summer’s program, the state’s website advises.

Those who aren’t automatically eligible were required to submit an application. The window for applications closed Aug. 31, and any received thereafter will be considered for next summer’s program, the department said. The agency received 17,000 applications.

Next summer, Watts said, the agency is expecting benefits to be distributed during the summer months, because the proper infrastructure will be in place.

The Cole County Courthouse, in Jefferson City (Annelise Hanshaw/Missouri Independent).

The Department of Social Services “knowingly and purposefully” subverted the state’s open records law to gain the upper hand in litigation, a Missouri judge ruled Monday.

Cole County Circuit Judge Jon Beetem determined the department violated the Sunshine Law by wrongfully denying a records request because of the identity of requester and not the contents of the records. 

The department also took months to respond to the request without a reasonable justification, Beetem ruled. 

A software company and former state vendor, HHS Technology, submitted the records request and filed the Sunshine lawsuit. 

Beetem in his decision ordered the department to hand over the records and set a hearing for Oct. 18 to consider penalties. HHS is entitled to civil penalties of up to $5,000 plus reasonable costs and attorneys’ fees.

The Department of Social Services declined to comment, citing the ongoing litigation.

HHS Technology was involved in years of litigation against the state for breach of contract and Beetem awarded the company more than $23 million in August 2022, over its work building a fully-integrated system for managing DSS programs including Medicaid.

The records request, submitted in April 2022, was for documents showing how the state requested and allocated public money for its Medicaid system and related communication about the competitive bidding process.

“These are prime examples of open records the Sunshine Law was intended to allow the public to access,” Beetem wrote, calling the records “indisputably open.”

The department acknowledged receiving the request but then, despite repeated inquiries, the company heard nothing for months.

Missouri Sunshine Law requires government agencies to respond to requests “as soon as possible.” They must provide the records within three days or explain the delay and provide a timeline for predicted fulfillment of the request.

The department decided the documents would be closed sometime in October, according to the decision. But the company did not hear back from DSS until February 2023. 

At that point, nearly a year after the request was submitted, the state formally denied it and refused to turn over records.

The state said the documents were exempt from the Sunshine Law because they were related to ongoing litigation. 

The litigation exception to Sunshine Law carves out records related to the nexus of ongoing litigation. Records must be inherently connected to litigation to qualify.

Beetem ruled the state’s interpretation of the litigation exemption was inappropriately broad and would justify closing any records that could be potentially subject to litigation in the future.

Beetem said the department “intentionally violated the Sunshine Law to impermissibly gain an advantage in the…litigation.”

The agency identified 570 documents responsive to the request that it deemed closed, according to the decision. 

Eleven of those were privileged communications with counsel.

But “none of the remaining 559 records at issue is a legal file, memorandum, or work product generated by the Department’s counsel,” Beetem wrote.

And DSS “did not close the 559 at-issue records based on their contents,” he added.

“Rather, they closed the records based on the identity of the requester (HHS) and their belief that HHS desired these documents for use in the…litigation.”

Last year, Beetem ordered the state to pay more than $240,000 in legal fees as part of a ruling that found the attorney general’s office  “knowingly and purposefully” violated open records law while it was being run by now-U.S. Sen. Josh Hawley.

(Marc Serota/Getty Images).

Two of every five Missouri adults owe money to medical providers, according to a survey published Tuesday by the nonprofit Missouri Foundation for Health.

Those debts include unpaid fees for services ranging from lab tests and doctors’ visits to emergency treatment and dental care. Often, the bills are from one-time or short-term medical expenses, the report states.

One in ten Missouri residents have more than $5,000 in medical debt.

The result is that Missourians with medical debt commonly cut back on spending for basic needs, exhaust their savings and increase other forms of debt, like credit card debt.

“When people struggle to access affordable health care, the effects ripple through our economy,” said Sheldon Weisgrau, foundation vice president of Health Policy and Advocacy, in a press release.

“It’s not just about health; it’s about financial stability, workforce productivity, and the ability of families to thrive,” he added.

The foundation commissioned a statewide survey of over 2,000 adults last spring, conducted by the research firm SSRS. Data were weighted to be representative of the population.

The survey found Hispanic and Black Missourians are more likely to have medical debt compared to white adults. 

Those in rural areas are also more likely to have current or recent medical debt, as are those with disabilities.

Half of Missouri adults have held medical debt at some point in the last five years, according to the report. Most of them — 78% of those under age 65 — had health insurance at the time they received the care that sent them into debt.

One reason those with coverage are incurring debt, the report notes, is that many have unaffordable deductibles — meaning out-of-pocket costs they must pay before the insurance company starts to pay. Cost-sharing measures, like copays, can also be high.

In 2023, the average family deductible in Missouri was $3,783, according to the nonprofit KFF. The average deductible for single coverage in Missouri was $2,340.

Yet many Missourians live paycheck to paycheck. 

Four in ten Missourians don’t have the money to pay for an unexpected $500 bill, the Missouri Foundation for Health survey found. 

“The burden of medical debt is not only financially devastating but also demoralizing for families,” said Samantha Schrage Bunk, MFH health policy strategist, in the press release.

The results in the survey were similar to the national average found in a 2022 survey conducted by the nonprofit KFF.

The states with the worst rates of medical debt haven’t expanded Medicaid, KFF has found. Missouri implemented Medicaid expansion in October 2021.

There has been increasing attention to medical debt at the state and federal level in the last few years. At least 17 states this year proposed legislation related to consumer relief for medical debt, though not Missouri, according to LexisNexis’ state legislative tracker.

The Missourians surveyed widely support policies that would require greater price transparency, limits for hospital charges and uniform criteria for financial assistance programs.

“Missourians are clear – they want policy changes that make health care affordable and accessible, and they’re looking for government and health care systems to listen to them and take action today,” Schrage Bunk said.

In an earlier report, published in March, Missouri Foundation for Health interviewed focus groups.

“[Medical debt is] something that I will have to pay for the rest of my life,” one low-income woman, who has between $1,000 and $2,500 in debt is quoted as saying.

Others quoted needed to declare bankruptcy due to medical debt, or took hits to their credit that hurt their ability to find housing and employment.

One rural farmer needed to take on odd jobs in town to try to pay off thousands in debt. A man with disabilities needed to pay hundreds each month for years, instead of saving for retirement. A young mother needed to cut back on spending for food and clothes for her kids to pay hospital bills. 

Another described the “vicious cycle” of taking out credit card debt to try to pay off medical debt. 

“Honestly, if you’re middle class or low class,” one interviewee asked, “how can you afford $2,000 a ride in an ambulance?” 

State Rep. Deb Lavender, D-Manchester, speaks during debate on March 1, 2023, in the Missouri House (Tim Bommel/Missouri House Communications).

House Democrats on Wednesday made an unsuccessful push to override Missouri Gov. Mike Parson’s veto of $2.5 million in funding for oversight of the state’s nursing homes, with all but eight Republicans voting to sustain the governor’s action.

It is the second year in a row Parson has vetoed funding for nursing home oversight. 

State Rep. Deb Lavender, a Democrat from Manchester, led the effort, arguing that the money would make Missouri’s nursing home residents safer.

“There are complaints that are going unanswered,” Lavender said, adding that one-third of Missouri’s nursing homes have been found to have serious deficiencies.

The additional funding would have helped the state’s long-term care ombudsman program hire more staff to advocate for nursing home residents.

The ombudsman program is composed of staff and volunteers tasked with helping protect and advocate for the interests of nursing home residents. They often serve as liaisons between a resident and the facility when issues arise, investigating and resolving complaints. Ombudsmen can help ensure residents are able to go to the bathroom, take their medications and be fed on time, for instance.

Missouri has consistently had one of the lowest nursing home staffing levels in the country which can contribute to residents not receiving proper care. 

The motion to override Parson’s veto failed by a vote of 56 for and 81 against. All Democrats present voted for the override. All but eight Republicans voted against it. 

“We just wanted to bring voice to the lack of being able to care for our seniors,” Lavender said during a press conference after the vote, adding that it was “no surprise” that a Democrat asking to overrule the Republican governor failed. 

In the scope of a $50 billion state budget, Lavender said, the governor’s decision to strip out the $2.5 million “doesn’t make sense to me.”

“This is twice we put it in,” she said, “and the governor has taken it back out.” 

The state budget signed by Gov. Parson in June left $1.9 billion unspent. 

Parson wrote to lawmakers this summer explaining his veto  that “while this supports the important goal of helping seniors throughout the state, there is insufficient funding from the appropriated source to support this item.” 

Last year, his veto letter noted a general need to ensure a balanced budget and the “financial stability of Missouri.”

Republican state Rep Jim Kalberloh of St. Clair said during the floor debate he was voting against the override to respect that there is “a reason why they did this,” referring to the governor’s office’s veto, but that he supports the funding and wants the legislature to try again next year to pass it.

“We spend a lot of money on a lot of things,” Kalberloh said, “If we can’t protect our elderly and are disabled, then we can think about where our money is going.”

Democratic state Rep. Doug Clemens, of St. Louis responded to Kalberloh, saying: “It’s our job, our responsibility to reflect the needs of our constituency,” rather than the will of the governor. Clemens said he has senior constituents who would benefit from the ombudsman program having more resources.

“And I don’t think it’s worthwhile to let somebody wait another year for us to get our act together,” he said. “…This is a paltry sum compared to the rest of our budget.”

In a report from AARP last year, Missouri ranked 48th in the country for nursing home quality and 46th in nursing home staff levels and turnover.

The most recent federal staffing data, updated in July, showed Missouri residents receive 3.3 hours of daily care, on average. That’s below the federal standard going into effect in the next few years, and was second only to Texas for the worst in the country.

Lenny Jones, state director of the Service Employees International Union (SEIU) Healthcare Missouri, which represents nursing home staff, told The Independent in an interview the cut is a disservice to residents and workers, and many of the issues arise from low staffing.

“There should be more eyes on what’s going on in nursing homes, not less,” he said.“So the more opportunities for family members, for residents, to be able to contact the ombudsman and issues around that is important, because that’s really, in many cases, the only voice.” 

Marjorie Moore, executive director of VOYCE St. Louis, an advocacy group for long-term care residents, said she was “really disappointed” in the vote Wednesday but “gratified” that more legislators and Missourians broadly are becoming aware of the need for the program and issues in nursing homes.

“We’re calling on whoever may be governor next year and next year’s legislators to continue this fight and get this funding in,” she said, “because this is an issue that’s not going away in any way shape or form.”

Missouri will have an increasing population of older adults, she said, and “we’re only going to have more people who are going to need those advocates.”

Moore said, despite the state’s failure to bring resources to the level needed, people should know the program is still operating statewide and residents in every nursing home throughout Missouri can contact them with concerns. 

A family enters the Missouri Department of Social Services resource center in Columbia on April 18, 2023 (Clara Bates/Missouri Independent).

Missouri’s backlog of unresolved child abuse and neglect cases has fallen by more than 80% since January, with officials anticipating it will be eliminated by the end of the year. 

From last September to January, there were over 10,000 open child abuse and neglect cases each month that had been languishing for over 45 days, raising concerns about child safety. 

Most of those cases were in St. Louis. 

That number has fallen every month this year, according to records obtained by The Independent through the Missouri Sunshine Law, and now stands at 1,869 open cases statewide as of July. 

“I’m very proud of our team,” said Darrell Missey, director of Children’s Division, Missouri’s child welfare agency. “They’ve worked really hard to take care of that backlog.”

There were over 6,000 open cases in St. Louis alone in January, which dropped to 74 in July.

Missey said the Children’s Division is almost fully staffed now — a “remarkable turnaround” from the hundreds of vacancies it had in recent years. 

“It shows what can happen when you start getting enough staff, and I think they’ve done a terrific job,” Missey said.

Jessica Seitz, executive director of Missouri Network Against Child Abuse, an organization that represents child advocacy centers across the state, said she is “really pleased” to see the improvement.

“The division turned an immediate eye toward this and made this a priority,” she said. 

Seitz hopes the cases were thoroughly investigated before being closed, noting that there are “kids behind every case, and so it’s my sincere hope that safety remained a priority as we looked at closing these.”

State law requires Children’s Division staff to investigate and complete assessments for child abuse and neglect hotline reports within a 45 day window unless there is good cause for a delay. 

Investigations typically include speaking to the hotline caller, going to a family’s house, interviewing the child and family members and checking the safety of the house. When the investigation is complete, staff issue a report determining whether the finding was substantiated or unsubstantiated. 

Around 5% of investigations result in a substantiated conclusion of abuse or neglect. Those children can be removed from their homes and taken into foster care.

But staffing issues over the last few years resulted in huge caseloads and delays getting those investigations done and reports out the door, especially in St. Louis.

As St. Louis Public Radio reported last year, the regional backlog spurred concern among advocates and lawmakers that children could be unsafe. 

The state worked with the consulting firm Change & Innovation Agency to focus on the St. Louis area workload, according to a July press release from the Missouri Department of Social Services. 

One of the consultants, Bill Bott, is quoted as saying among the several states and welfare offices the group has worked with, “St. Louis was, by far, the hardest hit by this national capacity crisis.”

The long-open investigations can also cause families stress, as the threat of having their kids taken away looms for months.

And high caseloads have contributed to a cycle of turnover in Children’s Division.

Now, the majority of overdue cases — 1,136 cases in July — are from Kansas City. 

Seitz said she is “alarmed” that that number is still high, but acknowledged it’s much lower than it was. Last September, that stood at over 3,000.

The agency has long struggled more to find staff in metropolitan parts of the state because the salaries aren’t adjusted for location-based cost-of-living. Entry level child welfare workers start at salaries of just over $44,000. They can make more in Illinois, Missey said.

The agency is getting to a place where the open cases are open due to an ongoing investigation, Missey said, and not just because they’re having trouble keeping up.

“All the backlog,” he said, “should be resolved by the end of the year, or close to it.” 

Child care providers have been struggling to keep their doors open, and in some cases forced to shutter, due to technical issues with the education department’s disbursal of federal funds (Rebecca Rivas/Missouri Independent).

Missouri legislative leaders are demanding answers from state education officials about a monthslong backlog in a child care subsidy program.

Two House committees — the budget committee and the education committee — have scheduled hearings into the matter next month, and a Republican Senate leader has called for her chamber to launch a similar inquiry.

“I think it is safe to say The Office of Childhood is a massive disaster,” Senate Majority Leader Cindy O’Laughlin, a Republican from Shelbina, wrote in a Facebook post Tuesday, referring to the office within the Department of Elementary and Secondary Education that is responsible for administration of the subsidy.

“… instead of creating more child care,” she wrote, “this office is running day cares out of business.”

Child care providers have been struggling to keep their doors open, and in some cases forced to shutter, due to technical issues with the education department’s disbursal of federal funds.

State education officials have largely blamed a contracted vendor for the monthslong backlogs. The system launched in December after the program shifted from the Department of Social Services to the Department of Elementary and Secondary Education.

Payment backlog leaves Missouri child care providers desperate, on the brink of closing

The subsidy, part of a federal block grant program that is state-administered, helps cover the cost for day care owners serving low-income and foster children. Some day cares rely on the program to pay their staff.

O’Laughlin said due to the “incompetence” of the office, she is requesting that Missouri Senate President Pro Tem Caleb Rowden appoint an interim committee to look into the issues. 

The technology vendor, along with leadership of the Office of Childhood, parents and child care providers would be asked to testify, she wrote.

The vendor contracted to develop and implement the new system for the subsidy program is World Wide Technology, a large technology services provider headquartered in St. Louis.

In addition to O’Laughlin, House Minority Leader Crystal Quade, a Springfield Democrat running for governor, demanded that her chamber’s leadership create an interim committee to look into the issues surrounding the subsidy. 

The problems administering the program have “escalated to the point of crisis, with families losing access to care,” Quade wrote in a letter last week to House Speaker Dean Plocher, “as some facilities have been forced to close, due in large part to the department’s failure to remit the payments owed in a timely manner.”

The education department has been “less than forthcoming” in communication, she wrote. 

“Since members of the House Democratic Caucus are being inundated with pleas for help from desperate families and struggling providers,” Quade wrote, “I’m certain our Republican colleagues are as well. 

“If the department is unable or unwilling to provide answers, it is our duty to demand them.”

Wednesday, Plocher announced the House Elementary and Secondary Education Committee will hold a hearing Sept. 10 to “investigate the causes and impacts of delays” in the state issuing child care payments.

A House Budget Committee hearing was already scheduled for Sept. 11 to discuss child care with the education agency.

“At any hearing that is scheduled with lawmakers,” the education department’s spokesperson, Mallory McGowin, said in an email to The Independent, “DESE plans to be transparent about the challenges that exist, and the work being done to address the issues.”

McGowin said there are currently backlogs in family applications for subsidy assistance, provider contract applications, and in providers’ requests to resolve outstanding payment issues.

And there are ongoing issues getting providers their full payment: “Payments are being processed daily and providers are getting paid,” she said, “though some are not receiving full payment due to ongoing technical issues.”

Regarding the backlog of family applications, McGowin said the department has contracted with a staffing agency and expects it to be cleared by “mid to late September.” The department has also cross-trained additional staff to clear the backlog of provider contract applications. That backlog is expected to be cleared “by early to mid-September.”

Regarding outstanding payment issues, she said the current contractors have doubled their staff working on “issues preventing or delaying provider payments.” DESE has also contracted with an agency to clear the backlog of subsidy payment corrections and hired part-time workers to help process requests for missing payments. McGowin didn’t provide a timeline for the department overcoming the backlog of payment corrections.

“DESE recognizes the importance of subsidy payments to the child care industry and the value the program provides to Missouri’s workforce, in particular for families who provide care to children in foster care,” McGowin said.

McGowin encouraged parents and providers with questions to call the subsidy hotline at 573-415-8605.

“DESE and its contractors, World Wide Technology and MTX, are working hard to address these issues and sincerely apologizes to the child care providers and families affected by this transition,” she said.

UPDATE: This story was updated at 10:20 AM on Aug. 28 to add news of the House education committee’s hearing. It was updated at 12:45 PM to add comment from DESE and clarify the timing of Rep. Quade’s letter.

The exterior of a Planned Parenthood Reproductive Health Services Center on May 28, 2019 in St Louis (Michael B. Thomas/Getty Images).

Missouri’s Planned Parenthood affiliates are asking the state administrative hearing commission to block a new law that prohibits the organization from being reimbursed for serving Medicaid patients. 

The law went into effect on Wednesday.

Nearly one in five Planned Parenthood patients in Missouri is insured through MO HealthNet, the state’s Medicaid program that serves low-income and disabled residents and has long banned funding for abortion.

The complaint to the Missouri Administrative Hearing Commission was filed after Missouri’s two Planned Parenthood affiliates say they received notifications of their termination from Medicaid, effective Wednesday.

“Despite an already overburdened health care safety net for Missouri Medicaid patients,” Planned Parenthood Great Plains and Planned Parenthood Great Rivers wrote in a joint press release, “lawmakers prioritized the legislative ‘defunding’ of Planned Parenthood this last session, harming Missourians with low incomes and forcing them to search for other providers.”

It’s the third — and Republicans hope final — attempt to end Medicaid reimbursements to any health centers affiliated with abortion providers.

Planned Parenthood alleges the state’s new restrictions violate federal Medicaid law, which protects patients’ right to choose their health care providers. 

The Missouri Department of Social Services, which oversees the state’s Medicaid program, said it doesn’t comment on pending litigation.

Abortion has been banned in Missouri since 2022, but Planned Parenthood clinics in Illinois and Kansas continue to perform the procedure. In Missouri, Planned Parenthood clinics provide services such as contraceptive care, STI testing, cancer screenings and wellness checks.

Missouri governor signs bill ending Medicaid reimbursements to Planned Parenthood

Critics of the law have argued it would primarily harm low-income Missourians who could be forced to find a new provider through the state’s already strained public health safety net if Planned Parenthood cannot foot the bill for these patients long-term. This could delay critical and potentially life-saving care.

In Missouri, women on Medicaid are 10 times more likely to die within one year of pregnancy than those on private insurance, according to an August multi-year report on maternal mortality published by the Missouri Department of Health and Senior Services.

“The impact of defunding efforts will only further destabilize Missouri’s fragile safety net,”  said Michelle Trupiano, executive director of Missouri Family Health Council in Monday’s press release, “by straining providers, extending wait times, and unnecessarily creating additional barriers for people accessing basic healthcare services.”

Planned Parenthood clinics in Missouri have been without Medicaid reimbursements for more than two years as prior attempts by Republicans to pass similar restrictions through the state budget were litigated and struck down in court. 

Planned Parenthood says it will continue to serve Medicaid patients despite the new law.

Some clinics, including Planned Parenthood Great Rivers, have offset the cost of care with private fundraising, according to the press release.

“Planned Parenthood’s doors remain open so patients can get the affordable, accessible care they rely on,” said Richard Muniz, interim president & CEO of Planned Parenthood Great Rivers, “as we challenge the state’s latest, illegal attempt to exclude us from participating in the Medicaid program.”

This story was updated Aug. 27 to add the Department of Social Services’ comment.

A crisis counselor answers a 988 call at the Ozark Center, which covers four southwestern counties (Photo courtesy of Freeman marketing).

Missouri has seen one of the nation’s largest increases in calls to the revamped national hotline that aids people facing mental health crises.

The number of calls to 988 from Missouri jumped 136% in May 2024 compared to May 2022, according to recent data from the health policy nonprofit KFF.

That’s a greater increase than the national average and ninth highest in the country.

State officials have celebrated Missouri’s volume increase as a product of significant efforts to ensure the public knows about 988.

“We are really proud of what we’re doing here,” said Jeanette Simmons, deputy division director of the Missouri Department of Mental Health’s Division of Behavioral Health, during a mental health commission meeting earlier this month. “In national meetings, lots of people ask us questions about our 988 efforts, and how we have had so much success, and how we’re doing it.”

She said they tell others they’re just “handing it out everywhere,” referring to outreach materials. 

The National Suicide Prevention Lifeline transitioned nationwide two years ago to the new three-digit 988 Suicide and Crisis Lifeline, which aims to be a comprehensive resource for people facing mental health, substance use and suicide crises. 

It’s part of a national effort to streamline access to services for mental health emergencies and craft a number that’s as easy and ubiquitous to remember as 911.

Last month, Department of Mental Health spokesperson Debra Walker said, Missouri’s 988 call centers answered more than 8,000 calls, 2,800 text messages and 600 chats.

The state answered 92% of calls at in-state call centers, which is above the national standard of 90%. 

The hotline directs calls based on callers’ area code to their nearest crisis center. When the in-state call centers are busy, the call is routed to the national phone line.

In July of 2022, around 12% of calls were abandoned before reaching someone on the other line.  That fell to 6% in 2024 despite the number of calls more than doubling in volume. 

The average speed to answer has decreased from 37 seconds in July 2022 to 19 seconds in July 2024, Walker added.

Walker said through the state’s training, strengthening partnership with community service providers and other partners, and prioritizing timely service, “Missouri has built an equitable and accessible crisis system.”

Going forward, the state will focus on continuing to educate people about 988 “with the  goal of reaching individuals most at risk for suicide and other negative mental health and substance use outcomes,” Walker said.

The federal government invested money for 988’s launch and rollout but requires states to establish long-term funding strategies. Missouri hasn’t passed legislation authorized by Congress to add a monthly fee to phone bills to help permanently fund the hotline and crisis services, similar to how 911 call centers are funded. 

So far, 10 states have added telecom fees.

And a report released in June by the national mental health nonprofit Inseparable found that although Missouri scores well in call center capacity, the availability of crisis mental health services is itself limited. The organization estimated the state would need 286 new short-term crisis residential beds to meet crisis stabilization needs, as well as 49 mobile response teams.

Missouri's Department of Mental Health building in Jefferson City (Annelise Hanshaw/Missouri Independent).

The number of people languishing in Missouri jails in need of court-ordered mental health treatment currently stands at 344 — and the wait time for a hospital bed averages one year. 

That’s up from 254 people this time last year, according to Missouri Department of Mental Health data provided to The Independent. A spokeswoman for the department said that because the agency’s inpatient beds are at capacity, the number of people waiting in jails for treatment will continue to rise.

Debra Walker, the department’s spokeswoman, said February was the first month the number of individuals waiting ever exceeded 300.

None of the people on the waitlist have been convicted of a crime. They were arrested, found incompetent to stand trial and ordered by the court into mental health treatment, designed to allow them to stand trial, a process called competency restoration that generally includes therapy and medication. 

“We do want to increase the number of individuals who are getting competency restoration,” said Jeanette Simmons, deputy division director of the Missouri Department of Mental Health’s Division of Behavioral Health, during a mental health commission meeting earlier this month. “We have a growing number of individuals who are waiting for those services.”

Missouri has faced a years-long struggle with this issue, due to increasing numbers of court referrals for competency restoration, staffing issues and limited psychiatric hospital capacity. It’s worsened over the last year.

The legislature appropriated $300 million this year for Department of Mental Health to open a new hospital in Kansas City, but it could be around five years before construction is complete.

State officials are also working to implement the “jail-based competency restoration” program approved by the legislature this year in response to the issue. This year’s budget set aside $2.5 million for the jail-based competency programs to be established in jails in St. Louis, St. Louis County, Jackson County, Clay County and Greene County.

Services in jail-based competency restoration will include room and board, along with medical care for 10 slots at each jail, contracted staff from a local behavioral health organization, and psychiatric care from “mobile team practitioners.”

The department is currently training two agencies in Kansas City that will be going into county jails to provide jail-based treatment. Clay County has a “tentative go live date” for September, Simmons said.

“So we're really looking forward to that and getting that launched, because we do believe that it's going to take a multifaceted approach to target those numbers,” she said.

Simmons said the agency has mobile teams of doctors going into county jails prescribing medications “to try and get folks started on those medications that they need to stabilize their mental illness.” The department is working with community behavioral health liaisons as well as jail mental health or medical staff, she said, to get people services.

The Department of Mental Health is also working on trying to get information to the courts about outpatient restoration, for those who can be safely treated in the community and don't require hospital-level care. A law passed this year gives the agency the authority to treat certain arrested people on an outpatient basis.

“Sometimes I think the courts don’t really consider that as an option,” Simmons said of outpatient treatment. “It’s something very new.”

In other states, including some bordering Missouri, lawsuits have been filed over similar wait times, alleging they violate individuals’ rights to due process and the Americans with Disabilities Act.

A federal lawsuit filed last year in Oklahoma alleged jails are holding patients for three months to one year. A proposed settlement set a benchmark of a 60 day maximum wait and ultimately a goal of 21 days, but it has faced opposition from the governor.

A lawsuit filed in Kansas in 2022 alleged that individuals are detained for longer waiting for a psychiatric bed than they would be if they had been convicted. Many of the charges are for low-level crimes, national investigations have found.

County sheriffs and jail administrators in Missouri have raised the alarm about challenges caring for individuals who are being detained pretrial. And state officials have acknowledged the long waits contribute to mental deterioration.

The Missouri Sheriffs’ Association recently published an issue of their ‘Missouri Jails’ magazine focused on managing mental health challenges in county jails, which shared several examples of local issues, including that one county spent $30,000 to provide around-the-clock guarding over a suspect for two months, because the secure medical centers didn’t have any openings.

Some county sheriffs are looking to build or expand jails to combat the issue, according to the magazine, including by increasing the number of solitary cells to keep those with mental health diagnoses out of the general population. Others have contracted with private health provider Turn Key Health Clinics to provide increased mental health care while people are awaiting transfer. 

“As mental health professionals and legislators struggle to find solutions to the crisis,” magazine contributor Michael Feeback wrote, “sheriffs and other agencies are looking for answers on their own.” 

In Missouri, 490,000 kids are estimated to receive benefits amounting to $58.8 million (John Moore/Getty Images).

Missouri’s social services agency announced Monday that it is officially launching a federal food program that could provide aid to over 400,000 kids in the state.

Each eligible child will receive a one-time benefit of $120, loaded onto a card that can be used like a debit card to buy groceries.

It’s part of a permanent federal program in its first year of existence called Summer Electronic Benefits Transfer, or SUN Bucks. The program aims to help kids who receive subsidized school meals avoid a summer drop-off in nutrition.

The money was intended to be distributed during the summer break. But state officials said they dealt with technical issues that delayed federal approval and hindered earlier launch of the program.

The Missouri Department of Social Services, which will oversee the program, did not lay out a timeline for dispersing the benefits, and a spokesperson didn’t respond to questions.

The following groups of kids are automatically eligible, and their families will not need to apply for benefits: 

• Students who are eligible for free or reduced-price lunch during the school year,
• Households already enrolled in Supplemental Nutrition Assistance Program (SNAP) or temporary assistance,
• And students who are in foster care, are experiencing homelessness or are migrants.

Those benefits will be issued on an existing card if the family is enrolled in SNAP benefits or temporary assistance, or on a new mailed card if they are not. Families who need a new EBT card can request one by phone or the ebtEDGE mobile app.

Families who are not automatically eligible must submit an application online by Aug. 31. The state’s eligibility navigator will tell families whether they must apply.

Even with the department announcing that money was set to be distributed, it warned in its press release that “delays in issuing benefits are possible.” 

Benefits will expire 122 days after they are issued, regardless of usage, so families must act quickly once the benefits are distributed. They should also keep the cards for next summer’s program, the state’s website advises.

Food security advocates in the state were relieved when Missouri opted into the program after weighing factors like technology issues and staffing.

Thirteen Republican-led states opted out of the program entirely this year.

The program is run through the U.S. Department of Agriculture and the benefits are fully federally funded. The state shares one-half of the administrative cost. DSS is leading Missouri’s administration, with the help of the Department of Elementary and Secondary Education.

In Missouri, 490,000 kids are estimated to receive benefits amounting to $58.8 million.

“Although we had to face some difficult challenges,” Director of Family Support Division Kim Evans said in the press release, “I am proud of our team members who worked diligently with our state and federal partners to get this important program off the ground. 

“We will be much more prepared for next summer when we anticipate a smoother rollout and even greater success,” Evans said.

A similar, temporary program called Pandemic EBT provided various benefits during the pandemic and was beset with administrative issues — particularly because it required a new data collection portal to collect and share eligible students’ information with two agencies in the state. 

The benefits designed to cover food costs during the summer of 2022 did not start going out until June 2023, and Missouri declined to participate in the summer 2023 program because of those issues — forgoing at least $40 million in aid.

Dave Wasinger (photo submitted)

Dave Wasinger secured the Republican nomination for Missouri’s lieutenant governor on Tuesday, emerging out of a crowded primary where candidates spent millions seeking the office. 

With all precincts reporting, Wasinger led state Sen. Lincoln Hough of Springfield by just under 7,500 votes.

Wasinger is an attorney from St. Louis who has not previously held elected office. 

The lieutenant governor is next in line for governor, sits on various boards and breaks ties in the state Senate. In Missouri, unlike many other states, the lieutenant governor doesn’t run on a ticket with the governor. 

Wasinger is an attorney at a St. Louis law firm he owns and manages, and a certified public accountant.

Wasinger grew up in Hannibal and attended the University of Missouri and then Vanderbilt Law School, before moving to St. Louis. He has worked at the law firm for over 20 years, specializing in business litigation.

After the 2008 financial crisis, Wasinger “took on Wall Street banks,” he said, representing whistleblowers in financial fraud cases against Countrywide Home Loans and JP Morgan Chase. The whistleblowers were key witnesses in the federal government’s case against the banks, helping federal prosecutors recover billions of dollars. 

Wasinger said the position of lieutenant governor “serves as a great bully pulpit to expose this corruption and these insider deals taking place in Jefferson City.”

Wasinger and state Sen. Holly Thompson Rehder received a last minute dual endorsement from former President Donald Trump, on Monday evening. Trump called Rehder and Wasinger “two highly respected America First patriots.” 

Wasinger was the main funder of his own campaign, loaning himself $2.6 million, as of July 31 campaign finance filings.

Hough raised the most money in the race. Hough’s campaign had raised $642,000 since the start of 2023 and $2.5 million through his joint fundraising committee, as of the latest campaign fundraising reports due July 31. Rehder had raised $555,000 through her campaign fund and another $369,000 through her joint fundraising committee. 

The other Republican candidates were businessman Paul Berry III and county clerk Tim Baker.

Missouri Attorney General Andrew Bailey delivers a victory speech to supporters in Columbia after winning the primary election against Republican attorney general hopeful Will Scharf on Tuesday (Anna Spoerre/Missouri Independent).

COLUMBIA — Missouri Attorney General Andrew Bailey survived a tough primary challenge from a member of former president Donald Trump’s legal team on Tuesday to win the GOP nomination for a full term in office. 

His opponent, Will Scharf, conceded the race shortly before 8:30 p.m. with Bailey leading 62% to 37%. Bailey soon addressed a crowd of supporters at the Stoney Creek Hotel in Columbia.

Taking the stage with his young son in one arm, Bailey raised his fist and deepened his voice.

“Tomorrow, when reveille sounds,” Bailey said, speaking about himself in third person, “Andrew Bailey will grab his rucksack and his rifle and will stand in formation with other conservative leaders as we march on to victory in November.”

Bailey has held the office since November 2022, when he was appointed attorney general by Gov. Mike Parson after his predecessor Eric Schmitt won a U.S. Senate seat. At the time Bailey was Parson’s general counsel and had no experience in elected office. 

An Army veteran and former assistant prosecutor, Bailey has said much of his career has been shaped by his time as an assistant prosecutor and county juvenile office in Missouri. He and his wife went on to foster and then adopt three of their four children.

“I am committed to serving the people of this state and delivering transformative, conservative change,” he told a cheering crowd Tuesday. 

Bailey promised to continue fighting the Biden administration and strengthening consumer protection.

His most high-profile cases since becoming attorney general include twice suing to block federal student loan forgiveness, and carrying forward a lawsuit alleging the Biden administration was censoring conservatives online by pressuring social media companies. 

Bailey has also touted awarding $32 million in settlements and judgments on behalf of defrauded Missourians through his office’s Consumer Protection Division.

Dorothy Berry, 71, said she was upset when Parson appointed Bailey instead of former state Sen. Kurt Schaefer, whom she favored. Berry kept a close eye on Bailey, ready to make a list of his mistakes. But at the end of the day, she said she couldn’t find any to write home about.

She said she agreed with Bailey’s role in the closure of Washington University Transgender Center at St. Louis Children’s Hospital and his push to drive former St. Louis Circuit Attorney Kim Gardner out of office. 

Berry, who spent more than two decades working for Missouri lawmakers, said she also liked that Bailey spent much of his childhood in Missouri. 

“He graduated from Rock Bridge High School,” Berry said. “He’s not some St. Louis or Kansas City millionaire.”

Bailey on the campaign trail often rebuked Scharf as “Wall Street Willie.” Scharf, who grew up in New York and graduated from Princeton University and Harvard Law School, moved to Missouri in 2011. 

Meanwhile, PACs backing Scharf spent millions attacking Bailey’s record. Scharf’s campaign committee and associated PAC raised $9 million in the campaign, including from influential conservative activist Leonard Leo. Bailey raised $4.1 million.

Bailey has faced accusations of corruption, incompetence and grandstanding, with his critics alleging he’s more interested in scoring appearances on Fox News than effectively running the sprawling office or winning in the courtroom.

Bailey recused himself from a gambling lawsuit filed against the Missouri State Highway Patrol after PACs connected to the lobbyist of the companies suing the state wrote checks to the committee supporting Bailey’s campaign. 

He was also criticized for accepting $50,000 in campaign donations from Doe Run, a St. Louis-based company being sued by thousands of Peruvians over allegations of lead smelter poisoning in their mining town in the Andes. A few months before the donation, Bailey filed a brief asking the federal court to move the lawsuit out of Missouri.

Just this week, the U.S. Supreme Court rejected Bailey’s attempts to delay the sentencing hearing in Trump’s hush money case in New York, which is scheduled for September.

Julie Engelbrecht, a Scharf supporter from Ladue who attended his watch party, said she believes Scharf’s legal successes are “lengths ahead” of Bailey’s, noting several cases Bailey lost, and several attorneys who’ve left his office. 

But in the end, Bailey benefited from a late endorsement of both candidates by Trump, taking away one of Scharf’s most potent campaign messages — his close ties to the former president. 

Bailey also enjoyed late support from Parson, who even used his official office to boost the attorney general in the campaign’s final days. 

Early Tuesday evening, Scharf told The Independent he was hoping for a long night, meaning a close race.

That didn’t come to fruition. An hour into vote counting, his corner of campaign staff looked concerned, hunching over laptops in a corner of Krueger’s bar in Clayton.

Scharf during a concession speech a short time later said he called Bailey to concede and offer his full support in the general election. 

“I’m not going anywhere,” Scharf said Tuesday night. “I intend to continue chalking up wins for President Trump and for the conservative movement in the months and years ahead. I’m just deeply sorry that I won’t be doing that as the state’s next attorney general.” 

Bailey later tipped his hat to Scharf’s tough-fought campaign. 

“This is someone who’s worked for President Trump in the past, and he pledged his support in the future,” he said, “and I’m excited to look for ways to partner in the future to move the state in a good direction.” 

Bailey will face Democratic candidate Elad Gross in the November general election. Gross, a former assistant attorney general who runs a St. Louis law firm, has been an outspoken champion of Sunshine law and, like Scharf, a fierce critic of Bailey.

Bailey’s speech was brief, ending when his son polished off his cookie. 

“That’s my signal,” Bailey said, “to cease and desist.”

Technical issues with the education department's disbursal of federal funds has left many daycare providers struggling to keep their doors open as they wait on payment from the state (Getty Images).

Missouri’s education department hopes to resolve a backlog of payments to daycares across the state in the next two months, agency staff told the State Board of Education on Tuesday.

The department previously predicted the backlog — which has left many daycares on the brink of closure — would be overcome by the end of July.

Everyone involved in the process “is frustrated, is exhausted, is at the end of their rope, myself included,” said Pam Thomas, assistant commissioner for Missouri’s Office of Childhood. “And I think that the only thing that you can say is you recognize it. We sincerely apologize.”

Technical issues with the education department’s disbursal of federal funds has left many daycare providers struggling to keep their doors open as they wait on payment from the state. 

“We understand this program is vital, not only to the providers and the families, but to the employers, to those that are going to school,” Thomas said. “We understand that and we are doing the best we can to get this cleaned up within the next month and get back on track.”

The subsidy, part of a federal block grant program that is state-administered, helps cover the cost for daycare owners serving low-income and foster children. 

The Missouri Department of Elementary and Secondary Education, which oversees the program, has largely blamed a contracted vendor for the months-long backlogs. The system, which launched in December, is still not fully operational. 

Payment backlog leaves Missouri child care providers desperate, on the brink of closing

The vendor contracted to develop and implement the new system for the subsidy program is World Wide Technology, a large technology services provider headquartered in St. Louis.

“The first time the vendor put more resources and came on site and took us seriously was May 1,” she said. “We are not experts in an information technology system in the department.”

She said World Wide Technology has doubled their staffing on the project and brought in experts, but until it did that, the agency was “treading water” because it didn’t have the expertise to fix various issues.

The state now has three vendors working on the program and “it takes all three of them to come together and get on the same page with what we need,” Thomas said.

Thomas said they are bringing in outside staff to help work through the backlog, because they have enough staff to process new requests as they come in but “do not have the capacity for the backlog on top of that.”

Those other vendors are MTX Support, to help with the data system, and KinderSystems for administering the system that tracks children’s attendance for payments, said Mallory McGowin, a spokeswoman for the education department, in an email to The Independent.

McGowin said it took “longer than expected” to contract with and onboard the vendors. There are now around 1,800 providers’ accounts that will be reviewed by the contractors, she said, a process that is currently underway.

Thomas estimated it would take 45 working days to clear the backlog, but that is “dependent upon the vendor getting those system glitches fixed.”

Board member Pamela Westbrooks-Hodge raised concern at the meeting for struggling daycare providers.

“I am keenly aware,” Westbrooks-Hodge said, “…of the challenges we’ve heard from providers who literally are going out of business because they’re not being paid.”

Providers, she added, “don’t have the margins to tolerate our issues.” 

Karla Eslinger, who has been commissioner of education since July 1, said her agency is doing all it can, and urged providers “just keep working with us.”

She said the problems should’ve been addressed earlier.

“We should have addressed it this way three months ago,” Eslinger told the board. 

Eslinger added that she has “no patience when it comes to this. We will get these folks paid. We will take care of these children.

“I’m hoping that next month we’re going to have a very, very different story.”

The Missouri state flag is seen flying outside the Missouri State Capitol Building on Jan. 17, 2021 in Jefferson City (Michael B. Thomas/Getty Images).

The Missouri Housing Development Commission awarded millions of dollars in public funds and tax credits without notice or public votes, a former employee alleged in a lawsuit filed last week.

The lawsuit, filed in Jackson County, claims the commission regularly violated the state’s Sunshine Law and the law governing its actions, which requires an “affirmative vote of at least six of the members.”

The lawsuit was filed by Jesse Mofle, who was employed by the MHDC from March 2021 until October 2023. 

In addition to the Sunshine law claims, the lawsuit alleges that Mofle was also sexually harassed by a coworker. He was fired in retaliation for complaints he made about sexual harassment and complaints he made to the attorney general’s office about Sunshine violations, the lawsuit states.

Rather than hold public meetings where commissioners would vote on which developers were to receive millions in public funds and credits, the lawsuit states, MHDC staff would email commissioners their recommendations, to be implemented unless there were objections.

The lawsuit also claims that the commission has violated the Sunshine law by failing to deliver records Mofle requested in September by the time the lawsuit was filed on July 31. 

The Missouri Housing Development Commission oversees the administration of low-income housing tax credits. There are ten commissioners, including the governor, lieutenant governor, attorney general and state treasurer.

Last year, it awarded $380 million in tax credits for low-income housing.

The lawsuit alleges that “in order to avoid conducting public meetings,” the MHDC staff would email commissioners the “list of proposed funding recipients and…if a given commissioner had no objection, [MHDC] would implement the list as is.”

That violates the statutory requirement to hold a public, noticed meeting with recorded, affirmative votes, the lawsuit alleges.

The agency “knowingly violated the Missouri Sunshine law,” the lawsuit states, “each and every time funding was allocated without an affirmative vote, a meeting, notice of the meeting, and recording of the vote.”

The lawsuit is a last resort, Dan Curry, Mofle’s attorney, wrote in the court filing.

Curry also serves as attorney for the Missouri Press Association.

Mofle “has exhausted any and all required administrative prerequisites” in an attempt to gain satisfaction without going to court, Curry wrote. 

The lawsuit alleges Mofle was sexually harassed by a coworker and reported the behavior — which included “her tracking [Mofle’s] movements and stalking behaviors” — several times without resolution.

Mofle took leave at the end of July 2023 because he was uncomfortable working due to the alleged sexual harassment and the “anxiety of being asked to violate the law,” the lawsuit states.

He submitted a request for accommodations signed by his doctor to find another position that would “avoid the need to follow directives from executive staff to violate the Sunshine law,” according to the lawsuit.

The lawsuit requests that the court void funding allocations that were made without proper votes.

A spokesperson for MHDC did not respond to repeated requests for comment.

The Independent previously found that developers who make large political donations to statewide officers on the commission received a significant share of the awards.

Between 2018 and 2023, approximately $1 of every $6 in tax credits awarded since the start of 2018 has gone to the five developers who contribute the most.

At the last meeting, held in December, members of the commission asked no questions about the staff recommendations. One member said he’d just seen the recommendations for the first time during the meeting.

(Credit: Katarzyna Bialasiewicz/Getty Images)

Missouri in the last year has significantly reduced its backlog of overdue nursing home inspections, recent federal data shows, though it still stands out for how low nursing staff is at many facilities.

Around this time last year, a quarter of nursing homes hadn’t been inspected in at least two years. 

Now the number is closer to 3%, according to Centers for Medicare and Medicaid Services data.

The state’s surveyors “have investigated complaints at night, early morning, weekends and holidays,” said Lisa Cox, spokesperson for the Department of Health and Senior Services. “The decline in overdue complaints can be attributed to the hard work and dedication of our surveyors and inspectors.”

The department also hired certified part-time staff to help with the backlog, received additional money in this year’s budget to increase the nurse surveyor salaries and has contracted with private agencies to get additional staff, Cox said.

The backlog had mounted in part due to state staffing issues, plus an increase in complaints.

When the state resumed its standard inspections in January of 2021, after a COVID pause, there were over 4,000 pending complaint investigations and now there are 265.

Still, advocates are worried about oversight in Missouri’s nursing homes. 

The main issue that has come up for years is Missouri’s low level of nursing home staffing.

The most recent data, updated last month, shows residents receive 3.3 hours of daily care, on average. That’s below the federal standard of 3.48 daily hours that is going into effect over the next few years — and even that was a level advocates fought for being too low.

Missouri has consistently ranked among the worst states for nursing home staffing levels.

Staffing varies widely by facility in the state. Two dozen facilities offer less than 2 hours of daily nursing care per resident.

The for-profit Reliant Care owns several of the largest facilities in Missouri. Sixteen of the entities associated with Reliant Care offer less than 2 hours of daily individual nursing care, according to the latest data.

One, North Village Park, offers just 37 minutes per day of care, the federal data shows.

Marjorie Moore, executive director of VOYCE St. Louis, an advocacy group for long-term care residents, said Missouri’s nursing home staffing is one of the biggest challenges facing residents.

“A lot of people are going to be laying in bed all day uncared for because there’s short staffing in the facilities,” she said. 

She said they’ve recently been hearing about a lot of residents who don’t have nurses to come get them out of bed to attend activities.

Moore said the state’s ombudsman program, which is an oversight arm composed of staff and volunteers who advocate for long-term care residents, can help but needs more resources.

Moore’s organization operates the ombudsman program for St. Louis and Northeast Missouri regions.

“Those residents really rely on ombudsmen, both staff and volunteers, to speak up for them and to make sure that they’re getting the care that they need and that they deserve,” she said.

Ombudsmen make sure residents can go to the bathroom, take their medications and be fed on time, as well as enjoy activities.

Without the oversight that ombudsmen offer, she said, “it’s very easy for people to just kind of say, ‘Oh well, the call light was on for a long time, I just didn’t get to it.’”

For the second year in a row, Gov. Mike Parson vetoed the $2.5 million increase the legislature approved for the program, which would have added around 25 staff statewide, Moore said.

Parson wrote that “while this supports the important goal of helping seniors throughout the state, there is insufficient funding from the appropriated source to support this item.” 

Moore said she was aware of some issues with the source lawmakers assigned to draw funding from but was hopeful they’d be resolved by the end of session.

“We have a lot of challenges here in Missouri for nursing homes,” she said. “…It’s definitely a disappointment.”

The Missouri state flag is seen flying outside the Missouri State Capitol Building on Jan. 17, 2021 in Jefferson City (Michael B. Thomas/Getty Images).

In just the last three months, Missouri has come under fire from two federal agencies and a U.S. district court judge over how it administers programs designed to help the most vulnerable.

The state’s dysfunctional call centers serve to deny low-income residents food aid that is guaranteed to them by federal law, a judge ruled in May. 

Missouri funnels mentally ill people into nursing homes, the Department of Justice concluded in June, rather than providing resources that could help them live in their communities. 

And delays processing Medicaid applications, among the worst in the nation, violate federal rules — which pediatricians say is causing chronically ill kids to miss medications.

The issues are years in the making — a product of decades of underinvestment and workforce cuts, advocates say.

And they’re not in isolation: There are also foster kids being housed in hospitals, people waiting for months in jail to be transferred to psychiatric facilities, daycares struggling to remain open because of state payment delays and staffing issues that have caused backlogged child welfare investigations.

On Aug. 6, Missouri will hold primaries to nominate the next governor. Three Republicans are considered the frontrunners for gubernatorial nomination: Lt. Gov. Mike Kehoe, Secretary of State Jay Ashcroft and state Sen. Bill Eigel. 

The two leading Democrats running are House Minority Leader Crystal Quade and businessman Mike Hamra.

The Independent asked each candidate what they would do about the various crises within the state’s fragile safety net.

Most agree that two broad issues lie at the root of these problems, particularly within the Missouri Department of Social Services: the fact that state workers aren’t paid enough and that the state has lagged in modernizing its technology.

The leading Republican candidates said they would invest more in workforce or technology, though at the same time all three want to slash the income tax. 

Democrats want to make similar investments without that cut to state revenue.

“Regardless of who the governor is,” said Casey Hanson, deputy director of Kids Win Missouri, a coalition of organizations that advocate for children and families’ wellbeing, “we hope that they will come in with that mentality that we need to have systems that work in our state, so that when families need to access the safety net, they’re able to.”

Workforce considerations 

On the Republican side, both Kehoe and Eigel said they’d be open to supporting raises for state workers.

The laundry list of safety-net issues is “not an acceptable situation,” Eigel said.

Broadly, Eigel said, more government spending has led to worse outcomes. 

But asked about whether more money would be needed to, for instance, ensure child welfare workers have reasonable caseloads — which St. Louis Public Radio has most recently reported on — Eigel said: “No question and nobody’s proposing zero government.”

Eigel would support raising salaries of child welfare workers “up to $80,000 or $90,000 per person so we can really recruit at a level where we’re getting quality individuals to investigate child abuse.”

“…And to do that is a fractional line item in a multi tens of billions of dollar budget.”

Entry level child welfare workers start at salaries of just over $44,000, DSS spokesperson Baylee Watts said. 

Eigel said several of the issues “may require more direct resources” but that he would also prioritize “getting rid of bureaucracy.” 

In terms of state pay, Kehoe said Missouri has come a long way in the last few years. But the state must continue to remain competitive with the private sector.

Kehoe has lived in Jefferson City for more than 30 years, and he says he’s seen firsthand how some state employees struggle to get by.

“I’ve been at Schnucks and watched someone take out a SNAP or food stamp card to buy groceries,” he said, “And I knew that person had worked for the state for 25 years.

“Now, we shouldn’t have somebody work for the state of Missouri for 25 years and have to use an assistance card to buy bread at Schnucks,” Kehoe said.

Quade served as House minority leader, and said her experience in that job gives her insight into the issues plaguing Missouri’s social services. She led hearings looking into people being kicked off Medicaid, and says she has met with numerous frontline DSS staff to hear concerns.

“Year after year,” Quade said, “I have led the fight to increase funding, not only for staff, but also things like our call centers…I can’t count how many hearings I’ve been in where agency directors have begged for adequate funding so they can successfully help Missourians but have been ignored or disregarded,” she added.

Quade said if elected, she’d meet with frontline workers and families who “have been left behind to ensure our state is doing all we can.” 

Hamra called the situation “unacceptable” and reflective of a lack of leadership. 

“I will both provide staff the resources they need to do their jobs, and in return, demand that they provide the level of service Missourians deserve,” Hamra said. “I have a 20-year track record of running a large organization where I have put this approach into practice and would bring this same mindset to state government as governor.”

Elsewhere in Missouri’s social services agency, benefits program workers in the Family Support Division start at just under $39,000 and youth services workers at the Division of Youth Services start at $42,000, Watts said. There are currently 252 job openings in the Family Support Division, 126 in the Division of Youth Services and 8 in Children’s Division, as of late May, Watts said.

And even if the agency could fill all its positions, it’d still be operating at a level far below where it used to be. Fifteen years ago, there were over 1,000 more staff members in the Department of Social Services than there are today, according to state budget documents — in part a result of substantial cuts under Democratic Gov. Jay Nixon.

Around one-fifth of the state’s population is on Medicaid. One-third of Missourians will interact with the Department of Social Services, according to agency leaders.

Watts said agency leaders “remain committed to advocating for higher pay” for staff.

The impacts of low staffing in the Family Support Division include delays for Missourians to access needed health and food assistance. A lack of benefits’ staff means various programs compete for resources, Missouri told the federal government.

And a decline in staff has coincided with shifts away from person-to-person interaction. 

The agency several years ago moved from assigning caseworkers to each benefits participant and toward a call center model, said Sarah Owsley, advocacy director for the anti-poverty nonprofit Empower Missouri, which she argues hasn’t proven successful in other states. 

“We would love to see some resources put back into local offices where families can have a personal contact, a person they’ve built a relationship with,” she said, adding that data shows the person-to-person model helps families secure benefits and move toward self sufficiency, rather than simply being denied access.

In Missouri, call center wait times can be hours long, and the remaining in-person offices sometimes direct clients back to the phones.

The agency is working toward “innovative ways to provide 24/7 self-service options for the public’s convenience,” Watts said.

She added that the agency is “actively monitoring and adjusting staffing to meet the demands of managing the call center and processing applications,” and has seen a reduction in wait times in recent weeks.

DSS “faces a challenge of increased workloads and call volumes while maintaining staffing levels for Medicaid applications and the call center,” Watts said.

Technology modernization

Ashcroft and Kehoe said technology is another area they think could be improved to help these safety net issues.

“The state needs to do a better job with information. The state needs to do a better job of making it easier for individuals to communicate and have their say,” Ashcroft said.

He would also undertake a broader reevaluation of state resources, he said — a “reset of government departments.”

Kehoe said Missouri hasn’t been able to keep up with technology compared to other states.

“We have to do that,” he said, “and I think we have to make sure we get to a point where the right people are getting the right help. eliminate as much of the fraud as we can and the people who actually are able to go to work, get them opportunities in the workforce.” 

There have been longstanding tech problems within Missouri’s social services department, including antiquated software systems.

After the state launched a new eligibility verification system for Medicaid in 2018, it saw a huge drop in Medicaid enrollees. Officials largely attributed the decline in participation to improved economic conditions, but there turned out to be significant system glitches. Quade called for an investigation of those drop-offs at the time.

A report published in 2019 found Missouri’s Medicaid data system has around 70 components and was partially developed in a system that dates from 1979 — which is “not positioned to meet both current and future needs.” A 2020 report concluded that for participants trying to enroll in benefits, “the system feels like a secret and no one has the answer.” 

Lately, the state has seen significant improvements in the number of Medicaid renewals it processes using existing data rather than requiring participant response, which it had long struggled with, called ex-parte renewals. Yet the remaining individuals who still need to send in their forms for processing and the advocates who assist them have reported a huge number of paperwork and tech issues, such as uploaded information being lost in the state’s online portal.

“To address children losing coverage,” Watts said, “we continue to educate community partners and participants on how to connect with FSD to apply, renew, and use the MyDSS portal, along with looking at ways to improve our ex-parte rates which will in turn decrease the numbers of renewal forms that must be sent out.”

Watts said one tool that is in the works would automate more data entry “to streamline processes and allow staff to focus on processing [applications] rather than manual entry.” The full benefits from this are expected by late fall, she added.

And the agency leadership are committed to continuing to advocate for tech upgrades, she said.

Late last year director Robert Knodell told the American Public Human Services Association that some of the problems that had plagued the agency included “decades of underinvestment,” legacy technology systems, and the challenges of bringing new participants onto Medicaid after the voters approved expansion. 

Advocates say they’re not just interested in governors’ policy proposals but what candidates think the purpose of these programs is. 

They say one goal of public assistance is to help people become self-sufficient and the way to do that is to eliminate barriers to their getting help.

“When those systems aren’t functioning properly, it puts more stress on families, but it also puts more stress on the state and state workers,” Hanson said, pointing to the case of the education department’s child care subsidy system’s issues since late last year when it moved from the social services department. Those issues have caused day cares to struggle to stay afloat, and daycares to submit more and more payment dispute forms to the state.

“And then that creates a backlog, and then the already overburdened state staff are then faced with that backlog in addition to their regular work,” Hanson said.

And for families, she said, “we hear about parents who have to turn down work or turn down jobs because their subsidy wasn’t approved in time.” 

Others have to wait hours on hold to access food benefits, sometimes missing work to do so.

Owsley said she hopes lawmakers think about what purpose it serves to impose barriers for people to access these programs.

“Families in poverty in Missouri needs support,” she said. “They don’t need more burden, and when they’re reaching out for that assistance, it’s because they need it.”

The Independent’s Jason Hancock and Rudi Keller contributed reporting.

Saira Khobab and her 8-year-old son, both of whom were cut from Medicaid and struggled to re-enroll, walk into a pediatrician's office in Kansas City on July 11 (Clara Bates/Missouri Independent).

Dr. Maya Moody, a community pediatrician in St. Louis, knows a new month has begun when her clinic’s billing department runs patients’ names and she hears about the children no longer covered by Medicaid. 

One of those patients, now 3 years old and deaf in one ear, was scheduled for a cochlear implant. But when his family unexpectedly lost Medicaid last year, they had to cancel the appointment. 

Delays getting their coverage reinstated and securing another specialty appointment set the procedure back by around a year.

“And now,” Moody said, “he has developmental delays because he wasn’t getting all of his services that he needed for his hard-of-hearing.” 

Other parents, she said, don’t learn their child lost Medicaid coverage until they reach the clinic’s front desk. And though they quickly submit paperwork to get coverage back, it can be months before it’s reinstated.

Since June of last year, Missouri has been re-checking the eligibility of all Medicaid enrollees, after a three-year federal pause due to the COVID-19 pandemic. 

The Medicaid rolls are down by roughly 136,000 kids since the process of recertification started up again. Many qualify for coverage but are losing out due to paperwork or “procedural” reasons.

And in recent months, the state’s application processing times for Medicaid have gotten so long the federal government was compelled to intervene to help Missouri improve the situation.

In the meantime, thousands of children who lost coverage are dealing with delayed or foregone medical care, which can include missed vaccines for infants, preventative care and prescriptions for chronic diseases like asthma and diabetes — doctors, families and advocates told The Independent.

“While we’re waiting for this bureaucratic process of solutions and people sitting at tables talking about procedural issues, I’ve got kids in my office who are suffering poor health outcomes, delayed care,” Moody said. “It’s just heartbreaking.” 

Worst-in-nation processing delays

Over the last year, the state’s Medicaid rolls shrunk by 249,209 people. Over half of that decline was children, even though children are eligible at higher income levels.

Of Missourians who lost coverage between June 2023 to May, state data shows nearly 80% were for a “procedural” issue, and the rest were no longer eligible. 

Procedural issues generally refer to paperwork issues, meaning a participant failed to return paperwork or the state didn’t receive it. Those can include people not understanding the forms, not receiving them because of a change in address or the state losing the paperwork upon receipt.

As the state evaluates hundreds of thousands of current Medicaid recipients each month and processes their updated information, it continues to receive new applications — some of which are from people who were cut and trying to get back on.

Federal data shows Missouri’s application processing times have been among the worst in the nation since late last year.

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

But more than half of applications took longer than 45 days to process in Missouri between December and March, the most recent available data. In February, that portion was 72% and in March it was 64%. 

Nationally, only 14% of applications took longer than 45 days to process in March. 

The federal Centers for Medicare and Medicaid Services wrote in a May letter obtained by the Independent that it is concerned the state is not doing enough to “achieve and sustain” compliance with federal rules on Medicaid and is intervening to help Missouri identify strategies to come back into compliance. 

The Department of Social Services, which oversees the state’s Medicaid program, declined to comment for this story.

Kids hospitalized because of Medicaid lapses

Dr. Thuylinh Pham, a pediatric urgent care doctor in Kansas City, said she’s been seeing kids come in who have had Medicaid lapses and “can’t afford their chronic medications.”

Some families are unable to get a primary care appointment because they’re no longer insured, and don’t go to the ER because they’re worried about the cost.

“These kids are coming in really, really sick,” Pham said. “We’re having to call 911, we’re having to get transport and get them into the hospital, and the reason for a lot of it is they want to avoid a bill, and so that is a really dangerous situation for these kids.”

Asthma medications out of pocket can cost over $100 per month.

“We are seeing kids who have been out of their medications for months and may have been well-controlled on the medications, but now…they’re being hospitalized for it because of Medicaid lapses,” she said.

Dr. Heidi Sallee, a pediatrician in St. Louis who is also president of the Missouri chapter of the American Academy of Pediatrics, remembers a specific patient’s deterioration.

A 5-year-old asthmatic girl was recently cut from Medicaid and her family couldn’t afford refills of her prescription. The girl ended up in the emergency room two times while waiting to be reinstated, Sallee said.

At one point, her mother had tried to fill a room with steam to ease the girl’s symptoms, but she stopped breathing and was rushed to the emergency room in an ambulance.

“If she’d been able to stay on her Medicaid and not have that interruption, she would have been on her medicines and would likely have not had that asthma exacerbation that then brought her to the ER two times,” Sallee said.

Parents’ difficult calculations

Dr. Shanon Luke, who for the past three years worked as a pediatric resident in Columbia, said she’s seen disenrolled families postpone preventative care, such as getting lab testing done to determine the cause of a child’s slow physical growth.

“It can be frustrating just wanting to provide the best care for the patient, but having this barrier,” she said, “…seeing the difficulty that they had in making the decisions on what to do for their kid because they were concerned about finances was just really sad.” 

Several pediatricians mentioned patients driving from hours away, from rural areas without pediatricians who take Medicaid, only to be turned away for lack of coverage.

Missouri Ozarks Community Health is a federally-qualified health center with six clinics in rural south-central Missouri. It offers limited pediatric care, said CFO Randall Gann, and is primarily seeing the current Medicaid issues in kids’ dental care, where they provide services for many more kids.

Gann said he’s seeing patients waiting five or six months to get dental care, after they’re disenrolled and try to come back on — and that those delays have gotten worse the last few months.

“We have a lot of parents making decisions right now to not pursue dental care for their kids,” he said, “unless, you know, they get on the Medicaid status and can actually get approved before bringing them back in.” 

A ‘multitude of systems issues’

Parents and advocates trying to get answers from the state about their coverage issues often run up against seemingly insurmountable barriers. 

The state has long been grappling with technology issues, including a dysfunctional call center, and staffing issues. 

LaNetta Nole, a mother of two living in Malden, in the southeast part of the state, has been trying to get her kids — a 14-year-old son and 10-year-old daughter — back on Medicaid since February. 

She works at Pizza Hut and her husband works as a mechanic. His employment health care plan would cost $500 per week to add her children, she said.

Her son got braces in December but hasn’t been able to go back to the orthodontist for his monthly routine checks and adjustments because he’s uninsured. Each visit to the orthodontist costs $170 without insurance, she said.

“We don’t have that,” she said. “…I don’t even have that to take him back to the orthodontist and he needs to go.” 

Cole has called the state each month since January. She has waited up to four hours on the phone to connect with a representative. 

When she tried going to her in-person Family Support Division office in East Prairie earlier this year, she said she was directed to a booth and told to wait for a call. She didn’t have time to wait beyond 20 minutes. 

“I’m so confused by it, and I’ve wracked my brain trying to figure out why they have not been reactivated,” she said, “Because I submitted everything.” 

Advocates who help people with their Medicaid enrollment issues say they’ve been frustrated the state hasn’t taken more action to address problems that have been there for the last year.

Joel Ferber, advocacy director at Legal Services of Eastern Missouri, said they’ve noted a “multitude of glitches and systems issues,” including with the state failing to process documents in a timely way, losing documents and people being kicked off due to computer errors. 

They’ve seen “so many newborns without coverage for more than a month missing doctor’s appointments,” Ferber said.

Jim Torres, program manager for health insurance services at Samuel Rodgers Health Center in Kansas City, said after he helps clients get their information to the state, “it’s hitting a brick wall,” often taking months to have the state register simple changes.

“Patients sometimes come back to us and say well, I gave you the information to send in. Didn’t you send it in?” Torres said.

“Yes, I did,” he replies. “It’s sitting on their computer system, it hasn’t been worked.”

Some women, Torres said, give birth before they finally are able to get switched from adult Medicaid to the pregnancy Medicaid category, which covers important services like prenatal visits.

“It’s a broken system,” Torres said “I think they’re dedicated hardworking public servants but the system just isn’t working.”

Ripple effects

Saira Khobab, a mother in Kansas City, spent the last month calling Torres in a panic.

At the optometrist in May, when Khobab went to buy a pair of glasses for her 6-year-old daughter, she was told her Medicaid had been deactivated. The glasses would cost around $200 out of pocket, which the family — her husband works overnight shifts at a gas station — couldn’t afford.

She worried her daughter wouldn’t be able to see the blackboard at school next month.

Her daughter, her 3-year-old son, 8-year-old son and Khobab all lost Medicaid coverage after the family’s annual renewal in April, even though they meet the income requirements for eligibility and Khobab remembers submitting the required paperwork. 

Her youngest son has several health problems. Khobab needs care, too, that she’s had to delay — she fell twice while pregnant, gave birth in May, and has had trouble walking. She needs to go to physical therapy, she said. 

“Especially after I gave birth, it’s been really stressful,” she said. 

Late last week, she finally got news their coverage had been renewed.

“I’m happy for her,”  Torres said, “because I could sense the frustration and the worry in her voice — ‘kids are sick, they have dentist appointments, doctor’s appointments, how are we going to do this?’”

The saga isn’t over. Bills are piled up on her dining room table for appointments she is relying on Medicaid to backpay, now that they’re finally reinsured. 

And she rattles off the specialty appointments she’ll need to make now for herself and kids. She worries about what will happen in the months of waiting for openings.

“Tomorrow,” she said, “I will call when my card is active. I’ll call and see what we are going to do.”

The Missouri State Capitol in Jefferson City, as pictured September 26, 2023 (Annelise Hanshaw/Missouri Independent).

When Eric Greitens was forced to resign from the Missouri governor’s office in 2018, he was replaced by Lt. Gov. Mike Parson.

Two years later, Parson won a full term of his own. 

Being next in line for governor is the major constitutional requirement for the lieutenant governor. In Missouri, unlike many other states, the lieutenant governor doesn’t run on a ticket with the governor. 

Five Republicans hope to win their party’s nomination for lieutenant governor on Aug. 6, vying for a job that involves sitting on various boards and breaking ties in the Missouri Senate.

Despite its limited constitutional authority, millions are being spent to capture the GOP nod heading into the fall, where the winner will take on one of two Democrats — state Rep. Richard Brown of Kansas City or Anastasia Syes of St. Louis  — and Libertarian Ken Iverson of Lake St. Louis.

Holly Thompson Rehder

Rehder, of Scott City, served eight years in the Missouri House of Representatives before being elected to the Senate in 2020.

The work she’s most proud of in the legislature, she said in an interview, was helping pass policies to “help people out of poverty, help them become self-reliant and and help with the mental health struggles we see,” pointing to veteran suicides and the opioid epidemic.

“I’ve lived paycheck to paycheck,” she said. “I grew up on the system and got myself out, turning into a business owner, starting from the ground up, not because anyone handed me anything but because it was because I worked for it and took the risk.”

Rehder, who married at 15 and had a daughter at 16, sponsored legislation this year to ban child marriage, which narrowly failed. 

She also sponsored legislation last year to prohibit transgender athletes from competing in sports that align with their gender identity, which was signed into law.

Before politics, Rehder worked in the cable television industry and co-founded a cable contracting company. She is a graduate of Southeast Missouri State University.

She said she decided to run for lieutenant governor to make a larger impact on people’s lives than she can as a senator, with the opportunity to “delve into some policy issues and really fight to help people.” Areas she is particularly interested in focusing attention toward include the foster care system and veterans’ mental health.

Rehder has $302,928 cash on hand in her campaign fund and $264,596 in Southern Drawl PAC, her joint fundraising committee, as of April 15 filings. Her campaign fund had spent $190,055 and the PAC had spent $40,508 on the campaign, as of April 15.

Dave Wasinger

Wasinger is an attorney at a St. Louis law firm he owns and manages, and a certified public accountant.

He ran for auditor in 2018 and lost in the GOP primary.

Wasinger grew up in Hannibal and attended the University of Missouri and then Vanderbilt Law School, before moving to St. Louis. He has worked at the law firm for over 20 years, specializing in business litigation.

After the 2008 financial crisis, Wasinger “took on Wall Street banks,” he said, representing whistleblowers in financial fraud cases against Countrywide Home Loans and JP Morgan Chase. The whistleblowers were key witnesses in the federal government’s case against the banks, helping federal prosecutors recover billions of dollars. 

Wasinger said the position of lieutenant governor “serves as a great bully pulpit to expose this corruption and these insider deals taking place in Jefferson City.” 

As of April 15 filings, Wasinger’s campaign had $222,554 cash on hand and had spent $17,759. Since then, he has donated $1.5 million of his own money to the campaign. 

Lincoln Hough

Hough, of Springfield, first won election to the Missouri House in 2010 and won a seat on the Greene County Commission in 2016. Two years later, he was elected to the Senate and was re-elected last year.

Hough is a “first-generation cattleman” who started his cattle ranch when he was in seventh grade. He graduated from Missouri State University.

“The most important thing I would want people to know about me is that I’m a self made person,” he said. “And I don’t come from a political family. I don’t come from money.” 

Hough has served as chairman of the powerful Senate appropriations committee since last year, giving him huge influence over the state budget. 

He said he’s proudest of his work in the legislature cutting the income tax, investing in Interstate 70 and providing state funds to support the National Guard when it was dispatched to the US-Mexico border by the governor.  He also said that in his time as chairman “we have completely defunded Planned Parenthood,” by preventing it from receiving Medicaid reimbursements.

 “I’ve got a good track record of actually getting things done in Jefferson City,” he said, “and not just not just doing the kind of the political talking points that people like to do.” 

Hough said he sees the focus of the lieutenant governor as  “promoting Missouri,” and “supporting the workforce initiatives of the governor.”

Hough’s campaign fund had $377,679 cash on hand as of April 15. A joint fundraising PAC, Lincoln PAC, had roughly $1.2 million. 

His campaign fund had spent $138,222 and the PAC had spent $143,683 as of April 15.

Paul Berry III

Berry, a St. Louis County businessman, has run unsuccessfully in five campaigns since 2012. 

He has also filed numerous lawsuits that have either been dismissed or withdrawn, including one intended to force state lawmakers to pass a congressional redistricting map and another alleging election irregularities cost him victory in his 22 percentage-point loss in the 2020 St. Louis County Executive race.

Though he isn’t an attorney, Berry represented himself in those cases.

Berry is a bail bondsman from Bridgeton and the great-nephew of rock-n-roll legend Chuck Berry.

His campaign filed a limited activity report with the Missouri Ethics Commission, meaning it raised and spent less than $500.

Tim Baker

Baker is the county clerk in Franklin County. He lives in Robertsville and before becoming clerk ran for county commissioner three times and lost.

As county clerk, Baker said, he has focused on saving taxpayer money by reducing “wasteful spending.”

He said he believes in the importance of the boards the lieutenant governor serves on, including veterans and tourism, and would hope to bring more attention to farming in Missouri.

“Farming is our number one industry in our state,” he said. “And a lot of people, especially in the urban areas, don’t necessarily know what a farm looks like or where their food comes from whenever you go out and talk to folks. And it would be nice to bring that to the forefront too.”

Baker has $5,646 on hand, according to April 15 filings, and had spent $4,079.

A series of changes to Missouri's child care subsidy program have created a major headache for day care providers, who say they've been forced to make difficult budget decisions as they wait on money owed to them by the state (Rebecca Rivas/Missouri Independent).

This spring, the state of Missouri owed Kimberly Luong Nichols $5,000 in backlogged payments for children at her Kansas City daycare who were part of a state subsidy program.

For four years, she’s operated a licensed daycare inside her home, where she currently serves 10 children. Luong Nichols stopped drawing a salary last summer to pay for improvements to her center and two new hires, expecting to draw down a salary again this year. 

When the full subsidy she was owed stopped arriving, she laid off those staff.

And as they’ve done for the past year, her family of six relies solely on her husband’s $53,000 salary. 

They’ve given up little luxuries like going out to dinner and buying fancier shampoo. And they’ve given up bigger luxuries, like vacations. 

When bill collectors started calling, her husband considered getting a second job. On several occasions, she considered doing away with the daycare entirely. But she didn’t, not wanting to leave the families — many of whom have children with developmental disabilities, or who are in the foster care system — with the stress of searching for a new day care. 

Luong Nichols is among thousands of child care providers across Missouri who rely on a state child care subsidy program to keep their daycares afloat.

The subsidy, part of a federal block grant program that is state-administered, helps cover the cost of serving low-income and foster children. 

But since late last year, a series of changes created a major headache for many providers and families, as parents were unable to register their children and providers in the most dire circumstances were left without money to pay their staff.

The Missouri Department of Elementary and Secondary Education, which oversees the program, has largely blamed a contracted vendor for the months-long backlogs. The system, which launched in December, is still not fully operational. 

“ … There have been a number of unforeseen challenges during the transition, which involves loading family and provider data from the existing state systems into the new (Child Care Data System),” Mallory McGowin, a spokesperson with the department of education said in a statement Wednesday. “The (Office of Childhood) is working hard to mitigate these issues and sincerely apologizes to the child care providers and families affected.”

But similar backlogs plagued the system three years ago, as parents struggled to enroll children and providers had to make serious budget cuts.

The latest problems have forced some daycares to close. Others have shifted from serving vulnerable children who qualify for the state subsidy to only admitting families who can afford to pay on their own. 

Many providers, like Luong Nichols, have weeks where they’re barely hanging on.  

Payment backlogs not new

In Missouri, child care providers can be registered to get a government stipend for every child on subsidy, meaning they receive a partial amount of tuition directly from families, and then the government covers the rest after care has been provided.  

The child care subsidy is a federal program administered by states through the Child Care and Development Block Grant. Families apply for the state to directly pay a child care provider for part of the cost of care.  

Only very low-income families qualify in Missouri, along with foster kids and children with special needs. The maximum income a family can make to qualify is 150% of the federal poverty line, or $46,800 for a family of four.

The average cost of full-time, center-based care for an infant in Missouri was $11,059 as of 2022, according to Child Care Aware. 

There were about 21,000 children receiving the state subsidy as of November, the last publicly available state data. The program shifted from being administered by Missouri’s Department of Social Services to the education department in December. McGowin said the current number is closer to 23,000 children.

Roughly 1,800 of Missouri’s 2,800 licensed and license-exempt providers, including school districts, are contracted to take children on subsidy, Pam Thomas, assistant commissioner for Missouri’s Office of Childhood, said at a State Board of Education meeting last month. 

“We do continue to struggle a bit with our vendor and meeting what our expectations are for an efficient and effective system and making clear what’s needed,” Thomas told the board. “And quite frankly the vendor is not delivering on those results to what I would say are our expectations as a department.” 

The vendor contracted to develop and implement the new system for the subsidy program is World Wide Technology, McGowin said, a large technology services provider headquartered in St. Louis.

Board members expressed concerns with how to move forward as Thomas reassured them that her department was working “around the clock” to urge the vendor to fix the bugs in the system, which spans about nine steps between a family’s application for subsidy and payment to the provider.

“We have to be cautious about how many more changes we add into the system right now,” she said. “ … We can bend it, but we certainly can’t break it, and I think we’re on the verge of that right now.”

Yet this isn’t the first time the state’s handling of the subsidy program has caused widespread problems for providers and families. 

Emails show months-long backlog of payments to Missouri child care providers

In 2021, the state blamed the COVID-19 pandemic and the rollout of a new system used to track attendance, called KinderConnect, for a backlog of thousands of payments. 

In spring 2023, parents reported waiting several months to be approved for the state assistance, leaving them struggling to juggle work and child care. 

State Sen. Lauren Arthur, a Democrat from Kansas City, said she was notified of the current spate of issues a few months ago by legislative staff who’d started hearing concerns from constituents. 

“It feels like way too much time has passed,” Arthur said. “I suspect that child care providers across the state have already closed as a result of these mistakes and it’s totally unacceptable when already providers are struggling. There are already not enough seats available for children who need them.”

Asked last month if she was looking at alternative vendors ahead of the current multi-million dollar contract running out in December, Thomas, with the education department, said she wasn’t opposed. 

However, on Wednesday, McGowin, said the department is not currently planning on finding a new vendor. The subsidy payment issues – 60% of which came from technical issues, according to the state – are expected to be resolved by the end of July. 

Missouri pays providers for services after they’re performed, rather than in advance. This, coupled with the fact that providers are paid based on attendance rather than enrollment for children in the subsidy program, makes budgeting nearly impossible for providers who take low-income and foster children.

“We’re really relying on the state and DESE to really prioritize solving these system challenges so providers can be paid quickly,” said Casey Hanson, director of outreach and engagement at the child advocacy nonprofit Kids Win Missouri. 

Hanson has spent hundreds of hours with child care providers over the past several years. She knows what’s at stake.

“They’re some of the most resilient people,” she said. “They care about children, they care about the future of our state more than almost anyone.”

‘Our own personal pandemic’

Tina Mosley was among the providers who made the difficult decision to stop taking children on subsidy. 

For 28 years, she has owned and operated Our Daycare and Learning Center in St. Louis, which is licensed for 10 children. It sits in the Normandy school district where the median household income is less than $39,000, and more than 56% of students in public school have SNAP benefits, according to 2021 data from the National Center for Education Statistics.

Every other provider she knows in the area accepts children on subsidy. And they’re all in the same predicament.

“Every one of my colleagues and friends, the state is behind on paying them,” Mosley said. “To the right of me, to the left of me, across the street from me, behind me.”

By only taking private paying families, and by ceasing to collect a salary, Mosley said she’s been able to continue employing her two staff, both of whom are young mothers. And while they no longer take children on subsidy, they still service lower income families, she said. 

As a result, she’s not left waiting on payments from the state. A handful of home and center-based providers she knows in the St. Louis area already closed because of the lag.

Several months ago, when most of her children were from the subsidy program, she was helping parents sign up for state benefits as the system transitioned over. She recalls parents sharing screenshots of hold times on the phone with the state surpassing an hour before they had to hang up and return to work, unable to get the immediate help they needed.

“Early child care right now, we feel like we’re in our own personal pandemic,” Mosley said. 

But unlike during the COVID-19 pandemic, when government bodies and communities showed up in stride to keep child care providers in business, Mosley said it feels like most people have now turned their backs.

Luong Nichols, in Kansas City, has considered doing what Mosley has done: stop opening her services to families on subsidy.

In an April email to a staffer in Arthur’s office, she lamented her situation. The system had two of her kids on subsidy listed as private pay. A glitch wouldn’t let her submit attendance. She hadn’t heard back on her help ticket. 

“I am due to renew child care subsidy next month and really considering not doing it,” she wrote in an email she shared with The Independent. “Payments are still not correct, they owe me all of February and past corrections. Now we are about to end March and that will be added.”

After sending this email, Luong Nichols went on to interview at a local school district. She ultimately turned down the job offer, unable to part with the children in her care, including foster children, kids with behavioral difficulties and low-income children.

“I have single moms and foster children that have been kicked out of other daycares or gone through many placements before they landed on my door. And the kids that I take care of, they’re like family.”

Instead she continued to spend hours on the phone during nap time begging anyone to make her business whole again. She called the Missouri Department of Elementary and Secondary Education and the governor’s office. She even called the White House. 

“I’ve had to take on an extra load of work just to fight for something that I’m entitled to,” she said. 

As of Wednesday, she said her payments were caught up through May. She credited her persistence, and assistance from Arthur’s staff, for speeding up the payment.

At the same time, Luong Nichols has seen three area centers and four private daycares shutter. She directs most of the blame at the department of education.

“DESE has pushed the industry to the point of no return right now,” she said. ”We’re not going to have enough child care providers in the state of Missouri by the end of this year to take care of subsidy children.” She said it will move to private paying families only. 

Hanson, with Kids Win Missouri, said there isn’t currently enough data to know the reality of the child care landscape. 

In response to a Sunshine request submitted by The Independent last month, the education agency said they do not currently track the number of backlogged payment resolution requests. 

“The reality is, yeah, there are providers that will close,” Hanson said. “That’s why we continue to advocate that we need more state level funding in this space to really maintain a supply.”

Missouri State Capitol in Jefferson City (Getty Images).

The feds are stepping in to help Missouri adopt strategies to “mitigate the harm being caused to applicants,” which can include patients forgoing and delaying medical care and prescription drugs (Getty Images).

Missouri’s delays in processing Medicaid applications — among the worst in the nation — have the attention of federal regulators, who will conduct a “focused review” of the problem, according to a letter obtained by The Independent.

The federal Centers for Medicare and Medicaid Services in a letter sent to the state May 22 and obtained Friday afternoon under Missouri’s Sunshine Law, said it is concerned the state is not doing enough to “achieve and sustain” compliance with federal rules on Medicaid and the Children’s Health Insurance Program. Because of these concerns, the agency will intervene to help Missouri identify strategies to come back into compliance. 

Medicaid applications for low-income Americans are required to be reviewed within 45 days. 

In Missouri, the most recent federal data from February shows 72% of applications took more than 45 days to process — the worst in the country that month. That’s up from 58% in January. 

Nationwide, most applications were processed within 24 hours last year.

The Missouri Department of Social Services, which oversees the state’s Medicaid program, is required to submit specified data to the feds this month to work on strategies for coming back into compliance. If it doesn’t improve, Missouri could be subject to formal compliance actions, including an official corrective action plan, and would be at risk of losing federal funding.

A similar letter was sent to Texas, according to the business publication Modern Healthcare. A CMS spokesperson didn’t immediately answer a question about which other states were included. 

Long processing times can cause low-income patients and those with disabilities to forego medical care and prescriptions. Patients have told The Independent they are delaying medical care during pregnancy because they can’t get enrolled in Medicaid.

The federal government said in the May letter it is concerned “particularly given the prolonged period of the state’s noncompliance.” 

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

As of February, Missouri’s 72% noncompliance rate stands far above other states. The next highest were New Mexico (58%), Alaska (53%) and Texas (46%). 

Tim McBride, a health policy analyst, professor at Washington University in St. Louis and former chair of the board that oversees Missouri’s Medicaid program, said it is “very concerning” just how much Missouri’s issues stand out.

“If we compare the state’s processing time to other states, we appear to really be an outlier,” he said, and “in not such a good way.”

It’s not clear why Missouri can’t meet the 45 day requirement, McBride said. 

“We have heard the problem is understaffing, antiquated computer systems and a problematic call center,” he said. “But more could be done to rectify this.”

In summer 2022, the federal government initiated a formal mitigation plan with the state to get the processing time down.

It worked, but wait times started creeping back up in October, according to the letter. In October, 34% of determinations exceeded 45 days. 

“Although we understand that the state continues to employ the strategies outlined in its July 2022 mitigation plan,” the letter states, “due to the persistent nature of the current backlog, we believe it is critical for the state to review its current processes and adopt additional alternative strategies that will mitigate the harm being caused to applicants.”

Missouri’s social services agency is committed to cooperating with the federal probe and improving the wait times, spokesperson Baylee Watts said, and will submit the data by the deadline.

“The Department of Social Services is actively working to furnish the information needed for CMS’s review process,” Watts said.

“Our goal is always to strive towards continuous improvement when serving Missourians, and we will continue to work with our federal partners to achieve that.”

The letter states that CMS engaged with Missouri staff in January to try to understand and fix the backlog, and that the state attributed the problem to an increase in applications at the time.

From November to mid-January, during open enrollment season for the federal insurance marketplace, the state generally sees an uptick in Medicaid applications.

McBride said that influx in applications “should have been anticipated” around open enrollment.

And the increase in applications hasn’t leveled off as much this year as was expected, officials previously said. McBride said some of the continual increase in applications could be due to people losing coverage and reapplying. 

The state around a year ago began re-checking every Medicaid participant’s eligibility, after a federal COVID-era suspension on annual renewals expired.

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

Around 356,000 people have lost coverage in the renewal process, preliminary state data analyzed by the Center for Advancing Health Services Policy and Economics Research at Washington University in St. Louis, shows. Around half of them were children.

Net enrollment, which includes the number of people who got on the program as others were getting removed, fell by 212,203 people. Medicaid participation sits at 1.3 million as of May, down from 1.5 million in June of last year. 

Joel Ferber, director of advocacy at the nonprofit Legal Services of Eastern Missouri, said he’s glad the feds are “finally taking action” to require Missouri to explore more strategies for compliance. 

Legal Services of Eastern Missouri is one of the state’s legal aid programs that provides free legal assistance to low-income and disadvantaged Missourians, including on Medicaid application issues. Advocates for months have noted the intensifying bureaucratic hurdles for Missourians to access and retain coverage, including issues with the state’s online portal to upload eligibility documents.

Ferber has been urging Missouri to pause its disenrollments while it makes improvements.

“Too many are falling through the cracks under the current system,” Ferber said.

Another issue the state identified, according to the letter, was that it “faced shortages in eligibility staff due to the needs of other human services programs, which compete with the state’s Medicaid and [Children’s Health Insurance Program] agency for resources.”

One of those programs competing for the Department of Social Services’ resources is food stamps: A federal court last month ruled Missourians were being illegally denied food aid by the state, in part due to hours-long call center wait times. 

The call center wait time issues seem to cut across all of DSS’ programs  — Medicaid’s average call wait time was the longest in the nation in Missouri as of February, according to federal data, though it’s not the focus of this probe. It was 56 minutes in February.

Secretary of State Jay Ashcroft, who is running for governor, speaks at a press event about St. Louis area nuclear waste Wednesday, June 12, 2024 in Florissant. (Clara Bates/Missouri Independent)

Several Republican candidates for Missouri statewide office on Wednesday evening urged stronger state and federal action to clean up St. Louis-area radioactive waste and compensate victims.

Parts of the St. Louis area have been contaminated for 75 years with radioactive waste left over from the effort to build the world’s first atomic bomb during World War II. 

Secretary of state Jay Ashcroft, who is running for governor, Will Scharf, who is running for attorney general and House Speaker Dean Plocher, who is running for secretary of state, attended the news conference outside the Florissant Municipal Court building. They spoke alongside advocates, victims and legislators representing the region.

The press conference preceded an annual update from the Army Corps of Engineers on cleanup efforts at the downtown site, Coldwater Creek, St. Louis Lambert International Airport and Latty Avenue.

And it came as the fight in Washington, D.C. to extend compensation to St. Louis-area residents continues, because the federal Radiation Exposure Compensation Act failed to get a reauthorization vote in the House and expired Friday.

“Let me tell you, I understand that most people that go to Washington D.C. are not exactly profiles in courage, but if you can’t stand up to stop little kids from getting incurable diseases because of radioactive waste that is left in the ground, there’s something wrong with you,” Ashcroft said. 

“And you know, if it’s not a problem, why don’t we have 10, 20 representatives, 10, 20 senators, come and wade through Coldwater Creek and talk about it?” 

Scharf said he’d been calling members of Congress and urging them to reauthorize RECA with St. Louis area victims included.

“The region has paid enough,” Scharf said, “and it’s time for the games to end and for the people who have been harmed to finally receive the compensation they deserve.”

Plocher said he was there to support Rep. Tricia Byrnes, R-Wentzville, who has been an advocate for compensation and cleanup of the waste and has “brought so much light to something I was completely unaware of.”

“…It’s astounding the cover up, the lack of transparency from the federal government that has befallen this community, all in the name of protecting our national sovereignty to create weapons to help defend us in the war,” he said. “So it’s about time somebody does something about it.”

Byrnes organized the press event. 

 “I do not want to make this about politics,” she said when asked if she has endorsed the candidates who participated in the news conference. 

Byrnes grew up in the area and, as a teen, swam in a quarry she didn’t know was contaminated in Weldon Spring.

The news conference was a last-minute decision and she reached out to the people “who have helped champion it,” including Rep. Chantelle Nickson-Clark, D-Florissant, she said.

In an interview with The Independent, Scharf, who was policy director for former Gov. Eric Greitens, said he first met advocates who work on the radioactive waste issue in 2016.

“I’d like to see a much more vigorous investigation and potentially a lawsuit against the Department of Energy,” Scharf said.  “I want to use every legal tool at my disposal as attorney general to fight for justice for the victims of this region.”

Ashcroft told The Independent he’d been “trying to raise awareness and get the state involved” for years.

If elected, he said, “the governor can help move policy,” pushing for more money in a statewide testing fund, and working with the Missouri congressional delegation to “push the feds to do more work with Congress.” 

“And the last thing the federal government wants is publicity about it. They buried it through multiple ways for 75 years. And one thing that I know I can do, even as Secretary of State is, I can be public about it. I can force them to face the issue.”

Plocher pointed out he didn’t mention his campaign in the news conference and told The Independent he hadn’t come as someone “running for office today. I’m here to be the speaker of the House,” and said he wanted to help Byrnes and Nickson-Clark. 

“The two of them have been working tirelessly,” he added.

‘People are still dying’

Around 80-90 people attended the annual community meeting held at the Florissant Municipal Courts Building Wednesday night. 

The Corps of Engineers has authority, through the Formerly Utilized Sites Remedial Action Program, over the downtown, Coldwater Creek, airport and Latty Avenue sites. Cleanup of the West Lake landfill is being overseen by the Environmental Protection Agency. 

After World War II, waste from the downtown site was trucked to St. Louis County, sometimes spilling along the way, and dumped at the airport. Decaying barrels released radioactive waste into Coldwater Creek, and despite acknowledging the risk of contamination, the private company that produced the waste thought it was too dangerous for workers to put the material in new barrels.

Eventually, the waste was sold to another private company and moved to a property on Latty Avenue, also adjacent to Coldwater Creek. The material was stored in the open where it continued to contaminate the creek. 

At the meeting, several residents expressed frustration with the government’s progress in cleaning up the sites and a lack of communication.

Ray Hartmann, a Democrat running for Congress in the 2nd District, said he had been to a similar meeting in 2013.

“What reason do these people have to believe you that this is going to be different than it was in 2013?” Hartmann asked.

Col. Andy Pannier, commander of the Corps’ St. Louis District said the agency is trying to make its  actions match its words and see “constant, continuous progress.”

At another point, Pannier added that “There is no property that can wait till tomorrow or the next day or the next day,” which was met with applause.

“There’s only so many we can work on at any given time. And so we try to prioritize that…we try to prioritize the areas that would have the highest risk for potential exposure to the public to be first and then move to the next and the next,” he added.

Pannier said “the timeline that we’re working off of is completion by 2038.”

The Corps has promised signs warning of the contamination but they haven’t been installed, said Deborah Bowles, who said she grew up in Florissant and has come to Corps meetings for years.

“It’s just not hard on our mental health,” she said. “It takes a lot out of us physically to come and try to advocate for this.”

Cleanup is a “huge process…but does it take this long to get signage out?” she asked, adding that people who move to the area may not know the risks.

Pannier said “I know this is absolutely an area of concern for many of you and so I will sit with my team and figure out how we got to what you saw versus what you’re asking.”

Nickson-Clark also raised the issue of sign placement at the news conference.

“People are still dying, children are becoming diagnosed with rare cancers…Where are the signs?” Nickson-Clark said. “This community is still walking, playing in Coldwater Creek. Families are still being affected by Coldwater Creek.”

Children made up 56% of the net decline in Medicaid enrollment between June 2023 and April 2024 (Joe Raedle/Getty Images).

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.

The Missouri State Capitol in Jefferson City, as pictured September 26, 2023 (Annelise Hanshaw/Missouri Independent).

Legislation that would have banned Missouri from seizing the Social Security benefits of foster children was on the precipice of passing during the final days of the legislative session, but died when GOP infighting caused the state Senate to adjourn early. 

That means the state will continue to take millions of dollars in the next year in benefits and use the money to help pay for foster care. 

“It’s more than disappointing,” said state Sen. Holly Thompson Rehder, a Scott City Republican and one of the bill’s sponsors. “It is a disservice to every taxpayer and voter in this state for our Senate to run the way that it is.”

The result of the practice is that kids who are orphaned or have disabilities are responsible for paying toward the cost of their care in state custody, while foster kids who are ineligible for those benefits pay nothing. 

The legislation would have forbidden that, instead requiring the state to use the benefits for the child’s unmet needs — not routine costs.

Rehder said she was expecting the bill to come up for a vote last Thursday, when the Senate suddenly descended into GOP infighting and adjourned for the day. When the Senate reconvened Friday, it was in session for only 10 minutes before going home for the year.  

“When we have bills that matter to people’s lives — to children’s lives — right there ready to be taken up and passed, and instead of doing that, the actual work that we’ve been sent there to do, we play games and fight and say, if this bill isn’t gonna get done, nothing’s gonna get done. It’s insane,” Rehder said. 

State Rep. Hannah Kelly, a Mountain View Republican and co-sponsor of the bill, said she heard from a foster child earlier this session who told her the bill would affect her personally as a recipient of survivor’s benefits.

“She lost parents, which means the state was taking her money and will continue to take her money,” Kelly said, “because we couldn’t get over ourselves and get past politics and pass a bill.”

Lori Ross, founder and CEO of the nonprofit FosterAdopt Connect, which advocated for the legislation, said the bill’s demise means another year of the state taking money that could otherwise be a valuable safety net for kids.

“By failing to make this change,” Ross told The Independent, “we are preventing our state’s most vulnerable children from accessing a critical means of support when they age out of the system and must navigate the world alone.”

It’s long been a common practice nationally to take foster kids’ benefits, but it’s come under increased scrutiny over the last few years. Several states, including Arizona, New Mexico and Oregon have halted the practice. 

There were 1,426 foster kids receiving benefits in Missouri as of July 2023. The state spent over $9.3 million in seized benefits last fiscal year.

Versions of the bill won approval from both the House and Senate, passing through to the other chamber, so there were two possible vehicles to get the bill to the governor’s desk.

There was no clear opposition to the foster care benefits portion of the bills, though there was some opposition to an amendment tacked onto the version that cleared the Senate regarding child custody, designed to fix a bill passed last year. 

The Senate version of the bill cleared a House committee, but was never brought up for debate in the House. Kelly said “all I know is it got stopped” before coming up for a vote. 

She’s hopeful it will pass next year.

“If you’re an average kid out here, you’re gonna get that money,” Kelly said, referring to the benefits. “But these kids don’t get that money and nobody seems to care that should care. And I hope that changes next year.”

On the Senate side, Rehder said “perhaps it will be a better year for protecting children” next year. But with the chamber’s dysfunction, she said it’s hard to know.

“It’s an excellent policy and you know other states are moving towards this that haven’t already” Rehder said “…We have to fix some things in the Senate. And until we do, I don’t know, I don’t know what any bill’s chances are.”

Jason White, a foster parent from Kansas City, traveled to testify in support of the legislation earlier this year.

The state seized his foster son’s survivor’s benefits, which amounted to around $30,000, White said in an interview with The Independent. Now 20, his son has “zero dollars” and little support to transition to adulthood.

White said this is an issue that affects “thousands of kids with little to nothing” and the reason to take it on is simply “to do the right thing.”

“I’m very disappointed,” White said, “that cheap politics killed this legislation.”

Interns Santino Bono (left) and Alanna Nguyen stand with legislative assistant Dustin Bax after receiving resolutions from the Missouri House of Resolutions to commemorate their service (courtesy of Santino Bono).

In March, the phone in state Rep. Deb Lavender’s office in Jefferson City started ringing constantly, but the calls weren’t for her.

They were for her interns, Santino Bono and Alanna Nguyen.

The interns, along with Dylan Powers Cody, who was interning for state Rep. Peter Merideth, had spent months cross-checking spreadsheets to pinpoint school districts who had not yet claimed pandemic-era federal funds for homeless students.

Those federal dollars are part of the American Rescue Plan and must be budgeted by September. A large part of the interns’ project was calling districts to notify them that they had money that could expire if they didn’t act quickly.

The office got so many calls back from schools about the interns’ project that Lavender’s legislative assistant needed to create a voicemail folder just for them.

So far, they helped districts claim $1.15 million in funds in four months that can be used for a range of services for homeless students — from buying washers and dryers to temporary hotel stays and transit cards.

“We had multiple school districts call back and say, ‘We have twenty grand in the bank that we can use to help homeless students? No one really told us,’” Bono said in an interview with The Independent.

Most of the districts the interns reached had no idea they had funding available, Nguyen said.

“Then, they wanted more information on it,” she said. “Once they got the information on it, they were able to kind of kickstart it up and get things moving along.”

Bono expected the internship might be more menial, including the “intern trope of having to get coffee for people,” he said.

“To know that I could have potentially a much bigger impact on actual students, as a student myself, I’m really proud of that,” Bono said.

Missouri received an infusion of $9.6 million in the American Rescue Plan Act of 2021 for students experiencing homelessness, and schools were able to start using it in 2022.

But many of those schools had never received federal dollars to support homeless students before.

Tera Bock, director of homeless education for Missouri’s Department of Elementary and Secondary Education, said the agency alerted school districts to the funding but that several challenges emerged.

“It is not funding that most districts are used to having, so they usually are supporting their students experiencing homelessness without any funding specific to that,” she said. “The extra funding creates the need for a shift in mindset as far as what they provide for those students.”

School districts have until the end of September to budget the remaining $6.1 million or lose out on it. 

Most schools received a few thousands dollars in federal aid for homeless students. The largest allocation, based on its homeless student population, went to St. Louis City which received $850,000.

The funding is best used for one-time costs, Bock said, like a vehicle to transport students with housing insecurity or to meet emergency needs.

“The district should really consider how they can use it in a way that is not going to create a financial burden in the future whenever they don’t have the funds anymore,” Bock said.

She said rural districts with a smaller population of students experiencing homelessness are the most likely to struggle to spend the money.

Bock has been in her role for a couple months, and the position was vacant briefly.

Part of her job is to contact each district’s homeless liaison, a position every district is federally required to have. But sometimes, the liaisons have multiple positions in schools, and Bock doesn’t hear back from them.

“Especially in the districts where they don’t typically see a large population of homeless students, they get multiple roles, and it just gets lost in the shuffle,” she said.

“We don’t have very many (districts) here in Missouri where that person is completely designated as their entire job for the most part,” she said. “They are wearing lots of different hats.”

Bock said she sends “lots of communication,” so “they should be aware” of the funds but wonders if liaisons are properly connected to district administration to get the money budgeted.

With more communication and activities planned, Bock is not concerned about being able to get more money claimed by districts.

“This is definitely a big piece of what I’m working on right now,” she said. “And our sights are set on Sept. 30.” 

Bock said the interns were “super helpful” in the process.

“There has been good communication whenever they need some backup information to support questions that are coming up,” she said. “So they’ve been great to work with.”

The interns are hopeful schools will continue allocating the funds.

“There’s still a lot to be done by September and session’s ending,” Bono said. “I’m going off to law school. I can’t keep calling school districts. So we’re just hoping that more awareness can be given to school districts to kind of get them to keep working towards this.”

Lavender said the funds might look modest in terms of the state’s overall budget but the impact on students is large. In Webster Groves, she said, the schools “got another $8,000 that I don’t think they knew was sitting there.”

Lavender’s legislative assistant Dustin Bax chimed in: “And $8,000 of backpacks, non-perishable foods, fuel cards — that goes a long way.”

Sen. Holly Rehder, R-Scott City, prepares for the penultimate day of legislative session Thursday (Annelise Hanshaw/Missouri Independent).

Child marriage will remain legal in Missouri for at least another year after Republican House leaders said they don’t have enough time to pass it.

Under current Missouri law, anyone under 16 is prohibited from getting married. But 16 and 17 year olds can get married with parental consent to anyone under 21. 

Under legislation that cleared the Senate with virtually no opposition earlier this year, marriage would be banned for anyone under 18. “It was very surprising that the House has not allowed it to come to the body,” said Republican state Sen. Holly Thompson Rehder of Scott City, who sponsored the bill along with Sen. Lauren Arthur, a Democrat of Kansas City.

“Banning child marriage should not be controversial. When I filed this bill, I had no idea it would be controversial,” Rehder added.

The bill was stalled by a group of Republican critics in a House committee, who said it would constitute government overreach and infringe on parental rights. It finally passed out of committee this week after several of those critics were not present at the vote. 

But House leadership told reporters Friday morning it was too late to place the bill on the House calendar for debate. Session ends at 6 p.m. 

“There’s some interest there, unfortunately the rules preclude us from doing that today,” said House Majority Leader Jon Patterson, a Lee’s Summit Republican.

Arthur said the failure is “shameful.”

“When I talk to people back home, they’re surprised to learn that minors can get married in the first place,” Arthur said. “And these are the kinds of headlines that my friends who are apolitical or live in different parts of the country send me and say, ‘What is happening in Missouri?’

“It makes us look bad,” she said, “but more importantly, we’re not doing enough to protect young girls who are forced into marriages and their lives are worse in every way as a result.”

Twelve other states have in recent years banned child marriage.

Rehder said she was told only around 20 out of 163 House members were opposed. She also said the House could have voted to suspend its rules to allow the bill to be debated and passed before adjournment, but suggested that House Speaker Dean Plocher refused to let the bill move forward to avoid embarrassing Republicans who are opposed to banning child marriage. 

“We have the votes,” Rehder said,  but it didn’t come up “because the speaker didn’t want to put his members in a bad situation.”

“…Because you shouldn’t be against banning child marriage.” 

Rehder said she’s hopeful the bill will succeed next year, in large part due to the “public pressure” of state and national media. 

“You cannot sign a legal binding contract in Missouri until you’re 18. But we’re allowing a parent to sign a child into a lifetime commitment. It’s ridiculous.”

Rehder attributed some of the opposition to generational differences.

“People who have been against it — the men who have been against it — who talk to me about it have said, ‘Oh, my grandmother got married at 15.’ Well, yes I did too, mine was 40 years ago,” Rehder said. 

“And it didn’t work out because I was operating on not an adult mindset.”

Fraidy Reiss, an activist who founded the nonprofit against forced marriage Unchained at Last was active in testifying in support of the bill in Missouri and has worked nationally to pass similar legislation. Upon hearing the news, Reiss said: “How can legislators live with themselves?”

She added that “dozens of teens will be subjected to a human rights abuse and legally trafficked under the guise of marriage in the coming year,” due to the failure to pass the legislation.

“…How will they explain that to their constituents?” 

Missouri Gov. Mike Parson begins the annual State of the State speech to a joint session of the legislature on Wednesday with House Speaker Dean Plocher and Lt. Gov. Mike Kehoe beside him (Annelise Hanshaw/Missouri Independent).

For the second year in a row, the fate of a bill creating new child care tax credits — one of Gov. Mike Parson’s top legislative priorities — is in the hands of a faction of Republicans in the Missouri Senate. 

Designed to help improve access and affordability of child care, the package of child care tax credits has received bipartisan support and was the first bill approved by the House this year. 

But that bill, sponsored by Republican state Rep. Brenda Shields of St. Joseph, stalled in the Senate. Democratic state Sen. Lauren Arthur’s version of the legislation hasn’t fared any better. 

With the legislative session ending at 6 p.m. Friday, and gridlock expected in the Senate, the odds of the bill making it to the governor’s desk are slim. 

A similar dynamic killed the legislation last year. 

“Hope remains,” Arthur said Friday. “But things are still up in the air.” 

The governor has pushed the legislation as a way to help parents in the workforce, highlighting the proposal in his last two State of the State addresses to the legislature. The legislation has also gained support from child advocacy organizations, chambers of commerce and business groups, and received little opposition in committee hearings this year. 

Casey Hanson, director of outreach and engagement at the child advocacy nonprofit Kids Win Missouri, which has advocated in support of the legislation, said she’s trying to stay optimistic. 

But this session, Hanson said, is looking increasingly like 2023.

“Same roadblocks. Same characters,” she said. “Different year.”

‘It’s welfare’

A proposal by Arthur to add the child care tax credits bill onto another bill as an amendment was shut down by the Missouri Freedom Caucus last week.

State Sen. Bill Eigel, a Republican from Weldon Spring who is running for governor, characterized Parson’s child care priorities as promoting a larger government and making it “a great time to be a Democrat in Jefferson City.”

“…And it’s not to actually protect the rights of the children. In this case it’s to give them something,” Eigel continued. “In this case it’s, well, we want to give away free child care.”

State Sen. Rick Brattin, a Harrisonville Republican and a member of the Freedom Caucus, also spoke in opposition to the proposal, saying “government created all the regulations that literally decimated the child care industry” and now government is trying to “swoop in” to fix a problem it caused.

State Sen. Mike Moon, a Republican from Ash Grove, later piled on.

“I think it is welfare,” Moon said, adding that he and his wife decided she would stay home with their children years ago. “We should be establishing an environment so our families can take care of themselves and their children on their own dime.”

Eigel has alluded to a potential compromise between the Freedom Caucus and the sponsors of the child care tax credits legislation. Arthur said she has been in ongoing conversations with him about finding a compromise between his desire for personal property tax cuts and her child care tax credits. 

But she admitted their idea of a reasonable middle ground will likely be very different.

“I’m frustrated that I have to defend legislation that working families are desperate for,” Arthur said. “Meanwhile my male colleagues get on the floor and decry the idea that government is going to play any role in trying to make child care more affordable and available.” 

But the likeliest roadblock to the legislation finally heading to the governor’s desk is a Senate bill hoping to make it more difficult to amend the state’s constitution by way of citizen-led initiative petition. 

That top priority for Republicans is likely to cause strife between parties in the last week of session, potentially halting any other legislation from moving forward. 

Democrats have vowed to filibuster the legislation as Republicans threaten to invoke an unpopular and rarely-used tactic called moving the “previous question” to force a vote on the bill. 

If Republicans do that, Arthur said Friday, “ultimately they’re deciding that nothing else is going to get done.”

‘I can’t find care’

As the Senate runs up against the session deadline, emails supporting her child care tax credits bill continue to pour into Shields’ inbox.  

“It’s not affordable for me to go to work,” some say. Others send pleas: “I can’t find care.”

Those who have been able to find affordable child care lament that the quality of care isn’t up to their standards. Other Missourians relayed stories of their child care provider closing their doors with less than 30 days notice, leaving them scrambling to find a new provider.

Shields often cites a 2021 U.S. Chamber of Commerce Foundation study that found lack of accessible and quality child care forced many Missouri parents to change or leave their workplace. The foundation determined this workforce disruption cost the state more than $1.3 billion annually. 

She feels for those families. Thirty-five years ago, Shields said, she faced a similar choice between her career and being a mother. She wanted both, and, thanks to a last-minute child care opening in St. Joseph, she got both. 

An investigation of child care spending by The Independent and MuckRock last year found that almost half of Missouri’s children under age five, or about 202,000 children, live in child care deserts, with one or fewer child care openings for every three children. 

The average cost of full-time center-based care for an infant in Missouri was $11,059 as of 2022, according to Child Care Aware. Meanwhile staff at child care facilities often make just over minimum wage, presenting a challenge to hiring and retention. 

“If we want to grow our economy,” Shields told The Independent on Wednesday. “It requires us to help people get back to work.”

Her bill would add three tax credits: 

• The “Child Care Contribution” tax credit would let those who donate to child care providers receive a credit equal to 75% of their donation, up to $200,000 in tax credits. 
• The “Employer Provided Child Care Assistance” would encourage partnerships between businesses whose employees need child care and providers by allowing employers to receive tax credits equivalent to 30% of qualifying child care expenditures. 
• The “Child Care Providers Tax Credit” would allow child care providers to claim a tax credit equal to the provider’s employer withholding tax and up to 30% of a provider’s capital expenditures on costs like expanding or renovating their facilities. 

Kids Win Missouri recently embarked on a community project highlighting child care needs in several counties across the state. This included Shields’ hometown of St. Joseph.

There, in surveying community members and providers, they found that there are only enough child care slots available for 29% of infants and toddlers, and 69% of pre-kindergarteners and 53% of other preschoolers. Families in the county, on average, put at least 20% of their income toward child care costs. 

To survive this “massive societal crisis,” said Hanson, with Kids Win Missouri, it will take everyone, especially as the state approaches a fiscal cliff leaving it without the same levels of COVID-era federal funding in place now.

Child care subsidies 

Parson’s push to expand access to child care also included higher payments for subsidized care. To fund it, Parson asked lawmakers for an extra $51.7 million in the coming year, which followed a $78 million boost to funding in the current year.

Ultimately, the increase was funded, but not in the way the governor requested.

The budget includes language authorizing increased rates, House Budget Committee Chairman Cody Smith said in a news conference after the budget was passed.

The additional funding sought by Parson was based on every eligible parent using their benefits, Smith said. Instead, the budget allows higher rates by assuming that some money would otherwise be unspent.

If demand for the subsidy increases, lawmakers will have to return to the table to discuss ways to continue funding the increase in the future.

House Minority Leader Crystal Quade said Democrats are still trying to calculate whether there are funding shortfalls.

Quade said despite child care being a persistent issue, the legislature failed to address the shortage in a meaningful way.

“We know there are too many Republicans in positions of power in this state who do not believe that I have a voice in this room, that I should not be elected, standing here as a mother, and I should be at home,” Quade said. “And I’m tired of them telling us that.”

The Independent’s Rudi Keller contributed.

Sen. Holly Rehder, R-Scott City, presents a resolution on the Senate floor Feb. 12 (Annelise Hanshaw/Missouri Independent).

Lawmakers trying to ban child marriage in Missouri hope a last-minute push in the legislative session’s final days can overcome opposition from some Republicans that put the bill’s chances in doubt. 

A bill outlawing 16 and 17 years old from getting married stalled in a House committee when a handful of Republicans voiced opposition. There are five days left before lawmakers adjourn for the year.

Republican state Sen. Holly Thompson Rehder of Scott City told The Independent last week that a last-ditch effort to save the legislation could take place as early as Monday, when she expects it to be added as an amendment to another bill. 

“There’s more opposition than I thought there would be,” she said. “But you know, I think that overall, it’s generational, and I haven’t had any women opposed come and talk to me about this.”

Under current Missouri law, anyone under 16 is prohibited from getting married. But 16 and 17 year olds can get married with parental consent to anyone under 21.

Those in favor of the ban argue child marriage is coercive and can transform into forced marriage, especially because children lack the legal rights of adulthood. Almost all minors married to adults are girls, data shows, and child marriage is associated with higher rates of dropping out of high school and later poverty.

But while Rehder’s bill, which she co-sponsored with Democratic state Sen. Lauren Arthur of Kansas City, sailed through the Senate nearly unanimously, it is stuck in a House committee due to critics who say a ban constitutes government overreach and would clash with parental rights. 

Fraidy Reiss, an activist who founded the nonprofit against forced marriage Unchained at Last and has been active in testifying in support of the bill in Missouri, called the opposition “horrifying.”

“How can anybody be opposed to legislation that costs nothing, harms no one and ends a human rights abuse?” Fraidy said in an interview with The Independent. “It is shameful it has not already passed and shameful that we’re coming up against the end of the legislative session. And we still don’t know for sure whether legislators are going to do this.”

Proponents hope to tack on the child marriage ban as an amendment to another of Rehder’s bills that deals with children. Rehder said she wants a roll call vote on the amendment, rather than a voice vote, which would show exactly how many and which legislators are opposed.

Republican state Rep. Jim Murphy of St. Louis chairs the House committee where the child marriage ban is stuck. He told The Independent that he supports ending child marriage but doesn’t have the votes to advance the bill to the full House. 

Murphy said he was “surprised” that changing the minimum age of marriage from 16 to 18 got as much pushback as it did. 

State Rep. Dean Van Schoiack, Republican of Savannah and the vice chair of the committee, was one of the voices in opposition.

“It’s government intrusion in people’s lives,” he said in an interview with The Independent on Friday. 

Asked what would be lost if 16 and 17 year olds couldn’t get marriage permits anymore, Van Schoiack replied, “Liberties that people currently have.”

“After what’s been through the press and what people are doing, I’m not changing my position now,” he said. “I don’t typically change my mind very easily.”

Other lawmakers who voiced concerns about the bill in committee include GOP state Reps. Ben Baker of Neosho and Mitch Boggs of LaRussell.

Rehder said the concerns about government overreach are “ridiculous” because the state government already sets a minimum age, “so why not set it at the age of when you’re an adult?”

“To me, a parent should not be signing their child into a lifetime commitment. That’s a decision you make for yourself as an adult,” said Rehder, who got married at 15 and has said she didn’t realize at the time she was not operating under an adult mindset.

Until the legislature voted to raise the minimum marriage age to 16 in 2018, Missouri had among the most lenient child marriage laws in the nation — making it an especially popular state for 15-year-olds to travel to be married.

Despite the 2018 change, Missouri law still does not align with international human rights standards, which set the minimum age at 18. 

Fraidy said around 70 minors every year are entered into marriage in Missouri.

“There’s no input required from the minor when they’re married — it’s their parent signing a form. There’s no recourse for a teen that doesn’t want to marry.

“And then once they’re married, they’re trapped because they can’t even file for divorce. So it’s about ending this nightmarish legal trap,” Fraidy said.

Missouri would join 12 states that have in recent years banned child marriage if the legislation passes.

Rehder said she hopes the House will attach the ban to a wide-ranging bill about children that bars the state from seizing foster children’s Social Security benefits. That bill will be handled by Republican state Rep. Wendy Hausman, Rehder said. Republican state Rep. Chris Dinkins, who is handling the House version of the child marriage bill, will be working to help Hausman get the amendment on, Rehder said. 

Timing is critical, as any changes to the bill would require it to return to the Senate, which has been bogged down in gridlock for much of the legislative session. 

All bills must be approved and sent to the governor by 6 p.m. Friday. 

(Getty Images).

A federal judge ruled Thursday that Missouri’s social services agency violated the law in the way it has administered its food assistance program. 

U.S. District Court Judge M. Douglas Harpool ruled that the state’s practices — including long call center wait times and a lack of accommodations for those with disabilities — violate the laws governing the federal Supplemental Nutrition Assistance Program and the Americans with Disabilities Act.

The Missouri Department of Social Services’ call center issues ultimately denied eligible Missourians meaningful access to benefits.

“While call wait times fluctuate and have shown some improvement, the record demonstrates too little progress,” Harpool wrote. “Consequently, Missourians who suffer food insecurity have been forced to either go hungry or seek alternative sources of food when their applications are denied.”

In February 2022, a federal lawsuit was filed against the social services department arguing the state’s “dysfunctional” call center deprives eligible Missourians of SNAP benefits, more commonly known as food stamps. 

‘Broken system’: Call center backlogs impede Missouri families seeking food assistance

Plaintiffs described subsisting on little food while using up prepaid phone minutes waiting on hold for an interview, and, due to disability, struggling to understand the application forms but being unable to get through the call center for help.

An interview is required to sign up for or recertify SNAP benefits.

Without interviews, SNAP applications and renewals are automatically denied after 30 days — even if applicants have tried and been unable to get through. Around half of all SNAP denials in the state are due to failure to complete an interview, according to data obtained in litigation. The average call center wait time for the SNAP interview line, as of late last year, The Independent found, was over an hour.

“The high percentage of denials based on failure to interview is a direct consequence of the failed administration of defendant’s SNAP program,” Harpool wrote in his order. 

“These denials are not based on the applicant’s eligibility but on the inadequacies of [the Department of Social Services’] process,” he wrote.

The lawsuit was filed by New York-based National Center for Law and Economic Justice, Legal Services of Eastern Missouri and Stinson LLP, on behalf of individual low-income Missourians and the advocacy group Empower Missouri.

“Today’s decision is a vindication of the rights of Missourians,” said Katharine Deabler-Meadows, attorney with the National Center for Law and Economic Justice.

“The Court has recognized the immense harm that DSS is causing to people who depend on SNAP to feed themselves and their families,” she said. “We are excited that DSS will now have to implement systems that ensure all Missourians can access SNAP.”

The decision orders the social services agency to come into compliance with federal SNAP law and the Americans with Disabilities Act, and outlines several steps the agency must take, under the court’s supervision. 

The steps the state must follow, as outlined in the order include: 

•  submitting a report with specific changes it will make to comply with the law within 30 days;
• filing monthly reports with the court with detailed data on SNAP applications and wait times, and filing that report with several members of Missouri state government outlined in the order;
• submitting a proposed plan of action and timeline of implementation “to address shortcomings in the administration of SNAP as identified” within 90 days, including a reduction in call wait times and denials based on failure to receive an interview and compliance with the ADA. 

After the state complies with the order, the court “will determine what, if any, further actions, orders, remedies, or proceedings are appropriate,” Harpool wrote. 

Harpool has been candid in previous hearings about his concerns over the state’s progress since the lawsuit was first filed.

“I continue to be amazed that it’s been since this case started,” he said in a January motion hearing, “that the state’s whole focus is how can we avoid liability rather than how can we get these benefits to our citizens.”

Hardin Haynes, the attorney representing DSS, rejected that characterization, according to court transcripts.

“The whole time this has been going on,” he said in the January hearing, “DSS has been doing what it can to increase its ability to do interviews throughout this process. That has never stopped.” 

A spokesperson for the Department of Social Services did not immediately respond to a request for comment.

DSS has previously said it is doing all it can to hire more staff,  grant overtime, move to automate assistance and contract with private call centers. 

Agency leaders pointed to resource issues and challenges getting more staff as it requested $4 million this year for a “call center bot” to increase automation and reduce the need for staff on the general call center line.

The Missouri House chamber during debate on March 12, 2023 (Tim Bommel/Missouri House Communications).

A push to eliminate Missouri’s requirement for children under 16 to obtain official work permits before they can begin a job could be debated by the House this week. 

In order to work in Missouri, 14 and 15 year olds must obtain a certificate issued by their school, with information from their prospective employer about the details of the job as well as parental consent and age verification.

The child’s school, or if they are homeschooled, a parent, must review that information to ensure it’s in line with state laws that restrict the kind of work children can do and their hours. Once the school issues the certificate, a copy is filed with the Missouri Department of Labor and Industrial Relations.

Children under 14 are generally not permitted to work and those 16 and older aren’t subject to the same restrictions.

The bill, sponsored by Republican state Rep. Dave Hinman of O’Fallon and a similar one sponsored by state Sen. Nick Schroer of Defiance, would eliminate the formal work permit process. Instead of being overseen by schools and the state labor agency, the only requirement would be that a parent sign a permission slip for the child’s employer. 

Proponents have characterized schools’ role in the process as unnecessary and outdated, and said parents should have the largest role.

“With discussions with our superintendent and other folks around here,” Hinman said in an interview with The Independent this week, “we felt it was better that the parents make that decision instead of schools being the ones that sign off on it.”

Hinman’s bill was voted out of committee in March, and he hopes the full House will debate it before session ends — perhaps as early as this week. The Senate version of the bill was heard in committee earlier this month and hasn’t been voted out yet.

The bill is about “empowering employers and youth,” Schroer said in a committee hearing earlier this month.

“While easing the regulations, this legislation also prioritizes parental involvement by mandating signed permission slips…ensuring that parents are informed and involved in their child’s work activities” Schroer said.

Arkansas passed a similar law last year eliminating youth employment permits, though it didn’t include the parental permission slip piece. It faced opposition from child advocacy groups and others, who worried it would remove a layer of oversight protecting child workers in a time when child labor violations have gained attention nationally for being on the rise. 

Proponents have insisted that the bill won’t affect child labor violations because businesses will still be required to comply with state and federal law.

In Missouri, the legislation has flown largely under the radar: No one testified in opposition during hearings on the bill the last two years. A handful of individuals submitted written opposition.

John Fliter, an associate professor of political science at Kansas State University, who studies child labor, said in an interview with The Independent that certificates are an important safeguard for children.

“We need to be careful because at the same time that [some states are] doing this, weakening restrictions, we’re seeing an increase in child labor violations and some really bad cases over the last few years,” he said.

The certificates, Fliter added, produce a record of employers acknowledging they will follow the law, and allow schools to play a “supervisory role” and ensure children are “not working to the detriment of their education.”

State Sen. Doug Beck, a Democrat from Affton, asked during a committee hearing earlier this month how the state could be sure employers were still doing things like age verification if the government wouldn’t be allowed to require permits to oversee the process.

“Where’s the enforcement on this bill exactly?” Beck asked. “…Where’s the accountability?”

“I think the accountability is with the parents and the business owners,” Schroer replied.

Schools’ role

Earlier versions of the House bill included language to extend the hours in the day children are allowed to work, but that’s since been removed because the sponsor found out it conflicts with federal law.

Children under 16 are legally required to be off work by 7 p.m. during the school year. 

The reason Hinman initially filed the bill was because he wanted to push that time back, after he was approached by a restaurant owner in his district who was struggling with staffing those later hours.  

“I’d like to see that time adjusted hopefully, up till eight o’clock, nine o’clock. Just to give a little bit more time for those businesses,” he said.

Now, the bill includes a provision that those restrictions apply “unless a later time is allowed by federal law,” which Hinman said is intended so Missouri can automatically change its law if the federal government does. 

When he started looking into these laws, Hinman found it “an odd thing that the school district did that,” referring to the certification requirements, which led him to look at a bill filed last year and incorporate some of its language.

Youth work permits aren’t federally mandated but the majority of states require them. 

Thirty-four states require youth work permits. The details vary, including whether they’re issued by a state agency or schools and what ages are included.

State Rep. Holly Jones, a Republican from Eureka, said in the committee hearing that she “hates” that schools are the ones who sign off on certificates. 

“I really don’t love the schools having so much power over families and students,” she said.

A similar bill last year, sponsored by Sen. Andrew Koenig, a Manchester Republican, didn’t gain momentum, clearing a Senate committee but never being debated by the full chamber. 

A Washington Post investigation last year found the Florida-based conservative think tank, Foundation for Government Accountability, and its lobbying arm, the Opportunity Solutions Project, has been behind the push to roll back certain child labor protections in state legislatures.

“States should be allowing their teenagers to decide, with their parents, to get a job — not the government,” an issue paper published by Foundation for Government Accountability last year said. The paper characterized the issue as pitting “parents vs. educators and regulators.”

That group played an important role in Arkansas’ elimination of work certificates, the Post reported, and in Missouri, a lobbyist for Opportunity Solutions Project, James Harris, sent Koenig’s staff draft legislation last year before he filed it. Hinman said Harris didn’t approach him with the language.

Harris was the first one to testify in the committee hearings this year. In the House hearing, he said his first job as a teen helped him when he was a “law breaker” youth.

“I look back at that job and I learned so much,” Harris said.

“…Part of this is to help businesses be able to have more of a workforce for people to work,” Harris said during a later discussion about how pushing back the 7 p.m. restriction could cause businesses to worry about breaking federal law and not bolster their workforce. 

Neither Harris nor the Foundation for Government Accountability responded to interview requests.

Other support has come from business groups including the Missouri Chamber of Commerce, Missouri Retailers and Missouri Grocers Association. 

The legislation was voted out of committee on party lines. Democrats opposed it.

Hinson said in an interview with The Independent that while he’s not optimistic it will pass this year — with just three weeks left in session — he is hopeful it will come to the floor and that discussion will help improve the bill for next year.

“I would love to have the opportunity to have a full discussion with everybody on the floor, both sides of the aisle and see what the thoughts are so next year if we need to make corrections to the bill, that we can make it an even better bill,” Hinman said. “…[The legislation] is one of my priorities.”

‘One more set of eyes’

Maura Browning, spokesperson for Missouri’s Department of Labor and Industrial Relations said the agency can’t comment on pending legislation.

But speaking broadly about how the state oversees child work requirements, labor department officials said they rely on the current licensing practice and see it as a tool to help ensure kids don’t enter hazardous work or take on excessive hours. 

The required form is just one page. In it, the child’s prospective employer must provide the specific job duties, hours and an acknowledgment they will abide by state law. Schools verify a child’s age and can review their grades. 

Todd Smith, who directs the Division of Labor Standards within the state labor department, said schools help identify when the descriptions employers submit should be flagged as hazardous.

Kids under 16 aren’t allowed to do certain jobs, like operating a meat slicer or handling any hot oil or grease.

“We will enforce whatever the legislature passes, obviously, but in a perfect world, I think it’s important to have that education piece to share with employers,” Smith said in an interview with The Independent.

Missouri issued over 10,000 youth employment licenses last year.

Patrick Watkins, who works as the wage and hour section manager in the state labor department, said going through the school “gives us one more set of eyes to look at those hazardous job descriptions.”

Watkins added that in the current process the employer “agrees that they understand our restrictions, but more importantly, they have to fill in exactly what job duties the child will be performing and we catch a lot of hazardous titles just in that reveal alone.” 

Child advocacy and social justice organizations reached by The Independent said they are not taking a position on the bill because they are deciding to stay out of the issue or are simply not up to speed on the legislation.

Sen. Mary Elizabeth Coleman enters the Missouri Senate on the first day of the 2023 legislative session (Annelise Hanshaw/Missouri Independent).

A bill winding its way through the legislature seeks to ease backlogs in child abuse and neglect investigations by allowing Missouri’s social services agency to outsource some work involving child abuse and neglect investigations to private contractors.

Sponsored by Republican state Sen. Mary Elizabeth Coleman of Arnold, the bill was voted out of committee unanimously in January and is awaiting consideration by the full Senate.

Elements of Missouri’s child welfare system are already handled by private companies — including some foster care case management and in-home services —  but not abuse and neglect investigations. Those are handled by state employees, sometimes with assistance from local law enforcement. After the state receives a hotline call, Children’s Division workers are responsible for assessing a child’s safety. 

In recent years, staffing shortages have led Missouri’s child welfare investigators to face mounting caseloads, contributing to rapid employee turnover and delayed investigations. 

There has been improvement over the last year, DSS spokesperson Chelsea Blair told The Independent. The department is now “on the upswing” with staffing, Blair said. 

Children’s Division has also adopted strategies to address overdue cases, Blair said, and “this plan is currently in action and working,” though the agency is still working through nearly 6,000 overdue reports.

Coleman said in an interview last week that the state continues to face a backlog of abuse investigations.

“Missouri is not responding quickly to our hotlines, and I think that’s really inappropriate,” she said. “We want to make sure that kids are safe and get to them quickly.”

Under the bill, the state would be allowed to use contractors to assist with investigations, meaning workers from private companies would help assess a child’s safety after a hotline call. 

In practice, Coleman said, the contractors under the bill would do “a lot of administrative functions” to sort through lower-risk hotline reports and help connect families with resources, freeing up state staff to focus on the higher-risk cases.

State workers, she said, would still have the final say in whether a child is removed from the home.

“It’s helping with some of the administrative functions, helping on the front end, to make sure that we’re able to get to credible abuse allegations and to help keep kids safer, faster, because we are not currently,” Coleman said.

Coleman said the bill “doesn’t allow us to offload that as a state. It’s just allowing contractors to be able to assist in the process.”

Clark Peters, an associate professor of social work at the University of Missouri-Columbia whose research specializes in foster care, said he was concerned to learn about the proposal.

“Given the stakes involved for children and families. I would tread very carefully in pursuing privatizing this important activity,” Peters said.

Investigations serve as the entry point into the foster care system for children, Peters added.

“What’s concerning to me is this is a tremendously fraught point in the child welfare system: You’re making a decision whether to investigate and ultimately whether to remove a child,” he said. “It’s the initial few steps that are so critical…So handing this off to private agencies seems really disturbing to me.”

Timely investigations 

Coleman started working on this legislation around three years ago, she said, and filed it as a standalone bill for the first time last year.

David Willis, a lobbyist for KVC Missouri, a nonprofit child welfare organization that provides the state with contracted foster care services, has testified in support of Coleman’s efforts. He said during a hearing last year that KVC Missouri had been working with the Department of Social Services “and this specific piece of legislation was kind of the result of those discussions.”

In an email to The Independent, KVC Missouri President Lindsey Stephenson said what prompted the discussion was “the state approaching us about some of the challenges Missouri has experienced in processing all cases of suspected child abuse or neglect in a timely manner.”

KVC, which is a national health system with a network of nonprofits in various states, works in Kentucky to help with investigations as well, Stephenson said, and that didn’t require a change in state law. State investigators in Kentucky make final recommendations based on comprehensive assessments. 

Blair said the agency cannot comment on pending legislation. But DSS has been working to address the overdue cases and making progress, she said. There has been an 11% increase in hiring among Children’s Division frontline workers since this time last year and an 8% reduction in turnover.

There are currently 5,942 child abuse and neglect assessments and investigations that have been open 46 days or longer, according to records obtained Wednesday by The Independent through Missouri’s Sunshine Law. The Kansas City region has the most (3,036) followed by St. Louis (2,074). In St. Louis, that’s an improvement from over 7,000 in January, according to reporting from St. Louis Public Radio earlier this year.

“DSS understands the importance of addressing every case of child abuse and neglect promptly and effectively,” Blair said. “By working diligently to close cases where possible, we are not only providing resolution for the children and families affected but also preventing further harm and promoting a safer environment for all.”

There are 36 vacancies as of late last month among the frontline Children’s Division workers, Blair said, which includes investigators, foster care case managers and family centered service workers, who do prevention.

Accountability

Richard Wexler, who runs the nonprofit National Coalition for Child Protection Reform, a Virginia-based advocacy group, said by email that sometimes privatization can mean state agencies shift blame to contractors — and vice versa.

“There is no reason to think private contractors would be any better, or any worse, than Children’s Division employees per se,” Wexler said. “ I do worry, however, that it may add even greater potential for buck passing.”

He added that that is the situation in Florida’s highly-privatized system — where everything except the investigations are privatized and where the state and contractors have pointed fingers at each other. State investigators and sheriffs have also pointed fingers at one another, Wexler said: In Florida, some investigations were, until a legislative change enacted last year, overseen by sheriffs’ offices. 

“The other question is whether this further reduces accountability,” Wexler said. “Will investigators for a private contractor have even more ability to hide what they do when things go wrong?” 

Coleman said “in the bureaucracy, often we have a lack of accountability anyways, because you have very little oversight,” she said, adding that she was speaking in general, rather than specifically about Children’s Division. 

“The state has an ability to be more responsive if a contractor is not meeting their needs, than, you know, trying to have bureaucracies go in and get entrenched people who have been doing these jobs for a long time and are underperforming,” Coleman said.

The bill stipulates that the contractor who handles the investigation can’t be the same one that then takes on managing the foster care case, which Coleman said is designed to avoid misaligned incentives that could cause more kids to be taken into state care.

There are other bills related to children attached to Coleman’s bill now, including a provision to allow the state to grant temporary child care licenses. In the two times it has come up on the Senate floor, debate has largely surrounded amendments, not the substance of the privatized investigations provisions. Coleman referred to the bill as “bipartisan non-controversial provisions” during Senate debate last month.

Sen. Holly Rehder, R-Scott City, listens during Senate debate of an initiative petition bill Monday, Feb. 12 (Annelise Hanshaw/Missouri Independent)

A bipartisan bill to ban child marriage in Missouri won initial approval in the state Senate Wednesday afternoon.

Under current law, 16 and 17-year-olds are allowed to get married with parental consent. Marriage between a minor and anyone 21 or older is prohibited.

The legislation discussed Wednesday would prohibit issuing a marriage license to anyone younger than 18 under any circumstances. 

Under identical bills co-sponsored by Republican Sen. Holly Thompson Rehder of Scott City and Democratic Sen. Lauren Arthur of Kansas City, Missouri would join 10 states that have banned child marriage. 

“We’ve heard from so many people who have endured a lot of trauma as a result of getting married at a young age and often having abusive relationships, or being forced to become pregnant,” Arthur said. 

Missouri lags behind most states for children’s rights, advocacy group finds

“There are all kinds of individual situations that have played out as a result of child marriage,” she added, “but all of them in their own way are terrible and should be warning signs to us all, that this is no longer an acceptable standard.” 

Rehder said that she got married at 15, “and so as a child that was married, I can unequivocally say that this: It’s a terrible idea and you’re not old enough to make those type of decisions.”

“…I was very alone,” Rehder said, adding that statistics bear out that child brides often face mental health issues.

There was no opposition on Wednesday. Those who have previously opposed banning child marriage often invoke parental rights or religious liberty. Last year, Sen. Mike Moon, a Republican from Ash Grove, garnered national attention when he said: “Do you know any kids who have been married at age 12? I do. And guess what? They’re still married.”

Arthur said Wednesday the bill adjusts the marriage age to align with children’s limited legal rights.

“We’re not telling someone that they can’t marry the person they love, we’re just saying that children aren’t allowed to engage in legal contracts until they’re 18,” Arthur said.

Rehder added that “all of us have stories of our great grandparents or getting married early and that was absolutely the norm. But that was before women had the opportunity that they have now. They didn’t have the opportunity for education. They didn’t have the opportunity for a professional life, like they have now.”

“…This is the one thing that can absolutely sidetrack all of that for our girls.”

Until the legislature voted to raise the minimum marriage age to 16 in 2018, Missouri had among the most lenient child marriage laws in the nation — making it  an especially popular state for 15-year-olds to travel to be married.

Despite the 2018 change, Missouri law still does not align with international human rights standards, which set the minimum age at 18. Activists argued at the time Missouri’s new law would continue to leave 16 and 17-year-olds vulnerable to potential coercion.

Those in favor of a ban on child marriage often argue that marriage under 18 is coercive and can transform into forced marriage, especially because children lack the legal rights of adulthood. 

Rehder said that since the 2018 change, “we got a little further, but we didn’t complete the policy process which says this is an adult decision.” 

Between 2000 and 2018, 8,007 children were married in Missouri and Rehder said around 300 have been married since 2018.

The bill that won initial approval Wednesday afternoon also had a provision added by Rehder and two amendments from other senators.

Rehder’s bill, folded into this legislation, would modify fees in divorce proceedings. When one person is failing to abide by the court’s orders in divorce proceedings, that person would be the one on the line to pay the costs of returning to court. 

Rehder said her former spouse was refusing to abide by the process the court decided on for divorce. She would have to pay “just to have a judge look at him and say, ‘Yes, you have to do what I’ve already told you to do.’”

“…And I’m like, you gotta be kidding me. I have to pay for that to make him do what he’s already been told to do?” Rehder said.

She said she’s heard from many women who’ve experienced domestic violence about “how this was another way of having that hold on them and making them pay more money to get away from a bad situation.”

Sen. Rick Brattin, a Republican of Harrisonville, voiced his support for this provision.

“I love the fact of kind of penalizing those that try to abuse the system,” Brattin said.

Brattin added his own amendment to the underlying bill as well. 

Currently, state law says sheriffs and other law enforcement officials “may” enforce the rights of custody or visitation agreements. His amendment changes that to make it required — that they “shall” enforce those rights.

Brattin said he faced his own challenges trying to get visitation with his kids after divorce, despite a court order, and said law enforcement could deter parents from failing to abide by those agreements.

“The law enforcement shows up, well then that parent’s gonna know, ‘I’m not gonna be able to get away with this, so I do have to buck up and I have to play nice, even though I don’t want to,’” Brattin said.

Arthur also added an amendment to the bill that would add considerations for judges when determining child custody, including the child’s “physical, emotional, educational and other needs.” 

The legislation still needs to receive final approval from the Senate before heading to the House, where a similar bill dealing with child marriage has yet to receive a committee hearing.

UPDATE: The bill passed out of the Senate on April 11 on a vote of 31 to 1. Sen. Mike Moon voted no. 

State Rep. Kurtis Gregory, R-Marshall, speaks during House debate on April 27, 2022 (Tim Bommel/Missouri House Communications).

The Missouri Farm Bureau would be allowed to sell health insurance plans that skirt certain federal regulations under legislation critics worry could leave consumers without proper protections or adequate coverage.

The bill, which has already cleared the Missouri House and is awaiting a committee hearing in the Senate, allows health plans that don’t follow the rules set by the Affordable Care Act, also referred to as Obamacare.

The Farm Bureau would be permitted to deny people coverage due to pre-existing medical conditions, for example, or offer benefits that are more limited than what is allowed under federal law.

Those practices would allow also allow the organization to sell less-expensive plans. Many farmers and other members of the Farm Bureau, proponents say, are uninsured because they can’t afford to buy a federally-subsidized plan on the Affordable Care Act marketplace or make too much money to qualify.

“What we’re really trying to do here is get coverage options to these young farmers, potentially ranchers and members of this organization to better have care for their family and their loved ones,” state Rep. Kurtis Gregory, a Republican from Marshall and the bill’s sponsor, said in a committee hearing in January.

The Missouri Farm Bureau is a nonprofit agricultural membership organization which partners with for-profit companies to sell various kinds of insurance to its members. Anyone can join, though historically the group has been primarily made up of people in farming communities.

“This is about allowing people to make choices for themselves,” state Rep. Dean Van Schoiack, a Republican from Andrew, said during House debate on the bill in March.

Missouri would join six other states that have passed similar carve outs for Farm Bureau insurance plans: Tennessee, Iowa, Indiana, Kansas, Texas and South Dakota. Several other state legislatures are considering similar legislation this year.

The idea has faced opposition from some House Democrats, patient advocacy groups and other insurance companies who have raised concerns about inadequate consumer protections and coverage, as well as disrupting the market.

“I don’t want people to sign up for something that is unregulated health insurance and then fall through the cracks even further,” said state Rep. Emily Weber, a Democrat of Kansas City, during the House debate.

Emily Kalmer, a lobbyist for the American Cancer Society Cancer Action Network, raised concern in a January committee hearing that Missourians could be “left without coverage, face large costs or denied coverage,” and lack any of the consumer protections in the law. 

The Farm Bureau would revert to the pre-Obamacare practice of what’s called medical underwriting, carefully evaluating applicants’ medical history and risk, to determine whether to cover them and at what price.

“While we don’t have experience in Missouri with Farm Bureau plans, we do have experience in Missouri with medical underwriting,” Kalmer said. “And that was horrible for cancer patients in the past…those practices used to be allowed in the state of Missouri and they were horrible for cancer patients. So it’s not a ‘what if’? It’s a ‘what would be legally allowed here’?” 

Coverage concerns

The Farm Bureau has argued that its members hold the organization accountable, even absent regulations, and that its enrollees in states with the program report high levels of satisfaction.

Benjamin Sanders, a lobbyist from Farm Bureau Health Plans of Tennessee, testified in committee in January that the organization’s acceptance rate for applicants is 90%.

Tennessee enacted a version of the law exempting the Farm Bureau from regulation in 1993.

“There are conditions that will cause someone to be denied coverage…The best way to look at it is if someone has an ongoing catastrophic health condition, they will likely be the non-covered,” Sanders said. 

The organization uses a six month waiting period, upon enrollment, before those with certain conditions can use the benefits. It’s a “safeguard,” Sanders said, to ensure people don’t sign on for an expensive surgery then drop the plan, for instance.

Some of the Farm Bureau plans offer the 10 essential benefits the ACA requires and some do not. Sanders said 75% of members select a plan that does include all of those benefits.

Asked about whether pregnancy could be considered a pre-existing condition resulting in that six-month waiting period or denial, Sanders said it depends on the plan.

“Generally speaking, pregnancy would be considered a pre-existing condition…it depends on when they join and the length of the pregnancy,” he said, adding that someone trying to join at eight months pregnant wouldn’t be eligible but a few days pregnant, would likely be. Individual plans don’t cover maternity care but the family plans do.

State Rep. Danny Busick, a Republican of Sullivan, said opponents of the legislation were presenting a lot of “what-ifs.”

The Farm Bureau in other states doesn’t need to abide by data transparency requirements of regulated insurance companies. But the organization says internal numbers show a high retention rate.

“Why is there a 98% retention rate in the states where they have this? If they weren’t covering these things, people would be getting out of the system right and left,” Busick said.

“Just because they’re not required by law doesn’t mean they won’t do it,” Busick said. “And I think that premise is what I have a problem with.”

The plans wouldn’t be overseen by the state’s insurance department: Proponents have said because it’s a contract, those with grievances could go to court. Opponents argued that is not a viable option for many.

“The current system, it’s a regulated product,” said Kalmer, the American Cancer Society lobbyist, “you have appellate rights with the Department of Insurance, you can call their consumer protection hotline and go through the processes and they’ll help mediate the issues.”

There are still issues with the regulated market, Kalmer said, “but at least there is a process by which you can make sure that anything that the legislature here has required them to do, that they’re legally doing it.” 

State Rep. Brad Pollitt, a Sedalia Republican, said the Farm Bureau “answers to their membership,” adding that if they started dropping people from their plans, for instance, “I believe their membership would hold them accountable for doing the right thing, because that’s how those folks have been raised.” 

Market dynamics

Other insurance companies oppose the legislation for allowing just one group to be exempt from federal rules, which they say gives the Farm Bureau an advantage over competitors.

Michael Henderson, lobbyist for the Missouri Insurance Coalition, called the proposal “unequal treatment in the marketplace.”

Henderson said insurers abide by pages of state health mandates.

“I have heard testimony that some of that coverage may be included in the plans,” Henderson said. “And Rep. Busick, I know you mentioned we’re talking a lot about what ifs. We’re also talking a lot about ‘trust us.’”

The Farm Bureau plans would be designed to help those who aren’t eligible for or can’t afford Affordable Care Act subsidies. 

Tim McBride, a health policy analyst and professor at Washington University in St. Louis, said his concern would be that the Farm Bureau plans would attract healthier people and have a more limited benefit package.

“The purpose of the ACA was to make sure that there wasn’t cherry picking going on by the insurance companies,” McBride said, meaning some companies siphoning off healthy people and driving up the cost of coverage for others.

He said research shows people get “enticed by the low premium number,” but don’t always study the fine print, which is one reason the ACA has rules about what needs to be covered. 

“I can certainly understand why people want to go to get low premium plans, especially farmers or their spouses or their children,” he said. “But that’s part of what the purpose of the subsidies are in the Affordable Care Act is to try to make the plans affordable.”

The federal government expanded subsidy eligibility in the Affordable Care Act marketplace through next year.

In Tennessee, Stat News reported in 2017, some experts say the effect of pulling healthy people onto Farm Bureau plans has been that participants in the Affordable Care Act marketplace are sicker than in other states, which can cause market issues such as companies being less willing to participate and sell plans. The Farm Bureau has denied having any such effect.

Gregory estimated around 11,475 Missouri Farm Bureau members lack health insurance, and said they would be the target audience for enrolling in the Farm Bureau plans. Others could sign on, too, including members who are currently insured but switch over to the Farm Bureau plans, or people who join the Farm Bureau in order to access the insurance. 

Sanders, with Farm Bureau Health Plans of Tennessee, said the volume wouldn’t be enough to make a difference in the market. 

“But to the members that use these plans,” he said, “it makes a difference.”

Sen. Holly Rehder, R-Scott City, presents a resolution on the Senate floor Feb. 12 (Annelise Hanshaw/Missouri Independent).

The Missouri Senate gave initial approval Tuesday afternoon to legislation that would end the state’s practice of seizing Social Security benefits from foster children.

The bill needs a final vote in the Senate before heading to the House.

Wednesday morning, the House followed suit by unanimously approving its version of the bill and sending it to the Senate — providing two possible vehicles for the proposal to reach the governor’s desk.

The state took at least $6.1 million in benefits from foster children last year — generally Social Security benefits for those with disabilities or whose parents have died. The money is used to reimburse the state for child welfare agency costs. 

It’s a decades-long practice that has come under increased scrutiny across the country over the last few years.  Several states, including Arizona, New Mexico and Oregon, have stopped the practice. 

Under the legislation, Missouri could only use those funds to pay for the child’s “unmet needs” beyond what the state is obligated to pay, such as housing as the child prepares to age out of foster care. The state would also be required to ensure the account in which the child’s benefits are deposited is set up in a way that doesn’t interfere with federal asset limits.

The legislation is sponsored by a pair of Republican state lawmakers: Sen. Holly Thompson Rehder of Scott City and  Rep. Hannah Kelly of Mountain Grove.

While there was no opposition voiced to the bill, it was hung up prior to legislative spring break earlier this month when numerous amendments were added and withdrawn. 

Rehder said she had been focused on working with senators to strip out amendments that might be outside the scope of the bill’s subject. Last year, legislation she sponsored to ban sleeping on public land was struck down by the state Supreme Court for failing that procedural requirement. 

The amendments that ended up included in the bill were thoroughly vetted, Rehder said, to make sure they fit under the title “relating to the care of the child.”

Those include: 

• Republican Sen. Rusty Black’s amendment which would exempt licensed child care providers who care for only school-age children from certain compliance requirements; 
• Republican Sen. Rick Brattin’s amendment which would add considerations for judges when determining child custody;
• Democrat Sen. Doug Beck’s amendment which would prevent child custody in paternity action to a parent who has been found guilty or pled guilty to certain offenses when the child is a victim;
• Republican Sen. Andrew Koenig’s amendment which would require that Children’s Division, when possible, places foster children with families of the same religious faith as their biological parents or the child;
• And Rehder’s amendment which would forbid juvenile courts from refusing to reunify a parent utilizing medication-assisted treatment for substance use disorder with their child. 

Despite Rehder’s effort to rein in amendments, Republican state Sen. Mike Moon of Ash Grove raised procedural concerns that the bill still wasn’t narrowly tailored enough to pass the single subject requirement.

“It’s not because I’m opposed to your effort,” Moon said, “it’s just my interpretation of what the constitution says.”

Despite Moon’s concerns, the bill was approved by the Senate on a voice vote. 

Kelly said she’s been involved in foster care policy for years because her daughter came into her life through the foster care system.

“This issue became part of my heart,” she said. “We have to make sure that we do what’s right by the kids.”

And it’s not just a financial issue, she said.

“For the kids who lost their biological parents, these benefits are in some cases the last tangible tie to your parents,” Kelly said. “It helps to create stability in the heart and mind. It’s just so hard for me to put into words, but it’s about more than the money.”

The Independent’s Jason Hancock contributed to this story.

Todd Richardson, Director of MO HealthNet, Kim Evans, Director of Family Support Division, and Robert Knodell, director of Department of Social Services, speak to the media in Jefferson City on March 28, 2023, about Medicaid renewals (Clara Bates/Missouri Independent).

Missouri’s backlog of Medicaid applications dropped in February, but the average time it took to determine eligibility for them continued to exceed the federal limit.

The median time it took Missouri’s social services department to process Medicaid applications for low-income Missourians in February was 77 days, an agency spokesperson told The Independent. 

That means half of the applications processed in February had been pending for at least two and a half months.

The federal Centers for Medicare and Medicaid Services requires that Medicaid applications for the largest group of participants — who are low-income children, families and adults — be processed within 45 days.

Missouri’s application delays have violated federal rules for three months.

In December, the median processing time was 49 days and it rose to 64 days in January. Median processing time is the metric the state is required to report to the federal government.

Processing issues can mean low-income Missourians go months without health insurance, delaying or foregoing necessary care. And it affects new applicants as well as those who may have lost coverage during the eligibility verification process and need to reapply. 

Alistair Wiley, of Ste. Genevieve, has been trying to get back on Medicaid since January. She and her husband lost coverage during the renewal process, despite submitting the paperwork and continuing to meet the income limit, she said. 

“It’s just been a living nightmare,” she said.

Since then, she says she’s endured several calls that were at least a two hour wait time each, submitted a new application in January, and received confusing information on why her application was stuck. She said workers couldn’t give her an estimate on when her application would be processed. 

Wiley has had to ration or miss several medications, she said, and her husband has had to delay surgery.

“I am only on half of the dose I need to treat my severe depression, which has made keeping track of this and fighting for myself incredibly difficult,” she said. 

On top of that, she said, she has called several state hotline numbers that don’t give the option to speak to a person and tell her to check the state portal, “even though it’s difficult to navigate.” When she reaches a human being, she said some staff “don’t seem to know what to do.”

“It feels like there are many roadblocks to receiving the help we need in this state,” she said.

Federal data lags, but as of November, Missouri’s processing delays were among the worst in the country, according to a report by Centers for Medicare and Medicaid Services published last month. 

According to that data, only New Mexico, Missouri, Georgia and Washington, D.C., were processing over 40% of applications in more than 45 days. Forty-two percent of all applications Missouri received were processed in violation of the federal limit as of November.

Leaders of the Department of Social Services have said they’ve shifted to devoting efforts to overcome the backlog and that the average processing time will soon decline as a result.

The backlog of applications dropped to 35,833 in February, from 52,891 in January.

Baylee Watts, a spokesperson for the Department of Social Services, says that’s because Missouri’s Family Support Division withdrew duplicates and ramped up efforts to process more applications, in “an effort to utilize all available staff to process applications during the large majority of their work hours.”

“With these efforts we were able to largely reduce our pending application numbers and expect to see the median days to processing return to an acceptable number,” Watts said. 

Missouri is required to report the median processing time to the federal government but publishes the mean — what most people think of as the average — in monthly public reports, Watts told The Independent. The mean posted in state reports is slightly lower but still exceeds the federal limit: It was 57 days in February and 50 in January.

The state has long grappled with processing delays and call center wait times and was put under a federal mitigation plan in the summer of 2022 for average processing times that reached 115 days. 

At the quarterly MO HealthNet oversight committee meeting last month, Kim Evans, director of the Family Support Division, said her agency has been in contact with the federal government about pending applications.

“I actually had a call with them this morning,” she said at the meeting. “We’re on schedule to have them back down, under the processing time, by the end of February.” 

The department didn’t respond to several requests for clarification. 

From November to mid-January, during open enrollment season for the federal insurance marketplace, the state generally sees an uptick in Medicaid applications. It is also in the process of re-evaluating the eligibility of all Medicaid participants on its rolls after a three-year pause due to the COVID pandemic.

Evans told the MO HealthNet oversight committee that she expects the state to experience longer processing times every year during open enrollment.

”So this is going to be a normal process for us from November to somewhere February or March depending on what our open enrollment period looks like,” she said. 

The same workers who process Medicaid applications are generally also the ones responsible for answering the phones, and they switch between those tasks based on need.

By the end of last year, the most recent data obtained by The Independent shows, the average phone wait time for the general line including most Medicaid queries was 1 hour 45 minutes.

State Sen. Tracy McCreery, a Democrat of Olivette who serves on the MO HealthNet advisory committee, cited The Independent’s findings when asking Evans last month about wait times. McCreery said she “remain[s] concerned” and asked what the state’s plans are to remedy it.

Evans said it  “is never our goal for individuals to wait this long. But there are different levels of the call center,” she said, going on to explain user error in selecting the correct phone line, or failure to listen to the automated answers.

She added that the department is asking the legislature for money to create a “call center bot,” to increase automation and reduce the need for staff on the general call center line.

The goal, Evans said, is to free up staff who are currently answering the general questions calls to transfer them to Supplemental Nutrition Assistance Program interviews instead. The state is facing a federal lawsuit over its call center wait times for SNAP.

Sen. Holly Thompson Rehder, R-Scott City, listens to Senate debate on Feb. 12, 2024 (Annelise Hanshaw/Missouri Independent).

Despite setbacks in both the House and Senate leading up to legislative spring break, proponents of bills seeking to end Missouri’s practice of seizing Social Security benefits from foster children expect to regain momentum on the issue when lawmakers return to Jefferson City next week.

In the Senate, GOP state Sen. Holly Thompson Rehder of Scott City saw her bill hung up in debate when it was heard late last month and earlier this month, with numerous amendments added and withdrawn. There was no vocal opposition. 

Since then, Rehder said she’s been working to strip out amendments that could threaten the bill’s passage. She says the bill is “really in good shape” and she “anticipates it getting out this coming week.”

“It’s ready to get brought up, and I honestly think that it’s supposed to be the first bill to get brought up Monday,” Rehder said in an interview with The Independent. 

Legislation aims to stop Missouri from seizing federal benefits owed to foster kids

The House version, sponsored by Republican Rep. Hannah Kelly of Mountain Grove, won initial approval but had that vote rescinded in order to remove an amendment deemed problematic. That means the bill still needs to be passed again by the House before it heads to the Senate. 

When lawmakers return to the Capitol on Monday, there will be only eight weeks left before the session adjourns for the year. And traditionally, getting a bill out of one chamber and into the other before the session’s homestretch improves its chances of making it to the governor’s desk.

The state took at least $6.1 million in benefits from foster children last year — generally Social Security benefits for those with disabilities or whose parents have died. The money is used to reimburse the state for agency costs.

“That is not taxpayer money coming in…That is literally money that is taken in the form of [survivors’ benefits] payments that children are owed because they have lost their parents,” Kelly said during House debate earlier this month.

The House seems likely to give Kelly’s bill final approval without much drama. 

In the Senate, factional infighting among Republicans has upended the chamber throughout the session — adding uncertainty to every bill’s fate.

No senator has spoken up against Rehder’s bills during debate, but discussion of various amendments has dragged out and slowed the bill’s progress. 

Under the legislation, the state could only use those funds to pay for the child’s “unmet needs” beyond what the division is obligated to pay, such as housing as the child prepares to age out of foster care. The state would also be required to ensure the account in which the child’s benefits are deposited is set up in a way that doesn’t interfere with federal asset limits.

In an interview, Rehder said she has been focused on working with senators to strip out amendments that might be outside the scope of the bill’s subject. Last year, a bill she sponsored to ban sleeping on public land was struck down by the state Supreme Court for failing that procedural requirement. 

Rehder said during Senate debate that “as I told the majority of folks that come up and talk to me about the underlying bill…the one thing I’ve requested is that any amendment that gets put on — I’m happy with amendments, I’m not saying don’t do amendments, I’m saying let’s do a limit that across this body we agree on.”

State Sen. Mike Moon, a Republican from Ash Grove, proposed an amendment that would remove the expiration date on a law passed last year that bans minors from beginning transgender health care treatments and limits sports participation for trans athletes.

During a subsequent debate over the bill, Moon said that “after thinking about [withdrawing the amendment] over the weekend, there are some things that I think need to be considered prior to that happening. I may be willing to do that.”

Rehder objected to the amendment for not being within the scope of the original bill, and Moon withdrew it after further discussion with Rehder.

Amendments that have been attached to the legislation so far include Democratic Sen. Karla May’s proposal to add suicide prevention-related phone numbers to those listed on student ID cards. Republican Sen. Rusty Black’s amendment would exempt licensed child care providers who care for only school-age children from certain compliance requirements. Republican Sen. Rick Brattin’s amendment would add considerations for judges when determining child custody.

Rehder hoped the bill would come up for a vote in the week before spring break, she said, but it didn’t due to a filibuster.

“We had to lay it over to go through these amendments” she said in a recent Senate communications video, “…and I’ll have those senators understanding that regardless of whether I’m for their language or not, if it will kill this underlying bill, that is to help foster children, I’m simply not going to allow it on.”

State Sen. Mike Moon, R-Ash Grove (Annelise Hanshaw/Missouri Independent).

A bill that would add child sex trafficking and statutory rape to the crimes eligible for the death penalty was debated Monday in a Missouri Senate committee — despite conflicting with U.S. Supreme Court precedent.

The legislation is sponsored by state Sen. Mike Moon, an Ash Grove Republican who said Monday that one of the “principal purposes of government” is to “punish evil.”

Rape of children under 14 and child trafficking of children under 12 would be crimes eligible for the death penalty under his bill.

“And what’s more evil than taking the innocence of the child during the act of a rape? Children are in large part defenseless and an act such as rape can kill the child emotionally,” he said.

“And so I believe a just consequence, after a reasonable opportunity for defense, is death.”

The Senate Judiciary and Civil and Criminal Jurisprudence Committee heard the bill Monday.

State Sen. Karla May, a Democrat from St. Louis, pointed to Moon’s stance of “believing in life” as an outspoken opponent of abortion without exception for rape or incest, yet supporting expanding the death penalty. 

“A 12 year old who gets pregnant, you believe that she should bring that child in the world, am I correct?” May asked.

“What crime did that child, that developing human child, commit to deserve death?” Moon replied.

“…But you believe in killing the father to that child?” May asked, if the father is a rapist.

“Yes,” Moon said.”If an attacker commits a heinous crime such as the ones that I mentioned in this presentation, I believe that if they’re charged and convicted, absolutely.”

The Rev. Timothy Faber testified in support of Moon’s bill, pointing to the “lifelong repercussions” of child rape and trafficking.

“It’s also a well established fact that those who commit sexual crimes seldom if ever change their ways,” he said. “Once a sexual offender, always a sexual offender.”

Elyse Max, co-director of Missourians to Abolish the Death Penalty, opposed the bill during Monday’s hearing. 

“If the goal is to overturn established U.S. Supreme Court precedent, it’s far from a guarantee,” Max said, “and the amount of resources the state of Missouri would have to spend as well as the trauma to child victims during the process cannot be understated.”

The U.S. Supreme Court in the 2008 case Kennedy v. Louisiana ruled giving the death penalty to those convicted of child rape violates the constitution’s ban on cruel and unusual punishment unless the crime results in the victim’s death or is intended to. Only homicide and a narrow set of “crimes against the state” can be punishable by death, the court ruled.

“Adding statutory rape and trafficking as death-eligible crimes are a slippery slope,” Max said, “of expanding the death penalty to non-murder crimes that would bring the constitutionality of Missouri’s death penalty into doubt.”

“Instead of spending millions of dollars to possibly change long-standing precedent, Missouri resources should be spent to protect children from abuse in the first place, and ensure survivors have access to mental health treatment and proper support, following the offense,” Max said.

Moon said, regarding the Supreme Court precedent, that it’s worth challenging.

“That’s something that we need to start the conversation about,” he said, “and those things need to be challenged.”

Florida passed a similar law for victims of rape under age 12 last year. It received bipartisan support. In December, prosecutors in that state announced they’d seek the death penalty in a case of a man accused of sexually abusing a child.

Florida’s Gov. Ron DeSantis has said the state’s bill could lead the U.S. Supreme Court to revisit the issue.

Mary Fox, director of Missouri State Public Defender, which provides defense for the majority of death penalty cases in the state, argued Monday that the death penalty is “no deterrent to a crime.”

Fox also noted that an 18 year old dating a 14 year old could be executed under Moon’s legislation because that would be considered statutory rape.

Mei Hall, a resident of Columbia who also said she was a victim of sexual abuse, also testified in opposition.

“I don’t wish my abuser death,” Hall said. “I wish them to be sequestered away and unable to harm more people, for sure. But I don’t think it’s the state’s place to kill people in general and I don’t think it’s the state’s place to make it more difficult for child victims to come forward.” 

Lobbyists from Empower Missouri and Missouri Association of Criminal Defense Lawyers also testified against the bill. A lobbyist from ArmorVine, testified in support.

Missouri was one of only five states to carry out death sentences last year, along with Texas, Florida, Oklahoma and Alabama. There are two executions scheduled for this year.

Three House bills filed this year would eliminate the state’s death penalty, but none has made it to a committee hearing. 

UAW Local 2250 headquarters in Wentzville (Clara Bates/Missouri Independent).

More than 30% of workers at a Troy-based Toyota manufacturing plant have signed union cards, prompting them to go public with their campaign on Wednesday to join the United Auto Workers union.

Troy is the first Toyota plant nationally where workers have gone public with a union drive — and the latest in a string of non-union plants seeking to join the UAW after it won record contracts late last year for the Big Three U.S.-based auto manufacturers that included raises of at least 25% over four years.

There are over 1,000 workers at the Toyota plant in Troy, an exurb of St. Louis, which manufactures a crucial car part, called aluminum cylinder heads. The plant makes the cylinder heads for every Toyota engine built in North America.

“When people say Toyota engines last forever, here in Troy, Missouri, we know what makes it possible,” workers say in a UAW video announcing the campaign, “Our hands, our backs, our knees, our work. We carry the proof every day.”

The reasons for seeking to unionize, according to the UAW’s video, include safety concerns and wages lower than their UAW counterparts and Toyota plants in other states.

‘Trying to set the example’: Wentzville GM strike enters its second week

“The plant is not safe,” Jaye Hochuli, a team leader at the Troy plant, is quoted as saying in the UAW press release. “They had me crawl under a deck to clean out the sand and silica dust and chemicals that come out of the machines…I should’ve been in a respirator and a hazmat suit. All they gave me was a KN-95 mask.”

“…How can the richest car company in the world not follow basic safety practices? We’re organizing to fix what’s wrong and win the protection we need,” Hochuli added.

The plant production workers make around $4 an hour less than production workers in Big Three facilities organized by the UAW, according to the union’’s press release.

“Seeing the new contracts with the Big Three, that’s when I realized we needed a union,” Charles Lashley, a team member in Troy, is quoted as saying in the press release. “…Toyota makes more money than all the Big Three. So there’s no reason why we should be so far behind. The company can’t run without us. We should get paid like it.”

After winning record contracts for the Big Three Detroit-based auto plants, the UAW announced late last year that it was starting a large-scale push to unionize the non-union auto sector in 13 companies, which are made up of around 150,000 workers.

“When we return to the bargaining table in 2028,” said UAW president Shawn Fain, “it won’t just be with the Big Three, but with the Big Five or Big Six.”

The Troy announcement comes on the heels of public unionization campaigns launched at the non-union Volkswagen in Chattanooga, Tenn., Mercedes in Vance, Ala. and Hyundai in Montgomery, Ala. 

Over 10,000 non-union autoworkers have signed union cards and workers at over two dozen other plants are continuing to organize, according to the union. 

Late last year, after a six week strike, UAW workers ratified contracts with Ford, General Motors and Stellantis that increased pay by 25% over four years, reinstated cost of living adjustments, and added a sped up path to increased wages. A Wentzville-based GM plant in Missouri had been among the first to strike.

Publicizing their union drive is the first phase in organization efforts. The union said they will make drives public once 30% of workers have signed union cards. At 50% of workers, they will hold a rally with UAW president Shawn Fain. At 70% of workers, they will seek voluntary recognition of the union, and if the company doesn’t agree, will file for an election with the National Labor Relations Board.

Ed Hellwig, a Toyota spokesperson, told The Independent, regarding the safety and wage concerns expressed in the video and press release: “These comments and views do not reflect the overwhelming majority of our team members and much of it is misleading and inaccurate.”

“At Toyota, team member safety is the top priority. Our safety record at our North American operations is among the best in the industry. Over the last four years, our North American manufacturing total incident rate has been reduced considerably.”

He added that the starting wage at Toyota Missouri is $21 per hour for production team members. Starting wage for skilled team members is $32 per hour. Both are up around 12% since March of last year, he said. Toyota generally announces wage increases twice per year and the next increase will be announced next week, he added.

“We are always looking at many factors to ensure we remain competitive in the market and adjust our compensation and benefits appropriately,” he said, and Toyota is “among the few companies” that provides medical benefits to retirees and spouses.

“Despite the ups and downs in the North American auto industry, Toyota has consistently provided long-term, secure and steady employment for all its manufacturing team members.

“Our philosophy has been and will continue to be to provide all of our team members with dependable, stable and long-term employment.”

In November, after the Big Three contracts were finalized, Toyota announced they would raise wages by 9%.

This story was updated at 9:25 A.M. to include comments from Toyota received after publication.

A pandemic era-benefits program dispersed $391 per eligible child last year, to cover summer 2022. Those benefits begin expiring March 7, so eligible families that lost the card or never received one have a short window of time to request a new one (Bruce Bennett/Getty Images).

Missouri families who haven’t claimed food benefits in a program launched during the height of the pandemic could lose out in the coming weeks unless they act quickly.

Federal pandemic-era summer food benefits, referred to as P-EBT, were designed to help cover costs in summer 2022 but did not begin being disbursed in Missouri until May of 2023. The benefits provide a one-time deposit of $391 per eligible child on a debit card called electronic benefits transfer that can be used to buy groceries.

The program was intended to help families afford food in the summer, without subsidized school meals. 

Now, those benefits are set to expire — for some families, as early as March 7. Thousands of eligible families have not yet used them. The state estimates that $36.7 million of benefits has not yet been accessed by families, according to records obtained by The Independent under Sunshine Law, which is equivalent to benefits for over 90,000 kids.

That’s part of a broader trend: Advocates nationally have said that states could have conducted more outreach to inform families of the pandemic benefits, so they would expect and use them.

The state social services agency has said it did all it could to publicize the benefits — working with schools, sending letters to affected households, issuing press releases and using their social media and websites to keep participants up to date.

P-EBT was a new, temporary program that changed each year of the pandemic, so families may not have understood what they were, weren’t expecting them and potentially threw the cards away. Other eligible families may not have received their cards in the mail to begin with, if the state didn’t have the correct address on file.

In Missouri, nearly 25,000 benefits cards were returned in 2023, meaning the state and schools may not have had the correct address on file, according to records obtained under the Sunshine Law and provided to The Independent by David Rubel, an education policy consultant from New York who has been tracking unclaimed P-EBT benefits nationwide.

The largest group of benefits expirations in the state will occur between March 7 and April 18, though expirations will continue through September and are staggered depending on when the state issued benefits to the family. Benefits expire 274 days after they were issued. The state sends out letters to families at least one month before expiration to warn them.

Families who believe they are eligible but didn’t receive or claim benefits can request new cards by phone. Cards generally take two to three business days to arrive, though the state tells participants it will be five to seven business days for a buffer.

With a possible deadline looming, families would need to call as soon as possible to access benefits. 

Children who qualified for subsidized school lunches in the 2021-2022 academic year are eligible, along with children under 6 who qualified for the Supplemental Nutrition Assistance Program, previously known as food stamps, during that period. 

Christine Woody, director of Empower Missouri’s food security policy program, said Missouri’s delayed benefits disbursal could have contributed to confusion and affected the rate of families redeeming the benefits. Benefits for summer 2022 were dispersed “a whole year later,” she said — at the same time that people were hearing the state wouldn’t be participating in the version of the program designed to cover summer 2023.

Families may have thought the benefits they were receiving at that time were fraudulent, she said, or could have forgotten about the delayed prior year’s benefits. The last of the summer 2022 benefits were distributed in December.

The reason the benefits were so delayed was due to administrative issues, including the need to set up a data portal from scratch. The state declined tens of millions in federal aid to run a summer 2023 benefit program in part because officials lacked confidence they could disperse those benefits before a federal deadline.

Missouri is now working to set up a new permanent federal program, rather than one tied to the COVID pandemic, that will provide $40 in food benefits per summer month, per eligible child.  Children who are eligible for free or reduced lunch during the school year will be eligible for the program, called Summer EBT, as part of a package approved and made permanent by Congress last year.

Missouri needs to fund half the administrative costs, and the federal government will fund the other half plus the cost of the benefits themselves.

In the supplemental budget request, Missouri’s social services department requested $2.65 million to fund the program: Half of that would be paid for with state revenue and the other half by the federal government. 

If the legislature approves the funding, Woody said, the issues with benefits not being used are unlikely to persist. The summer program is an “entirely different program” from the temporary P-EBT program, she said, with different federal assistance and funding. Rather than a temporary program with ever-changing federal guidance, the new program will be permanent, enabling more consistent messaging to participants.

“I don’t believe that will be the case in 2024 and beyond,” Woody said, “because I think there’s going to be some changes in how the program is run, how it’s administered, the timeline and all that sort of thing.”

Woody said the “key to making this successful” will be clear, frequent and concise communication to families from the state and schools about their benefits.

The state needs those administrative funds to get approval from the federal government before they can proceed with the program, said Baylee Watts, a spokesperson for the Missouri Department of Social Services. 

Watts said DSS and the state education department are working “to ensure a smooth process should the program have approval,” with data solutions, and they are planning communication and outreach strategies.

The current plan is those receiving SNAP won’t need a separate summer EBT card, Watts said. And those not on SNAP will need to apply for the benefit, she said, “which would give us their current address information.” Only the head of household will receive a card rather than one per child, Watts said, under their current proposal, which will reduce the number of cards needed to be issued.

This story was updated at 1:20 P.M. 

Kim Evans, director of Family Support Division, and Patrick Luebbering, chief financial officer, of the Department of Social Services at a December 2023 budget hearing (screenshot).

Missourians in need of help accessing public benefits saw wait times for the state’s long-overloaded call center increase in the final months of 2023.

The average hold time for the state phone line dealing with food assistance interviews reached 1 hour and 12 minutes in December, more than double what they had been in August, according to records obtained by The Independent under Missouri’s Sunshine Law. 

A pending federal lawsuit filed two years ago, when wait times were up to three hours, argues long hold times for required food assistance interviews constitutes an illegal denial of benefits. 

For the state’s phone line dealing with general questions — including about programs such as Medicaid, temporary assistance for needy families and the child care subsidy — wait times exceeded one hour and 45 minutes in December. That number has crept up every month since August.

Many callers give up before they ever get to talk to a person. 

Records show 72% of callers hung up before reaching a representative when calling the general line in December, and 35% abandoned calls for the line for Supplemental Nutrition Assistance Program interviews, previously known as food stamps.  

“If you are working, where are you going to wait on hold for an hour and 45 minutes?” state Rep. Deb Lavender, a Manchester Democrat, told The Independent. “If you’re not working, you probably have some reason that’s preventing you from working, including perhaps watching kids. That’s not manageable for any of us these days.”

At a House budget committee hearing for the social services department in early December, Lavender pressed Kim Evans, director of the agency’s Family Support Division, on whether SNAP interviews were being done in a timely manner.

“I was excited this morning,” Evans testified, “when we first came into the hearing, we were at an 11 minute wait time.” 

Lavender responded that she was also excited that wait times were down to only 11 minutes, but “I’ve also been in hearings with you before that you told me we’re getting better at wait times,  and then in between I keep hearing about hellacious wait times.”

During that December hearing, records show the prior month average was actually one hour and 19 minutes. The average for the month of December ended up being over an hour as well.

The department didn’t respond to several questions attempting to clarify how Evans calculated that day’s wait to reach 11 minutes. Baylee Watts, a spokesperson for the Department of Social Services, said in an email to The Independent that “times can widely vary throughout the month.”

In another budget committee hearing Tuesday, Lavender again pressed Evans on the wait times.

“Every time we’re in here, you tell me our call times are getting better,” Lavender said, “and every time I step out of this room and talk to anybody else they tell me call times are still terrible.”

Evans said the wait time for those in need of assistance “fluctuates.”

“We’re coming out of open enrollment for the federal marketplace right now, so we are backlogged in applications, so folks are calling us,” she said. “We’re unwinding renewals, people are calling us. We are seeing an influx in SNAP applications, people are calling us. And so, you know, as the economy goes, so does our call center. As the weather goes, so does our call center.”

The state is asking for $4 million for a “call center bot,” to increase automation and reduce the need for staff on the general call center line.

The goal is to free up 100 staff who are currently answering the general questions calls to transfer them to SNAP interviews instead, by having a virtual agent to “tackle those calls and those long wait times on tier three,” Director Robert Knodell told lawmakers Tuesday, referring to the SNAP interview tier.

Knodell said if implemented it would be a “game changer.”

‘Disappointing for the people in our state’

In a January letter to The Independent, DSS’ deputy director of operations, Teri Armistead, wrote that Family Support Division “continues to execute on strategies, such as blitzes,” which shift workers between processing applications and answering calls depending on need.

“This has resulted in significant improvement to our call center wait times,” she wrote. 

In an interview with The Independent last week, Lavender said she’s “just so disappointed.”

“It feels like we continuously talk about SNAP wait times,” she said, “and why we haven’t been able to solve this is just so disappointing for the people in our state who need to rely on these services…I don’t think we’ve ever gotten accurate information in budget committee about what true wait times are.” 

Delayed or missing SNAP benefits born out of the dysfunctional call center looks like families struggling to feed their young children while rearranging their days to wait on hold, Missourians with disabilities who can’t understand the application forms being unable to get help and some subsisting on little food while using up prepaid phone minutes on hold.

It’s not just those seeking SNAP interviews who bear the cost — people on a range of benefits programs encounter issues enrolling in or maintaining their services and then call and can’t get through. Sometimes when they go to in-person resource centers, they are directed back to the same troubled call center for help. 

The general questions line — which reached an almost 2 hour wait in December — is where many people with Medicaid issues end up.

Last year, Missouri was one of 16 states the federal Centers for Medicare & Medicaid Services flagged, writing that long wait times and high abandonment rates for calls “are impeding equitable access to assistance and the ability for people to apply for or renew Medicaid.”

Missouri argued at the time that CMS was misunderstanding state data. Callers to the state who have Medicaid questions can end up in the state’s general questions tier — which generally has long wait times — or one of two contracted-out lines.

The state works with two private companies, Automated Health Services and Wipro, that answer calls for a limited subset of Medicaid queries that don’t require the authority of state staff. They have shorter wait times — 26 minutes for AHS in October and 1 minute for Wipro — but by far the largest volume of Medicaid-related calls ends up in the state’s general questions line.

The contracted lines can handle annual renewals done by phone, order replacement Medicaid cards and handle reported changes, according to Watts.

The state has generally characterized callers as making the wrong choices, which lead to them being in the general questions line rather than the more-efficient contracted lines — though callers have told The Independent the contracted lines often aren’t equipped to answer their questions, including about the status of an application submitted months prior.

“…We strongly encourage Medicaid participants to utilize the Medicaid lines to free up resources for SNAP and [temporary assistance],” Watts said.

One advocate helping with a Medicaid application that hadn’t been processed for months, directed to Medicaid from the federal Marketplace Exchange, sent The Independent a screenshot of her call Feb. 1 to the agency that lasted 6 hours. She said she was speaking to the representative for just 30 minutes of that time.

This was the fourth call this year, with the previous ones also involving hours-long waits.  

‘This is going to be a cycle’

In addition to increasing call-center wait times, the state’s processing time for Medicaid applications has been rising, exceeding the federal limit in December.

It took a median time — the metric DSS is required to report to the federal government — of 49 days in December to process a Medicaid application for the group that includes most low-income Missourians, Watts said.

Federal rules limit processing time for those applications to 45 days. 

One pregnant applicant previously told The Independent she had to postpone getting prenatal care because her Medicaid application was taking months to be processed.

In a report published by the federal Centers for Medicare and Medicaid Services in January, Missouri’s percent of applications in October processed outside the federal limit was 34%. Only three states were worse. The abandonment rate for Missouri in October, referring to calls abandoned before reaching a representative, was 47%, second only to Nevada.

“It is always the goal of the Family Support Division to provide excellent customer service while working as efficiently as possible,” Armistead said. “There are, however, very real limitations related to capacity that they must navigate,” citing limited staff call centers, processing and working in person, along with limits on hours those staff can work in the system.

The confluence of Medicaid renewals beginning again, an increase in SNAP applications and the opening of federal enrollment “can and does impact processing times,” she said.

Now that open enrollment is over, Armistead said, applications should start to “slow down and we will start to work through the backlog. This will happen every year from November through January.”

Evans said Tuesday, about the call wait times increasing in recent months, that “this is going to be a cycle, you’re going to see with (Family Support Division), that’s going to happen.”

Lavender responded: “I hope there’s an end of this.”

“​​I don’t think I’ve sat in a budget meeting yet, and this is the end of my sixth year, that we haven’t talked about long wait times for one reason or another.”

A bill signed into law last year created a transitional state benefits program for the Supplemental Nutrition Assistance Program, previously known as food stamps, along with Temporary Aid for Needy Families and the child care subsidy program (Justin Sullivan/Getty Images).

A law enacted last year aimed at helping individuals transition out of public assistance programs remains in limbo, with Missouri’s social services agency saying it can’t implement the change without a huge infusion of state funding. 

The impasse is, in many ways, unsurprising. The legislation, which was approved with bipartisan support, came with a fiscal note that estimated it would cost the state over $100 million because the tweaks to the benefits programs wouldn’t be covered by the federal government.

“We continue to have conversations with our federal partners and the General Assembly to enable implementation of this legislation in the event that funding is appropriated and approved,” said Baylee Watts, a spokesperson for the Missouri Department of Social Services.

The law’s proponents, however, have questioned the accuracy of the fiscal note and say the state isn’t doing enough to implement the law, which was overwhelmingly approved by the legislature. 

“I don’t think that the program would cost what they’re saying,” said state Sen. Mary Elizabeth Coleman, a Republican from Arnold who co-sponsored the legislation, in an interview with The Independent.

The strategy the legislation uses is different from a federal policy for the food stamp program enacted in 41 states, called broad-based categorical eligibility. Advocates are urging Missouri to adopt that policy in lieu of the transitional benefits law passed last year, arguing it aligns with the intent of the legislation but wouldn’t require the state to bear the majority of the costs or require additional legislation.

“If there’s broad consensus that that’s the way that we should go, I would be open to having that conversation,” Coleman said, but later added that she could not support any policy “outside the scope of conservative welfare reform that was put forward and adopted by the legislature.”

‘Reforming our welfare system’

The bill passed last year and signed by Gov. Mike Parson created a transitional state benefits program for the Supplemental Nutrition Assistance Program, previously known as food stamps, and Temporary Aid for Needy Families, which provides limited cash assistance. It also expanded existing transitional benefits for the child care subsidy program. 

SNAP is the largest program the law addresses. Over 653,000 individuals in Missouri received SNAP benefits in December. There were just under 13,000 people receiving TANF direct assistance that month and 20,900 receiving the child care subsidy in November.

SNAP benefits are already federally designed to gradually decrease as income rises. The law, if implemented, would create a separate state program with a higher income maximum and its own benefit level calculations. The bill was designed to help mitigate the issue of participants being forced to choose between a small income bump and losing benefits.

Current Missouri law allows people to receive SNAP while earning a gross income of up to 130% of the federal poverty line. For a family of three, that is a maximum of $33,566 per year. The new law would transfer those with a gross income of between 130% and 200% of the federal poverty line to the transitional state program, with its own framework for how benefit amounts would be determined.

“Transitional benefits should be designed as a hand up, not a hand out trapping people in dependence,” Coleman said after the law passed last year. “This is a great first step in reforming our welfare system.”

The fiscal note attached to the legislation included the personnel and technology costs of creating it, along with the cost of paying for the benefits themselves, which the federal government wouldn’t cover. 

The estimated cost of the change annually was estimated to be at least $140 million, in the fiscal note published in June.

State Rep. Alex Riley, a Republican of Springfield, said in an interview with The Independent that he’d need to speak to the social services department before he could offer any comment about the delayed implementation. But he noted that he and others have long doubted the accuracy of the fiscal note.  

“We were frustrated,” he said, “because we didn’t think that they took into account that there will be people going off of public assistance because of implementing this and because of the structure that we created with this bill.”

At a budget hearing for the Department of Social Services in December, lawmakers expressed surprise at the price tag.

Just to implement the system changes for the programs would cost $39.8 million, Patrick Luebbering, the agency’s chief financial officer, told the House Subcommittee on Appropriations for Health, Mental Health and Social Services. That’s because, he said, “we’ll have to build brand new systems.” 

“Not only will we not get federal funding,” he said, “the way it was laid out, we can’t even use our existing systems — they’re requiring us to build new systems.” 

The agency’s budget request for the next fiscal year, which begins July 1, didn’t include the benefits themselves. Luebbering said that’s because it would take a year to build the system, so expenses for actual benefits wouldn’t be spent until the following budget year.

A route to ‘accomplish the intent’ for SNAP

Most states have taken another path to help SNAP participants take higher-paying work while avoiding a steep drop-off in benefits.

Under an existing federal policy option, states can increase the gross income limit from 130% of the federal poverty line up to 200%. States can also lift the restrictions on assets.

Missouri is one of nine states that has not opted in to this policy, called broad-based categorical eligibility, which allows states to pursue either or both strategies.

 Twenty-three states and D.C. set the gross income limit to 200%, with the remaining to somewhere between 130% and 200%. 

Two hundred percent of the federal poverty line is equivalent to an income limit of $51,640 for a family of three. 

The federal government pays the full cost of the additional benefits — the policy modifies a state’s existing SNAP program rather than requiring a state to set up its own, self-funded benefits program with its own rules. 

Thirty-seven states, plus Washington, D.C., have abandoned the SNAP asset tests through the categorical eligibility policy — to encourage saving and reduce the complexity of the application for individuals and state agencies processing them.

Missouri currently limits SNAP to those with assets of under $2,750 for most people, or $4,250 if at least one member of the household is over 60 or disabled. 

Christine Woody, food security policy manager for the nonprofit Empower Missouri, said she has been working with the department and urging them to adopt broad-based categorical eligibility for SNAP as a way to carry out a goal of the bill without it costing the state money it doesn’t have. 

The social services agency can apply on its own — it doesn’t need a legislative mandate.

Robert Knodell, director of the Missouri Department of Social Services, said at the December budget hearing that the department would pursue an application for that policy to avoid the full costs of implementing the program as a state-funded one.

“That would allow us to basically accomplish the intent of the transitional benefit,” Knodell said. “…We could use federal dollars for the program. And I do believe it would somewhat reduce systems and staffing needs around this program.”

According to records obtained by The Independent through Missouri’s Sunshine Law, the department in December submitted an application that relied on the language of the transitional benefits law instead of the standard language other states have used to raise the cutoff for SNAP eligibility.

In January, the federal government rejected the state’s application but expressed readiness to keep providing guidance to help “streamline the administration of SNAP and help ensure all eligible households in Missouri receive the SNAP benefits to which they are otherwise entitled.” 

Watts, a department spokesperson said it is “important to note [the federal government] considers broad-based categorical eligibility to be a different program than the transitional benefits outlined in [the legislation] passed last year.”

In an email to the department in December obtained by The Independent, Coleman expressed concern about whether the state’s application would be accepted. She attached a copy of the application to her email. 

“Our office has had discussion with DSS regarding a waiver, which we are supportive of, but had not seen a copy of the application,” she wrote. “The attached document doesn’t seem to match what we had discussed. I’m cc’ing DSS on this email.  Hopefully they can provide clarification of the source and intent of the language used in the application.”

She said in an interview last week that she never received a response to that email or to a follow-up.

Watts told the Independent Friday that “since last September, DSS has had monthly teleconferences with Senator Coleman about the legislation, including one this week, and we are willing to do the same with other members of the General Assembly in the event that they reach out with questions.”

The Department of Social Services has not clarified whether it plans to submit another version of the application to pursue broad-based categorical eligibility, but Woody said she’s “cautiously optimistic” it will. 

The story was updated at 9:33 A.M. on Feb. 5 to reflect the 2024 poverty levels. 

Bills to ban child marriage in Missouri were heard Jan. 29, 2024, in the Senate's Judiciary and Civil and Criminal Jurisprudence committee (Clara Bates/Missouri Independent).

A bipartisan bill debated in a state Senate committee Monday would ban child marriage in Missouri. 

Under current law, 16 and 17-year-olds are allowed to get married with parental consent. Marriage between a minor and anyone 21 or older is prohibited.

The legislation discussed Monday afternoon would prohibit issuing marriage licenses to anyone under the age of 18 under any circumstances.

Under the identical bills, co-sponsored by Republican Sen. Holly Thompson Rehder of Scott City and Democratic Sen. Lauren Arthur of Kansas City, Missouri would join 10 states that have banned child marriage.

Thompson Rehder said she got married when she was 15 years old to her 21-year-old boyfriend.

“And at the time, I was operating in what I thought was an adult mindset…but it was only until much later that I realized at 15 years old, you really don’t have the mental capacity to make those types of decisions,” she said Monday in the state Senate’s Judiciary and Civil and Criminal Jurisprudence committee. 

“Being someone who did get married at 15,” Thompson Rehder said, “I know that it is something that you really shouldn’t be doing before you’re an adult.”

Arthur said raising the age is a “moral imperative that protects the innocence and potential of our youth.”

“You can picture a young girl, 16, eyes filled with dreams and aspirations,” Arthur said, “being asked to take on the responsibilities and challenges of marriage and potentially motherhood. And I would argue that’s not necessarily the future we want to envision for our daughters.”

Until the legislature voted to raise the minimum marriage age to 16 in 2018, Missouri had among the most lenient child marriage laws in the nation — making it  an especially popular state for 15-year-olds to travel to be married.

Despite the 2018 change, Missouri law still does not align with international human rights standards, which set the minimum age at 18. Activists argued at the time Missouri’s new law would continue to leave 16 and 17-year-olds vulnerable to potential coercion.

Those in favor of a ban on child marriage often argue that marriage under 18 is coercive and can transform into forced marriage, especially because children lack the legal rights of adulthood.

Nationally, those opposed to a ban often invoke parental rights or religious liberty.

Five people testified in support of the bill Monday and one in opposition.

Lauren Van Wagoner, of Kansas City, testified that at 17 she was married to her 21-year-old boyfriend.

“The reality is I wasn’t mature enough to make that decision,” she said, “I was only thinking of not having a curfew…And preventing my husband from religious excommunication. Neither of those things should have been my responsibilities at that point.”

The next twelve years, Van Wagoner testified, were “a horror story,” which included abuse from her husband. After her husband left her in 2018, she said, through tears, “I found myself without any real job skills or continuing education.”

“My story is rare,” she said. “I’m one of the lucky ones: I got out of my marriage.”

Many who married as children are “stuck in the cycle of poverty and abuse because they can’t escape,” she added.

The others testifying in support of the bill included those lobbying for the Missouri Coalition Against Domestic and Sexual Violence, Missouri Kids First, Rape and Abuse Crisis Service of Jefferson City and a family law attorney.

Missouri lags behind most states for children’s rights, advocacy group finds

“We’ve worked in a lot of other policy areas like juvenile justice to raise the age of 18 and have a standard for the state,” said Jessica Petrie, representing Missouri Kids First, “and we believe it’s time we get our marriage laws in line, and bring it to that age as well.”

Matthew Huffman, representing Missouri Coalition Against Domestic and Sexual Violence, said child marriage “undermines our statutory rape laws,” as a marriage license “essentially becomes a ‘Get Out of Jail Free’ card” for what would otherwise be considered child rape.

The child marriage law passed in 2018 already aligned with Missouri’s statutory rape law, which prohibits an adult who is 21 years old or older from sexual intercourse with anyone under 17.

A study from the advocacy group Unchained at Last in 2021 found that between 2000 and 2018, 8,007 children were married in Missouri. Nationally, most children who married were girls and most were to men over the age of 18.

Eighty-six percent of children married over this time period nationally, the nonprofit found, were girls.

The person testifying in opposition was Rev. Timothy Faber.

“We certainly have empathy for those who have experienced negative consequences to marry at such an early age,” Faber said, adding that as a minister for 40 years, he has never conducted a marriage ceremony for a minor.

“However,” he said, “I can see a few rare circumstances where that might be appropriate.”

Sen. Curtis Trent, a Republican from Springfield, asked Faber for detail on those instances.

“I guess I’m just not seeing what situations that this would prevent — you’ve tried to identify some rare circumstances where the bill might be too restrictive and I’m not sure if any have been identified yet,” Trent said.

Faber replied: “To close the door totally just seems too much. I think we ought to certainly tighten it up.”

Rehder said the work she could get as a 15-year-old supporting herself was limited to cleaning houses: “That was all I could get because I was a child,” she said.

“Years ago when our great-grandparents got married very early, that was before women had the opportunity that they have now of education,” she said. “So I think this is something that protects the girls, and it gives them a start like anyone else for them to make these choices as adults instead of children.”

This story was updated at 11:38 a.m. on Jan. 30 to clarify that Missouri’s statutory rape law prohibits an adult who is 21 years old or older from sexual intercourse with anyone under 17. 

CORRECTION: This story was updated Feb. 1 to reflect that Timothy Faber is no longer a registered lobbyist with the Missouri Baptist Convention; he was testifying as an individual. 

State Rep. Hannah Kelly, a Republican from Mountain Grove (Tim Bommel/Missouri House Communications).

Missouri’s practice of taking millions of dollars in Social Security benefits owed to foster kids to defray the cost of providing care could come to an end under legislation debated last week in a House committee. 

The state took at least $6.1 million in foster kids’ benefits last year — generally Social Security benefits for those with disabilities or whose parents have died — to reimburse itself for agency costs.

It’s a decades-long practice that has come under increased scrutiny across the country over the last few years.  Several states, including Arizona, New Mexico and Oregon, have stopped the practice. 

The bill, sponsored by Republican state Rep. Hannah Kelly of Mountain Grove, would prohibit the state from using those federal benefits to pay itself back for routine foster care expenses. 

Instead the division could use the funds for the child’s “unmet needs” beyond what the division is obligated to pay, such as housing as the child prepares to age out of foster care. The state would also be required to ensure the account in which the child’s benefits are deposited is set up in a way that doesn’t interfere with federal asset limits.

“This money is important for their future,” Kelly, who has been a foster parent in the past, said at a House Children and Families committee hearing last week. “We have a responsibility to make sure that it is safeguarded for their future.”

The state withheld $8.1 million in foster kids’ benefits in 2018, $7.9 million in 2020 and $7.1 million in 2022, according to data shared at the House Children and Families committee.

State agencies are allowed to be designated as the payee for kids in their custody, though nationally it’s been documented that kids aren’t always informed the state is receiving their benefits.

The main federal benefits at issue are through Social Security: Supplemental Security Income for those with disabilities and survivor’s benefits for those who have a parent who has died.

Kelly’s bill also includes benefits issued by the Railroad Retirement Board and Veterans Administration.

Around 10% of foster kids are entitled to Social Security benefits for survivors or those with severe disabilities, national reports have estimated. That would mean somewhere around 1,200 kids are eligible yearly in Missouri. 

The agency didn’t respond to a request for these figures.

The result of the practice is that kids who are orphaned or have disabilities are responsible for paying toward the cost of their care in state custody, while foster kids who are ineligible for those benefits pay nothing.

“No child really wants to be in foster care,” said Democratic state Rep. Raychel Proudie of St. Louis, “…to make them pay for it is just absolutely egregious.”

“We don’t usually make children pay for their care under any other circumstance,” Proudie added.

The state uses the money to pay for routine foster care costs, though agency staff did not provide details when asked by lawmakers about those specific expenditures. In other states, it’s used to help offset the money states pay foster parents and group homes, for instance, for costs like housing and food.

The bill would prohibit that practice, so the agency would only be able to use the money to pay for things outside the bounds of their obligations, such as tuition, transportation, technology or housing. 

A foster father, Jason White, testified at the House hearing that his foster child, now 20, “has exactly zero dollars to his name,” which he said would not be true if the state had put his federal benefits money into an account.

The state is supposed to provide a quarterly accounting of how it is using a child’s money but White said in practice that hasn’t happened. He has no record of where his foster child’s benefits went.

Madison Eacret, lobbyist for the nonprofit social service organization FosterAdopt Connect, said the annual social security disability benefit per child is around $10,000: equivalent to “two years of books and supplies for college, 10 months of rent for a one bedroom, nine to 12 months of child care for a young child, or four years of SNAP benefits.”

“Currently the vast majority of foster youth beneficiaries including those in Missouri never see a dollar of this money, and they don’t even know that someone has applied for their benefits,” Eacret testified. 

Mary Chant, CEO of Missouri Coalition for Children, said the money could help foster youth who age out of the system and can become homeless.

“This funding would make a considerable difference in helping youth better position themselves for independence,” Chant said. “This money belongs with the child.” 

Fifteen states and cities have, according to NPR, “taken steps to preserve the money of foster youth.” Nationally, state leaders have raised concerns they wouldn’t be able to fill in the budget gap left by abolishing the practice. California’s governor last year vetoed a bill that would’ve halted the practice, saying it would have cost too much.

No one testified against the bill at last week’s Missouri House hearing. 

Missouri lawmakers are again seeking to push through child care tax credit legislation in the hopes of mitigating the state’s child care crisis (Rebecca Rivas/Missouri Independent).

In early 2020, Peapod Learning Center in Springfield had a waiting list years out. 

The nature and farm preschool earned state recognition as it continued to expand after opening more than a decade earlier.

“It was off the charts wonderful,” said owner and director Carly Walton. 

Then the pandemic hit. By June 2020, the farm school was forced to close and enrollment at the nature school dropped to 50% capacity as some parents left the workforce and others struggled to afford care.

“It’s never recovered,” she said.

Now Walton worries what will happen once COVID-era American Rescue Plan Act Child Care Stabilization funds — “instrumental,” she said, to keeping her doors open during the pandemic — dry up at the end of the year. 

She’s not the only one concerned. Missouri is facing a child care crisis, with about 200,000 children living in parts of the state considered “child care deserts” where there are one or fewer child care slots for every three children. Even areas not officially deemed deserts often can’t hire enough staff to serve as many kids as their capacity allows. 

A bipartisan group of lawmakers, along with Gov. Mike Parson, have once again put this crisis atop their legislative agenda, pushing a package of tax credits they hope will make child care more available and affordable for working families while helping private providers stay afloat.

A package of child care tax credits were on the cusp of passing last year but Senate filibusters stalled and then killed the bill before it could come up for a vote. 

The legislation, refiled this year by Republican state Rep. Brenda Shields of St. Joseph and Democratic state Sen. Lauren Arthur of Kansas City, would offer three types of credits: for taxpayers who donate to support child care centers, for employers who make investments in child care needs for their employees and for child care providers.

Also among the child care priorities Parson highlighted this year is a $51.7 million budget increase to the child care subsidy program for low-income children, on the heels of a $78 million increase last year. 

“Today, we have the capacity to serve just 39% of Missouri children in licensed facilities,” Parson said during last week’s State of the State address. “It’s time for change.”

Arthur, like Parson, said child care is an issue that crosses the political divide. She said bipartisan support of the issue has seemingly grown since last year. But she’s wary of obstacles the legislation could again face.

“There’s a real need, but there are people who are ideologically opposed and there are people who use any bills as leverage to further their own interests and their own agenda,” Arthur said. “That’s what we saw last year, and I think it’s possible we will see it again this year.”

Sam Lee, a long-time anti-abortion lobbyist who has pushed for this bill as pro-life legislation, said he’s hopeful the tax credits succeed, but is worried their prospects could be doomed in a divided Senate. 

“This is the year no one really knows what’s going to pass and it’s not because of the lack of merits of the legislation,” Lee said. “It’s just because of the consternation in the Senate.”

Building on momentum

Child care related funding and legislation last year gained traction primarily as a workforce issue and has garnered wide support from business groups.

Accessibility, quality and cost-related hurdles to child care, a 2021 U.S. Chamber of Commerce Foundation study found, force many Missouri parents out of the workforce or cause disruptions to their work, costing the state more than $1.3 billion annually. 

Missourians, like many Americans, confront a limited supply of child care that, when available, can rival the cost of a mortgage or in-state college tuition. An investigation of child care spending by The Independent and MuckRock last year found that almost half of Missouri’s children under age five, or about 202,000 children, live in child care deserts, with one or fewer child care openings for every three children. 

The average cost of full-time center-based care for an infant in Missouri was $11,059 as of 2022, according to Child Care Aware. On the other side of the equation, staff at child care facilities often make just over minimum wage, which can make hiring and retention difficult. 

Running a high-quality facility is often even more expensive than the fees parents can pay, so providers aren’t generally cashing in, but rather operating on thin profit margins.

“Early care and education providers cannot continue to subsidize care,” Nicci Rexroat, owner of A Place to Grow child care centers in mid-Missouri, testified at a state Senate committee hearing last week. “We just can’t afford it.”

“Without substantial and sustainable investments, the quality that the children deserve will continue to decline or become more and more scarce,” Rexroat added.

Lawmakers last year passed a $78 million boost to child care subsidies to encourage child care providers to offer services to low-income and foster families and another $81 million for state-funded pre-kindergarten targeted at low-income four-year-olds. Both were backed by Parson.

Casey Hanson, director of outreach and engagement at the child advocacy nonprofit Kids Win Missouri, said she sees this session as a chance to build on the momentum from last year.

Hanson called the child care tax credits “an interesting and innovative way we can engage both government, private business and individual and child care providers in a solution.” 

‘Child care is infrastructure’

The child care policy that so far has taken center stage is the tax credit package, though other proposals have been filed, as well. 

The three components of the legislation include:

• The “Child Care Contribution” tax credit, which would allow donors to child care providers to receive a credit equal to 75% of a qualifying donation, up to a $200,000 tax credit. The provider must use the donation to “promote child care” including by improving facilities, staff salaries or training. 

• The “Employer Provided Child Care Assistance,” which would be aimed at creating partnerships between businesses whose employees need child care and providers. It would allow employers to receive tax credits equivalent to 30% of qualifying child care expenditures.

• The “Child Care Providers Tax Credit,” which would allow child care providers to claim a tax credit equal to the provider’s employer withholding tax and up to 30% of a provider’s capital expenditures on costs like expanding or renovating their facilities. 

Supporters of the tax credits include various chambers of commerce and business groups, child advocacy groups and children’s health organizations. No one testified against the bill at the Senate committee hearing and just one person did at the House hearing, while dozens testified in support.

Rexroat testified that the credits could give providers the opportunity to raise wages and bring back qualified staff who can’t afford to work in the industry now.

“These tax credits could create a buy-in from other businesses and the community, helping to shift the narrative to what those of us have always known in the industry: that child care is infrastructure,” she said.

Some Republicans have raised concerns about tax credits being inefficient. 

At a Senate committee hearing last week, state Sen. Rusty Black, a Republican from Chillicothe, said he wanted to make sure “I’m not creating more red tape, more paperwork.”

The bill includes a provision allowing an intermediary nonprofit organization to help providers with the tax credits, which Arthur said is designed to provide technical expertise to those who don’t have the resources. Black wondered whether that intermediary could add additional hurdles to providers’ participation.

Missouri child care deserts include nearly half of kids 5 and under, new data shows

“I’m on the side of child care, but we’ve come up with way too many rules and regulations,” Black said, citing the passage of Nathan’s Law, which limited the number of related children that in-home daycares could supervise, for safety reasons.

“Are there gonna be more hidden rules to make it more restrictive?” Black asked, “…Because that scares me.” 

Amanda Coleman, vice president of early childhood and family development at the Community Partnership of the Ozarks, said there is a need for hundreds of infant spots in the Springfield area, “an alarming number.”

Coleman has worked with Kids Win Missouri to identify ways businesses can be part of the solution. She said a tax credit would be an immense help. Surveys she’s helped conduct show many parents in the Springfield area have left the workforce or changed jobs to accommodate child care needs. That leaves private child care providers struggling to keep their doors open.

“This is really important because we need adults to come to work, and those parents need to be able to have a safe, high-quality place for their children to go to during the day or while they’re at work,” Coleman said.

Coleman said another area survey found the average cost of full-time care in southwest Missouri is about $14,300 a year for infants and toddlers and $10,400 a year for preschool-age children.

Shields said she spent the summer traveling the state speaking with providers and parents. The stories were the same: parents are paying upwards of $20,000 a year for child care, if they can find it in the first place. Providers are crushed each time they turn down families.

“It breaks their hearts not to be able to provide services to these families that are struggling and who want to go to work,” Shields said.

Shields said she’s hopeful they’ll have success in the House again this year. Her bill cleared a committee on Thursday and could be debated by the full House as early as this week.

“I will work the Senate hard to make sure that that happens, but I think we will do it,” she said. 

Subsidy rate increase

Parson’s proposed $51.7 million increase to the state’s child care subsidy program would increase the rate the state reimburses providers who accept children on the program for low-income children. 

Higher state rates means families, generally, would pay less, and can mean subsidy recipients become competitive with parents paying entirely out-of-pocket.

The subsidy increase, Arthur said, may be even more important than the legislation that accompanies it because of how far behind other states Missouri is. 

The federal government recommends states pay providers at the 75th percentile of market rates, but few do. A boost last year brought Missouri up to the 58th percentile of what the market rate study found to be the rate of care.

The governor’s proposed increase would bring rates to 100% of the market rate amount for infants and toddlers and the 65th percentile for preschoolers and school-aged children.

Hanson said sustainable, long-term investments are crucial in “making sure those that are taking care of our kids are able to take care of themselves and valuing that it is important work.” 

The subsidy rate increase, Shields said, might be a tougher sell than the tax credits, but she’ll continue showing her colleagues how desperate families are for safe, reliable and affordable care. 

“The reason the support has grown,” Arthur said. “Is because people have heard from their constituents and businesses in their districts that this has caused major problems.”

The Department of Social Services resource center in Poplar Bluff, July 17, 2023 (Clara Bates/Missouri Independent)

Hannah Kaplanis applied to Missouri’s Medicaid program nearly two months ago, but hasn’t received any response from the state.

Just shy of 18 weeks pregnant, she’s in need of prenatal care and growing increasingly hopeless. Aside from a free ultrasound in November, she hasn’t been able to access any care. She called Missouri’s Medicaid helpline earlier this month but had to hang up after waiting on hold for 45 minutes, and she is unable to apply for other insurance until she is out of Medicaid limbo. 

“It feels like I’m doing motherhood wrong already, but it’s out of my hands,” she said. “I’m at a loss. It’s just a waiting game and that gives me anxiety.”

Jim Torres, program manager for health insurance services at Samuel Rodgers Health Center in Kansas City, helped Kaplanis submit her application and has been checking its status. He said that he hasn’t seen “any movement on her most recent application that was submitted on Dec. 4.” 

Kaplanis’ struggles are not isolated. 

Missourians trying to enroll in or retain Medicaid — the government-run health insurance program for low-income Americans — report running headlong into the state’s increasingly-strained system. Interviews with advocates, applicants, participants and experts reveal increased pressure on the state’s capacity has intensified bureaucratic hurdles to accessing Medicaid, which include lost and missing paperwork, indecipherable state notices and marathon call center wait times.

“I’ve been doing this with my organization for 10 years now,” said Saralyn Erwin, a marketplace and Medicaid coordinator at Northeast Missouri Health Council who assists with applications and renewals, “and this is the worst that I have seen it.” 

“I know Medicaid is doing the best that they can,” Erwin said. “It’s just overwhelming.” 

Missouri, like all states, is in the midst of the massive undertaking: evaluating the eligibility of every participant on its caseload for the first time in three years. 

After the COVID-era federal pause on annual renewals expired last year, the state in June began to review the eligibility of all 1.5 million Missourians on its Medicaid rolls, also called MO HealthNet in Missouri — which is around one-quarter of the state’s population. Now, just over halfway through the process, Medicaid enrollment has dropped by over 106,000 individuals, with half of them being kids.

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

From November to mid-January, during open enrollment season for the federal insurance marketplace, the state generally sees an uptick in Medicaid applications — a situation Erwin called, coupled with the resumed eligibility checks, a “double whammy” compounding the state’s capacity issues. 

The backlog of applications under review swelled to over 45,000 last month — a “pretty alarming number,” said Tim McBride, a health policy analyst, professor at Washington University in St. Louis and former chair of the MO HealthNet Oversight Committee. The average processing time has ticked up in the last few months and is now 36 days for low-income Medicaid applicants — approaching the federal maximum of 45 days.

Joel Ferber, director of advocacy at the nonprofit Legal Services of Eastern Missouri — one of the state’s legal aid programs which provides free legal assistance to low-income and disadvantaged Missourians — called the situation the  “perfect storm of problems.” The result: Eligible Missourians can slip through the cracks of a complex bureaucracy and be denied health care they’re entitled to and in desperate need of.

“There are all these different breakdowns in the system,” he said, “and that causes people to lose coverage who are eligible.” 

Routine changes turn painstaking

Brittani Rusu, of Washington, spent a month and a half last fall trying to inform the state of her pregnancy so she could be switched from the adult Medicaid coverage category to Medicaid for Pregnant Women — a process that was “way too stressful…when it should have been super easy.”

“I couldn’t go to doctor’s appointments, I couldn’t do anything until Medicaid was switched to pregnant women,” Rusu said, citing potential billing and coverage issues.

But she says she couldn’t seem to get her information through to the state.

“I updated changes within the system online and went and dropped off physical copies at the local office here in Washington,” Rusu, a mother of six said, “and nothing changed.”

She tried several times to contact the state’s call center to update her information but faced hours-long wait times and queues of dozens of people ahead of her, even when she would strategically time her calls for right as the center opened.

When she went to her local social services office for help, she said she was directed to a phone in the back of the room, where she faced the same call center wait she was trying to escape.

“In order to have things changed, you will have to wait on the phone in the office,” she said she was told. “And I waited there for two hours one day.”

Torres said routine changes like switching coverage for pregnant women or getting coverage for newborns used to be a “pretty quick and painless process.”

“The easiest things,” he said, “are becoming very difficult right now.”

The Department of Social Services, which oversees Medicaid, didn’t respond to a list of questions sent last week but in August told The Independent the agency was working to improve wait times and would “continue to explore additional strategies and implement enhanced technology options to assist participants in connecting with our services.”

Kim Evans, director of the Family Support Division, which oversees Medicaid eligibility within the Department of Social Services, previously attributed the long call center wait times to individuals selecting the wrong phone line.

There is one phone line devoted to renewals and one for other Medicaid questions, which are run by two separate companies. When The Independent called last week and selected the non-renewal Medicaid line, the wait time was one hour before the call dropped, and after calling back, it was 1 hour 54 minutes before being connected to a representative. 

Thirty seconds of the same piano loop plays on repeat during the wait, punctuated by a 10-second automated voice message: “Your call is very important to us,” it begins.

‘Chronic’ administrative issues

At each stage, advocates say, the system’s flaws can prevent people from keeping or getting coverage.

The state’s computer system produces sometimes-confusing notices, Erwin said, which can leave participants unsure whether they are losing coverage or not.

One Legal Services client’s renewal form listed nine different reasons for the termination of benefits, eight of which weren’t applicable or relevant, Ferber and a group of attorneys wrote in a letter to the federal Medicaid agency late last year. 

“People should not have to guess why their coverage is changing; they need a clear reason for the change,” they wrote.

One participant told The Independent they didn’t receive a denial letter until after the date by which they were allowed to appeal. 

The state’s online portal for document submission, which launched last year to allow people to scan and upload their documents virtually, has also been a source of concern. Ed Kolkebeck, public benefits attorney at Legal Services of Mid Missouri, said online document submission issues have been, “I think, the biggest problems that I’ve seen amongst my clients.”

Kolkebeck said he’s helped several people who were certain they’ve uploaded documents, who were then notified the state had no record of them ever turning anything in.

After clients receive notice that the state never got their documents, they must go in person, complete the renewal by phone, or submit documents by mail. The process “kind of defeats the purpose of having a document upload portal in the first place,” Kolkebeck said.

Once the state does manage to receive information, Erwin said, it often seems to “be sitting there” without being processed.

Torres said he’s seen documents being lost, the state requesting pay stubs they’d already received and documents languishing without being worked on by staff.

“Me, everybody on my team, I’ve been in meetings with people from health centers across the state, everybody’s really frustrated,” Torres said. “And it’s not just one off. It is chronic and almost across the board.” 

He added: “This is the worst we’ve seen in a long time.”

Steve Foelsch, who lives in St. Louis, has utilized a Medicaid program for over a decade designed to help people with disabilities be able to work.  

But he’s spent the last six months under the threat of losing it. 

Foelsch is a quadriplegic and the program, called Ticket to Work, helps pay for his personal care attendants. His yearly renewal for the program resumed last summer, after the three year pause.

He had issues pre-COVID with the annual renewal. But this year it’s gotten worse, he said, with a variety of issues including the state initially finding his income too high to qualify, then later in the year, failing to collect his premium and providing conflicting information about his status in the program.

He had to take a day off work last summer to take the bus to go to his local resource center, in downtown St. Louis, and said he waited for around four hours before being helped.

Disability Resource Association, a local nonprofit, had to step in to cover the cost of his payments to his personal care attendants at the end of last year after he was incorrectly determined to be inactive. The issues weren’t resolved until earlier this month, he said.

Looking ahead 

Some advocates think the state could be doing more to reduce the number of eligible recipients removed from the rolls.

Around three-quarters of all denied renewals are due to what are called procedural reasons, meaning generally that the participant failed to return paperwork or the state didn’t receive it. Missouri’s rate is around the national average.

“There are other states that are doing better on this,” said McBride, the health policy analyst at Washington University in St. Louis, “and we think the state could probably improve these numbers.”

Missouri could rely on more existing data to assess renewals, McBride said, without needing to get back information from the participant, erring more on the side of keeping people covered with other data than insisting they provide verification. Those are called ex parte renewals.

Children are eligible at higher income levels but have made up half of those removed from the state’s rolls. That portion of kids disenrolled is currently fourth highest in the country among the 21 states reporting age breakouts, according to the health policy nonprofit KFF. 

There were 53,673 fewer kids on Medicaid in December as there were in June. The state has, in prior months, stressed that it is focused on the issue and working to ensure kids remain covered if they are eligible, even if other members of their household are not. They have also pointed to the fact that kids make up roughly one half of the state’s overall caseload.

After kids, the next two Medicaid groups with the highest rates of net loss were low-income adults (18% decline) and persons with disabilities (15% decline).

Centers for Medicare and Medicaid Services, the federal agency overseeing state Medicaid programs, has released guidance and options to increase the rate of renewals using data the state already has. They’ve expressed particular concern about the coverage loss for children.

Ferber has been urging the state to take up more of those optional strategies, which include renewing those at or below 100% of the federal poverty when no data is returned. 

He said he wishes the state could fix the portal, act on documents in a timely manner and staff adequately. In the meantime, though, “It just seems like any way they could ease the burden on families and their staff like the ones CMS is offering is worth trying,” Ferber said. 

“That’d be a starting point.”

State Rep. Chad Perkins speaking during House debate on March 1, 2023 (Tim Bommel/Missouri House Communications).

A group of Republican lawmakers raised concerns about the death penalty and advocated for legislation that  would abolish it in Missouri during a Tuesday press conference at the state Capitol — characterizing it as an issue of restraining government overreach and protecting life. 

Rep. Chad Perkins, a Republican from Bowling Green, has filed legislation to abolish the death penalty and sentence those on death row instead to life in prison without parole.

“I think morally, I feel obligated,” Perkins said. “Anyone who says they’re pro-life should feel a little conflicted on this topic — because if you’re pro-life then I think you’ve got to look at it and say you’re that way from the beginning to the very end. And I don’t think that the government should have a monopoly on violence.”

Joining Perkins at Tuesday’s Capitol rally were Republican Reps. Tony Lovasco of O’Fallon, Jim Murphy of St. Louis and Travis Smith of Douglas.

Missouri was one of only five states to carry out death sentences last year, along with Texas, Florida, Oklahoma and Alabama.

Missouri executed four people in 2023 and two in 2022.

Between 1989 and 2021, the state executed 91 people, according to the Death Penalty Information Center.

Four people on death row in the state have been exonerated in Missouri since 1989.

“If we are truly at a 100% pro-life state, and being 100% pro-life,” Murphy said, “I believe that the death penalty is something that we really need to examine and put an end to because there’s just too many errors to be made and it’s just too big an error to make.”

Demetrius Minor, national manager for that national advocacy group Conservatives Concerned About the Death Penalty, said Missouri could look to other states like Ohio, where there is a Republican trifecta and momentum against the death penalty, with legislative hearings over a bill to abolish it.

“The trend is beyond dispute,” Minor said, “An increasing number of conservative Republican state lawmakers nationwide are taking the lead because they believe in limited government, they demand fiscal responsibility and most importantly, they value life.”

Lovasco, who filed the bill in previous years seeking to abolish the death penalty in Missouri, said he’s seen increased momentum on the issue from his fellow Republicans. 

“We’re seeing, finally, willingness to have a discussion about this within the Republican Party,” he said, “both behind the scenes and now finally in public.” 

Last year, after Lovasco introduced an amendment during the budget process to defund the death penalty, he said, “almost double the number of people in the Republican Party voted in favor of defunding the death penalty than when it had happened previously, when roll call votes had been done in the past by Democrats.”

Perkins is hopeful the issue gains traction this session, but it hasn’t been referred to a House committee yet. 

“Oftentimes an idea comes about and starts to get a bit of traction, and it doesn’t quite make it across the finish line,” Perkins said. “But you can feel that there’s a direction that people are going and so maybe it’s an idea whose time hasn’t quite come about, but I think that the time is coming.” 

Another bill, filed by Republican state Sen. Mary Elizabeth Coleman of Arnold, would limit but not abolish the death penalty. Her legislation would repeal a state law allowing a judge to decide on a death sentence when a jury is not in unanimous agreement.

Most of the states with active death penalty laws  require unanimous jury decision. In only Indiana and Missouri, a judge is allowed to impose a death sentence when a jury decision can’t be reached on sentencing. 

CORRECTION: This story has been updated to reflect that the state executed 91 people between 1989 and 2021. In total, there have been 97 executions to date.

State Sen. Mary Elizabeth Coleman, a Republican from Arnold, is one of two senators sponsoring legislation that would remove Missouri’s remaining restrictions on providing food benefits to those convicted of felony drug offenses. (Annelise Hanshaw/Missouri Independent)

A decade ago, Missouri lawmakers passed legislation that was celebrated as lifting the lifetime ban from food stamp benefits for people with a drug felony on their record.

But that legislation created a host of restrictions and requirements to be eligible for and access benefits, modifying the ban rather than eliminating it outright.

Now, two Missouri senators have filed legislation that would remove Missouri’s remaining restrictions on providing food benefits to those convicted of felony drug offenses. They argue the current system has severely hindered access to benefits for a population particularly in need of food aid as they reintegrate after incarceration.

“Successful reentry into society from the criminal justice system requires being able to meet basic needs such as food,” said state Sen. Lauren Arthur, a Kansas City Democrat. “Denying access to basic needs programs makes it harder for people with convictions to get back on their feet.”

Under current law, those who’ve been incarcerated can only have a single felony for drug possession or use to be eligible — and they then must participate in a treatment program and drug testing.

“I have not seen anyone who has been able to get it,” said state Sen. Mary Elizabeth Coleman, an Arnold Republican. 

Coleman, along with Arthur, is sponsoring legislation that would lift the ban completely, arguing that denying access to basic needs like food increases the risk of recidivism.

Missouri would join 29 other states in entirely opting out of the ban under the legislation.

Federal law since the mid-nineties has prevented those convicted of felony drug offenses from accessing food benefits under the Supplemental Nutrition Food Assistance Program, also referred to as food stamps. But states can modify the ban or opt out of it entirely.

Missouri has had a modified ban in place since 2014 allowing an individual convicted of a felony drug offense to apply for an exception allowing access to SNAP benefits. But a host of requirements must be met to qualify, including drug testing and treatment. 

Missouri’s requirements comprise “one of the nation’s most stringent bans for receiving SNAP benefits,” according to a report released in December by the nonprofit Collateral Consequences Resource Center.

Disqualifications include having been convicted of multiple felonies for possession or use, or any felony for drug manufacturing and distribution. 

Individuals also must also pass a drug test that they pay for, comply with their probation or parole conditions and be in or completed drug treatment.

Coleman said that in practice, Missouri lacks a system to grant the exceptions. 

“You have to get a system in place to allow that drug testing to happen to be able to apply,” she said, “and right now there is no system in place to allow it, so it is effectively a full ban.”

The Department of Social Services, which administers SNAP, did not respond to questions about how many people have been granted the exception or are turned away from SNAP due to drug felony convictions.  

But in other states with partial bans, thousands are disqualified each year — including because they may have trouble surmounting the various bureaucratic hurdles, such as getting proof that they completed rehabilitation treatment years earlier. States have also reported the additional work to process these cases can burden agencies’ capacity and limiting staff.

“I feel very, very strongly,” Coleman said, “that access to food and access to nutrition is not something that should be punitive.” 

This story has been updated since it was first published.

The program, which is administered by the Department of Social Services in conjunction with the Department of Elementary and Secondary Education, would provide $40 in food benefits for each month an eligible child is on summer break (Scott Heins/Getty Images).

Missouri has made the tentative decision to participate in a federal food assistance program for kids, potentially opening the door for millions of dollars in aid through a program called Summer EBT. 

However, the decision is not binding and Missouri still has to submit a detailed plan to the federal government on how it plans to run the program and secure the necessary administrative funds.

The state had until Jan. 1 to take this initial step or foreclose the option to participate entirely. 

“We’ll still have some work to do to support (the Department of Social Services) in putting together all of the pieces needed to actually receive these critical funds,” said Mallory Rusch, executive director of the nonprofit Empower Missouri, which urged the state to submit the letter of intent. “Nonetheless, this is an important win.”

The program, which is administered by the Department of Social Services in conjunction with the Department of Elementary and Secondary Education, would provide $40 in food benefits for each month an eligible child is on summer break, loaded onto a card that can be used like a debit card to purchase groceries. Students who are eligible for free or reduced lunch during the school year are eligible for Summer EBT. 

States have until Feb. 15 to submit a detailed management and administration plan to the federal government. 

Missouri officials wrote to the federal government in their letter of intent dated Dec. 21 that a “lack of final guidance” from the federal government regarding implementation of the program “poses potential unforeseen challenges to the implementation.”

Additionally, Missouri’s ability to meet the state funding requirements is contingent on obtaining funds from the state’s General Assembly, the letter noted, and Whaley said the department would need to secure those funds “before we are able to proceed further.”

The federal government will pay for the benefits but split the administrative cost 50/50 with the state.

The social services department will be the lead agency on the Summer EBT program, working with the education department.

At least 30 other states signed on, according to the Food and Nutrition Services site, the federal agency which administers the program.

In some states, the program has spurred controversy. Iowa Gov. Kim Reynolds recently announced her state would not participate, saying “an EBT card does nothing to promote nutrition at a time when childhood obesity has become an epidemic.” Nebraska Gov. Jim Pillen also decided his state wouldn’t participate, defended his opposition to the program by saying, “I don’t believe in welfare.”

Last month, Missouri officials were weighing considerations including: “technology solutions and the timeline in which a system would be in production and complete,” along with the level of staffing assigned to EBT implementation and administrative funding, education department spokesperson Mallory McGowin said at that time.

The Summer EBT program was approved and made permanent by Congress last year. A similar, temporary program called Pandemic EBT provided various benefits during the pandemic, including over the summers.

The temporary pandemic-era food programs were beset with administrative issues in Missouri that made dispersing benefits difficult — particularly because it required a new data collection portal to collect and share eligible students’ information with two agencies in the state.

The benefits designed to cover food costs during the summer of 2022 did not start going out until June 2023, and Missouri declined to participate in the summer 2023 program because of those issues — forgoing at least $40 million in aid.

States have until Jan. 1 to notify the federal government of their intent to participate, and must submit a plan by Feb. 15 (Brandon Bell/Getty Images).

Missouri education and social services officials have not yet made a decision on whether to participate in a federal food assistance program next summer, weighing their ability to execute it after years of administrative challenges and delays.

Participating in the program, called Summer EBT, would provide approximately $51.5 million in food benefits to 429,000 Missouri children next summer. States have until Jan. 1 to notify the federal government of their intent to participate, and must submit a plan by Feb. 15.

The state is evaluating federal guidelines and “assessing Missouri’s ability to implement the [Summer EBT] program in 2024,” said Mallory McGowin, spokesperson for the Missouri Department of Elementary and Secondary Education, the agency that administers the benefits. 

At least 20 other states have already notified the government of their intent to opt in to Summer EBT. 

The program provides $40 in food benefits for each month the child is on summer break, loaded onto a card that can be used like a debit card to purchase groceries. Students who are eligible for free or reduced lunch during the school year are eligible for Summer EBT. 

“We know how important this program is for kids and families,” said Crystal FitzSimons, director of School and Out-of-School Time Programs at the D.C.-based Food Research & Action Center.

“And we know what a huge impact it would make on reducing summer hunger, and easing the pressure on families’ household food budget. So we are really hopeful that Missouri and other states come onto the program.”

In a letter to Gov. Mike Parson sent Wednesday afternoon, a coalition of Missouri advocacy groups including Empower Missouri urged the governor to direct the education and social services agencies to operate the program.

“Missouri’s Department of Social Services or Department of Elementary and Secondary Education must act soon to meet this deadline,” the letter said. “…It is vital that Missouri leverage this opportunity to keep summer hunger at bay in 2024 and beyond.”

Missouri officials are weighing considerations including: “technology solutions and the timeline in which a system would be in production and complete,” along with the level of staffing assigned to EBT implementation and administrative funding, McGowin said.

The Summer EBT program was approved and made permanent by Congress last year. A similar, temporary program called Pandemic EBT provided various benefits during the pandemic, including over the summers.

The temporary pandemic-era  food programs were beset with administrative issues in Missouri that made dispersing benefits difficult — particularly because it required a new data collection portal to collect and share eligible students’ information with two agencies in the state.

The benefits designed to cover food costs during the summer of 2022 did not start going out until June 2023, and Missouri declined to participate in the summer 2023 program because of those issues — foregoing at least $40 million in aid.

The state is still troubleshooting benefits from summer 2022, McGowin said — primarily cases in which the department did not have the students’ correct address. Around 348,000 school children received the summer 2022 benefits, which is more than 100,000 short of the number predicted to have been eligible  — a discrepancy McGowin has previously attributed to instances such as students graduating or moving and no longer qualifying.

Summer 2022 Pandemic EBT also included children under age six, which the permanent program will not. Those benefits were dispersed in September 2023, McGowin said.

In July, McGowin pledged that going forward the state would “focus on implementing the system changes necessary to facilitate participation in Summer EBT programs in future years,” but said to participate, the state’s “data collection systems need to be addressed well in advance.”

FitzSimons said some states are “in a better place coming out of pandemic EBT.”

“Others I think didn’t really set up the long-term systems to build off of,” she said.“And Missouri did not participate in 2023. So I think they do need to do some work, probably, in setting up more permanent systems.” 

She added that putting in the effort now to create the system for this summer would ensure there is “less food insecurity over the summer in Missouri, that kids are able to return to school in the fall well nourished and ready to learn,” she said — and create a framework for years to come.

States are also facing the broader challenges of implementing a program with new guidance from the federal government and securing the funding to do so. 

The federal government will pay for the benefits but split the administrative cost 50/50 with the state. There is no budget request in the education department’s current fiscal year 2025 budget request for Summer EBT. 

McGowin said a request would be added during the legislative appropriations process if a decision to implement the program is made. 

The Supreme Court of Missouri in Jefferson City, as photographed on May 24, 2023 (Annelise Hanshaw/Missouri Independent).

A wide-ranging bill passed by the state legislature last year banning sleeping on public land was struck down on Tuesday by the Missouri Supreme Court for violating the constitution’s single subject requirement. 

Missouri lawmakers last year made sleeping on state-owned land a Class C misdemeanor and restricted state funds for combating homelessness. The legislation was passed as an amendment in a broader bill relating to political subdivisions just before the end of the 2022 session.

Critics of the bill feared it essentially criminalized homelessness. Supporters characterized it as reducing the prevalence of encampments they deemed dangerous to unhoused people and surrounding communities.

Legal Services of Eastern Missouri, along with Public Citizen Litigation Group and a Springfield homeless shelter, filed a lawsuit last year against the state, arguing the homelessness provisions did not fit within the bill’s overarching subject of “relating to political subdivisions.”

The case centered on whether the way the law was passed — as an amendment in a bill pertaining to “political subdivisions”  — violates constitutional requirements that legislation have a single subject, clear title and adhere to its original purpose. Those requirements were designed to support transparency and discourage legislative maneuvering to tack amendments that wouldn’t pass as stand-alone bills onto popular bills in order to pass.

Advocates, providers scramble as Missouri’s new homelessness law goes into effect

In March, Cole County Circuit Court Judge Cotton Walker ruled in favor of the state, and the plaintiffs appealed to the Supreme Court.

The Supreme Court unanimously overturned the circuit court’s decision Tuesday, with Judge Paul C. Wilson authoring the opinion.

The homelessness provisions added on to the bill “introduced at least one impermissible  additional subject, i.e., homelessness,” Wilson wrote.

The “primary inquiry,” he wrote, is whether all provisions of the bill “fairly relate to, have a natural connection with, or are means to accomplish [the bill’s] subject, i.e., ‘political subdivisions.’”

Even though some of the homelessness provisions regulate state funds that would apply to political subdivisions receiving those funds, Wilson wrote, the provisions also apply to nonprofits and private developers.

Other homelessness-related provisions in the bill, he wrote, don’t relate to political subdivisions at all. 

With the homelessness provisions found unconstitutional, the court then weighed whether that required it to strike down the rest of the sprawling bill.  

“It takes an extraordinary showing to convince this court to engage in judicial surgery to save a bill infected with the otherwise fatal constitutional disease of multiple subjects” Wilson wrote, “and no effort was made by any party to make such a showing here.”

As a result, the rest of the bill — including provisions related to county financial statements, county coroners’ salaries, and more — were also struck down Tuesday, with the court arguing it was unable to determine whether the bill would’ve passed without the homelessness provisions.

Boone County Public Health & Human Services advertises services to participants of WIC, a federal nutritional assistance program for qualifying low-income women, infants, and children that now faces funding uncertainty. (Clara Bates/Missouri Independent).

Around 27,000 Missourians who rely on a federal nutrition program for infants, young children, and pregnant and breastfeeding mothers could see benefits eliminated next year unless Congress increases funding. 

That’s according to a recent report from the D.C.-based nonpartisan think tank Center for Budget and Policy Priorities, which estimates that two million people nationally could be turned away from the Women, Infants and Children program, better known as WIC, by September of next year if it continues to operate at its current funding levels.

There were just over 93,000 WIC participants in Missouri as of September of this year.

The Biden Administration requested around $1 billion in emergency funding for the program this federal fiscal year, which began Oct. 1, because of increased participation and rising food costs. 

But Congress has not provided any additional funding in its two short-term funding bills passed so far, and some U.S. House Republicans have called to shrink the longstanding program. 

The most recent stopgap funding bill, signed last month, included $6 billion for WIC for 2024, but Center for Budget and Policy Priorities estimates around $7 billion will be needed to cover those projected to utilize the program this year. Congress’ stopgap funding extension expires Jan. 19. 

“Congress shouldn’t let us even come this close to this point,” said Ty Jones Cox, vice president for food assistance policy at the Center on Budget and Policy Priorities, during a press call Tuesday. “We are a wealthy nation that can afford to make sure toddlers have milk and vegetables.”

If there is a funding shortfall, the researchers predict states will implement wait lists and turn away participants. March could be the earliest states begin implementing measures to reduce participation, according to the report, assuming Congress finalizes the current funding levels in mid-January.

“WIC is a nutrition program,” said Sharon Parrott, president of the Center on Budget and Policy Priorities, “but it is also a connector program: It’s connecting people to the other particularly health services that they need,” including prenatal care.

The report notes that turning people away due to insufficient funding would “severely undermine” progress made nationally with a “recent uptick in participation” and could have a lasting effect on participation.

Missouri has faced particular participation challenges over the last few years but has pointed to recent improvements.

Only 39.5% of eligible Missourians participated in WIC in 2021, one of the lowest participation rates in the country, due in part to the state’s burdensome in-person system for benefit dispersal. But from October 2022 to September 2023, the rate of participation increased by around 8%, the department previously told The Independent.

The Missouri Supreme Court building in Jefferson City (Annelise Hanshaw/Missouri Independent).

Missouri’s highest court this week heard arguments over the constitutionality of a two-year-old state law terminating parental rights following a conviction for certain crimes against children. 

The case, heard Wednesday by the state Supreme Court, involves a Jefferson County father whose parental rights were terminated after he pled guilty to child molestation and sexual misconduct in 2022. Both the father and the child are unnamed in legal filings.

Termination of parental rights means the permanent severance of the parent-child relationship and is sometimes referred to as the “death penalty of civil cases.” 

Before the law was amended by the legislature in 2021, there was a requirement the child victim be familially related to the parent in order for the state to have grounds to prove parental unfitness. In this case, the victims were unrelated to the father and the crimes to which he pled guilty occurred before the child was born.

The father’s attorney, David Crosby, argued Wednesday that not all felony offenses “involving a child under 18 warrant a termination of parental rights,” including in his legal brief the hypothetical of an 18-year-old assistant coach having a sexual relationship with a 17-year-old student, which is a class E felony.

“The question is, where do you draw the line?” Crosby said. “Well, the legislature needs to draw the line or this court needs to draw the line because the judges need to understand what’s required.”

He added: “The process of eviscerating family ties should not be simple, it should not be easy.”

Jason Sapp, an attorney representing the juvenile office, which files petitions for courts to terminate parental rights, emphasized on Wednesday that the government has a “duty to protect children.”

The criminal acts that could lead to termination of parental rights under the law include criminal sexual offenses, prostitution offenses, criminal offenses against the family and criminal pornography and related offenses. 

“You have proven contact of a parent that rose to the level of a felony and speaks to how that parent behaves towards children,” Sapp said.

To terminate parental rights, the state is required to first prove parental unfitness — designed to be a steep hurdle to protect parents’ liberties. It  requires clear, cogent and convincing evidence. Only then comes an evaluation of what is in the child’s best interests, which requires a lower standard of evidence.

Crosby argues the law is unconstitutional because it makes felony convictions involving children proof of unfitness — providing automatic grounds for termination of parental rights rather than case-by-case evaluation of fitness and depriving people of the chance to contest the conclusion of unfitness.

The state counters that a conviction itself “speaks to the conduct of the parent that goes to parental unfitness,” and the parent’s chance to rebut that finding came earlier, in the criminal proceeding.

“There is a more than reasonable logical connection,” the state’s attorneys wrote in a brief, “between a person engaging in felonious criminal acts under any of these chapters where a child is the victim and that person’s fitness to serve in a parent’s authoritative role of responsibility for the care and well-being of a child.”

The judges’ questions Wednesday surrounded the trial court’s discretion to choose to enter a judgment terminating rights after the juvenile office filed for it. Crosby said that although the court does have some discretion, that is not a sufficient check guaranteeing a parents’ constitutional rights.

“The court is supposed to have the least-restrictive means to protect the liberties of the parent. And statute offers them no guidance at all. It says if it’s a conviction, then you go straight to the best interest, regardless of what it is,” Crosby said.

Crosby argued there should be a specific case-by-case judicial finding that the parent is unfit, which could include factors such as the parent’s treatment and rehabilitation, age and frequency of the crime. 

“There are sexual offense crimes that do not involve family members that — I’m not here to protect people who have been charged with sex crimes — but they are people that are entitled to the right to have their children,” Crosby said. “And what the legislature is doing is punishing. Instead of saying this is what’s best for the children. We just want to punish people who have perpetrated crimes against children.”

The court did not take action in the case on Wednesday. 

Missouri's Department of Mental Health building in Jefferson City (Annelise Hanshaw/Missouri Independent).

There are 285 people in Missouri jails waiting to be moved to state psychiatric hospitals for treatment, the Department of Mental Health told lawmakers Monday.

There were 229 people waiting for treatment in March, 253 in September, 260 in October and 272 in November. These individuals were arrested, deemed unfit to stand trial and ordered into rehabilitative mental health services that could allow them to stand trial, a process called competency restoration. 

They wait in jails for months to be transferred to state-run psychiatric hospitals, without having been found guilty of any crime.

“Those lines don’t seem to be going in the right direction,” Rep. John Black, R-Webster, who chairs the House subcommittee on appropriations for health, mental health and social services said of the numbers of people waiting for evaluations.

“You’re absolutely correct,” replied Valerie Huhn, director of the Department of Mental Health.

The state is working to mitigate the situation in several ways, Huhn said, but the number of people waiting in jail for services “does keep going up.”

A new program, which aims to bring treatment to jails, is in the process of being implemented, Huhn told lawmakers, and the agency hopes to have contracts with the county jails signed soon.

Staffing issues along with an increase in court-ordered referrals have contributed to the capacity issues. There are also limited options for community-based treatment for patients in the hospital who could be discharged.

Vacancies in the department are “getting better incrementally,” Huhn  said, citing pay increases earlier this year, but the agency is still short-staffed, particularly at Fulton State Hospital. Many of the existing staff are part-time.

The department this year added state-operated beds in Fulton and St. Louis, she said, though there are still 16 beds in Fulton that are not open.

Huhn also cited a focus on recruitment and retention in the department. 

“We recruit like it’s 1980 and everybody just wants to come work for the state and that’s not the case anymore. We have got to be a more active recruiting type organization,” Huhn said, adding that they have seen success working with a contractor to help with hiring in Independence and Higginsville. 

The department received $300 million this year to open a new hospital in Kansas City and expects 100 beds there to be used for competency restoration, Huhn said. Site selection for that hospital is underway and the agency expects it to be built in around four or five years.

A law passed this year gives the agency the authority to treat people within jails, called jail-based competency restoration, or on an outpatient basis if the person can be safely released. This year’s budget set aside $2.5 million for the jail-based competency programs to be established in jails in St. Louis, St. Louis County, Jackson County, Clay County and Greene County. Counties are in the process of reviewing contracts.

Services will include room and board, along with medical care for 10 people at each jail, contracted staff from a local behavioral health organization, and psychiatric care from the department’s “mobile team practitioners,” which is expanding. 

“We’ve been working with the community providers who will then be going into the jails,” Huhn said,”and hopefully we can get some folks restored to competency in those settings so that they don’t need to come into the state operated psychiatric hospital.”

Languishing in jails, individuals’ mental health, the department’s budget book notes, “will continue to deteriorate… in many cases individuals never fully recover from the extended period of decompensation.” 

At least 13 other states have offered jail-based competency restoration services since the first program was established in the late 1990s, though they vary widely in design, and some oppose the programs, arguing jails are the wrong treatment setting for a person with severe mental illness. 

“Those programs are not going to work for everybody,” Huhn said. “But one of the things we know with jail-based is that if we can at least start maybe we get somebody, when we can actually get them into the state psychiatric hospital they’re in a better position than they would be if we weren’t doing anything.”

Huhn said this will save the state money and is  “also better for the people we support and the jail and everybody else who’s involved in their life.” 

Rep. Deb Lavender, D-Kirkwood, asked about money in the budget for legal expenses related to those waiting for treatment and asked whether anyone is “looking at a lawsuit against the state.”

“Not yet no, not that I know of,” Huhn said. “They have in many other states gone down that path.”

Elsewhere, there have been recent high-profile lawsuits against long wait times in jail for those needing mental health services in states including Indiana, Kansas and Pennsylvania, arguing that long wait times are unconstitutional because they deprive people of due process. 

Investigations nationally have found many of the people awaiting hospital beds are held for longer than they would be if they had simply been convicted of the crime.  

The Downtown Children's Center in St. Louis (Rebecca Rivas/Missouri Independent).

Missouri’s Board of Education changed a rule on Tuesday that had prevented many child care providers from accessing the $26 million in grant funding allocated by lawmakers this year.

The grant money was set aside for community-based child care providers to expand access to pre-kindergarten but included certification requirements that shrank the pool of eligible providers. Around $7 million of that fund has so far been awarded or is expected to be awarded from the September and November rounds of applications.

The vote to change the requirements was unanimous, effective immediately, to carry out the goal of expanding access to child care across the state — “a huge priority and a huge need,” said Kari Monsees, Missouri’s deputy education commissioner.

Casey Hanson, director of outreach and engagement at the child advocacy nonprofit Kids Win Missouri, said her organization heard from many providers unable to qualify and worked closely with the department to try to fix the grant’s requirements. 

“[The rule change] will really create a better pathway to child care providers being able to access that money,” Hanson said.

Previously, child care providers needed to prove they had a traditional teaching certification, which Hanson said is a “much higher threshold than the national standard.” 

“In talking to providers,” Hanson said, “the reason that most of them, even accredited providers in Missouri, can’t qualify for those dollars is because of that teacher qualification piece.”

The rule change expands the qualifications that child care staff can have to be considered eligible for the state funds. That includes allowing teachers who have a bachelor’s or associate’s degree in childhood development to qualify.

The education department’s spokesperson, Mallory McGowin, said it has begun awarding grants in two rounds since September, totaling to just over one-quarter of the total fund.

The first round awarded grants to 51 programs to add 789 child care slots. The second round closed in November and the department expects to award grants to just 28 programs for 568 slots, she said. Those add up to around $7 million to date. The payments haven’t been processed, McGowin said, because “invoice information is currently being verified.”

The department, McGowin said, expects to announce the next round of grants later in December.

The House's Subcommittee on Appropriations - Health, Mental Health, and Social Services on Dec. 4 (Clara Bates/Missouri Independent).

A state investigative team has helped locate 628 foster kids this year who were missing from state custody in Missouri, state lawmakers were informed at a House budget hearing Monday. 

That effort began officially in 2022, after the Department of Social Services was under fire for the high number of children in foster care who had gone missing. Since then, the team has helped locate more than 1,200 missing foster children, said Frank Tennant, director of Missouri State Technical Assistance Team — the law enforcement agency within the state’s social services department that works on child maltreatment issues and has focused on locating missing foster kids over the last few years. 

“We have been so successful that we have been approached by the Missouri State Highway Patrol,” said Tennant — to help with their list of missing kids, too.

He cited the team’s success using tools like social media to locate children. 

“There’s been several cases where they’ve gone out, found kids, got them back to where they needed to be and back in care to where they’re safe and secure,” Tennant told lawmakers.  

There are 74 missing foster kids as of Monday morning, Tennant said, though the state could not immediately make available comparable data over time.

State Rep. John Black, R-Webster, who chairs the social services appropriations subcommittee in the Missouri House, said he “appreciate[s]” hearing about the department’s successes along with the budget information. 

States lose track of thousands of foster children each year

“This can be a circumstance where good things that happen can get lost in numbers,” Black said. “And so we want the committee to be able to understand some things that the department is pleased about.”

A 2021 federal watchdog report found there were 1,780 instances of foster kids going missing in Missouri from  July 2018 to December 2020, spurring lawmakers’ scrutiny.

There were 978 children missing at some point from Missouri foster care in 2019.

Part of the issue was that the state’s system couldn’t distinguish between missing kids and kids whose location was known but unauthorized — which they said has been since fixed. The monthly data the agency publishes still combines both categories, spokesperson Caitlin Whaley said.

In 2022, a program called the Unaccounted for Foster Children went into effect in Missouri to help find children missing from state care and custody. Roughly 600 children were located and returned to state care last year, according to data included in the state budget. 

In many states, overburdened caseworkers have been hard-pressed to protect all the children they are responsible for monitoring — and when kids go missing, caseworkers often struggle to prevent it from happening again, Stateline reported this year. 

Robert Knodell, director of the Department of Social Services, said during another discussion that staffing issues department-wide have improved since COVID but haven’t rebounded entirely.

“We’re filling positions at a higher rate today than we have since prior. So, we are having success,” he said. “But we’ve got a long way to go. We have a less experienced workforce than we’ve historically had.”

A qualifying foster parent under the proposed federal rule would need to be educated on the needs of the child’s sexuality or gender identity and, if the child wishes, “facilitate the child's access to age-appropriate resources, services, and activities that support their health and well-being" (photo illustration by Ross Williams/Georgia Recorder).

Missouri Attorney General Andrew Bailey this week joined with 18 other states to oppose a proposed federal rule that aims to protect LGBTQ youth in foster care and provide them with necessary services.

The attorneys general argue in a letter to the U.S. Department of Health & Human Services that the proposed rule — which requires states to provide safe and appropriate placements with providers who are appropriately trained about the child’s sexual orientation or gender identity  — amounts to religion-based discrimination and violates freedom of speech.

“As a foster parent myself,” Bailey said in a news release Tuesday, “I am deeply invested in protecting children and putting their best interests first.”

“Biden’s proposed rule does exactly the opposite by enacting policies meant to exclude people with deeply held religious beliefs from being foster parents.”

The rule is part of a package of federal proposals on foster care and is an extension of the Biden administration’s broader push to protect LGBTQ kids in foster care.

“Because of family rejection and abuse,” the Biden administration said in a September press release, LGBTQ children are “overrepresented in foster care where they face poor outcomes, including mistreatment and discrimination because of who they are.”

State agencies would be required under the rule to provide safe and appropriate foster care placements for those who are “lesbian, gay, bisexual, transgender, queer or questioning, intersex,” along with children who are “non-binary or have non-conforming gender identity or expression.”

A qualifying foster parent would need to be educated on the needs of the child’s sexuality or gender identity and, if the child wishes, “facilitate the child’s access to age-appropriate resources, services, and activities that support their health and well-being.”

An example of a safe and appropriate placement is one where a provider is “expected to utilize the child’s identified pronouns, chosen name, and allow the child to dress in an age-appropriate manner,” according to the proposal, “that the child believes reflects their self-identified gender identity and expression.”

The attorneys general characterize that as “forcing an individual to use another’s preferred pronouns by government fiat,” in violation of the First Amendment.

Robert Fischer, director of communications for Missouri LGBTQ advocacy organization PROMO, said the freedom of religion “doesn’t give any person the right to impose those beliefs on others, particularly to discriminate.” 

“Any state official who claims to put ‘children’s interests first’ and in the same breath is willing to risk their well-being and opportunity to thrive in the name of religion — I think that speaks for itself,” Fischer told The Independent. 

The rule prohibits retaliation against children who identify as LGBTQ or are perceived as LGBTQ.

Public agencies would need to notify children about the option to request foster homes identified as “safe and appropriate” and tell them how to report concerns about their placement.

Agencies would also have to go through extra steps before placing transgender, intersex and gender non-conforming children in group care settings that are divided by sex.

The “majority” of states, according to the proposed rule, would have to “expand their efforts” to recruit and identify providers who could meet the needs of LGBTQ children.

Missouri guidelines

Laws and policies for protecting LGBTQ youth in foster care — relating to kids’ rights, supports, placement considerations, caregiver qualifications and definitions — currently vary by state. 

According to a federal report published in January, which reviewed states’ laws and policies, Missouri does not have laws or policies explicitly addressing any of those five categories.

Most states — 39 states and Washington, D.C. — have “explicit protections from harassment or discrimination based on sexual orientation or gender identity or expression,” according to a federal report, as of January. Missouri is not one of them. 

Twenty-two  states and D.C. as of January, require agencies to provide tailored services and supports to LGBTQ youth, and eight states and D.C. offer case management and facilitate access to “gender-affirming medical, mental health and social services.”

Children’s Division, the agency within the Missouri Department of Social Services that oversees foster care, offers guidance on their website for providers and child welfare staff in “supporting LGBTQ youth in foster care,” but still does not appear to have official policy on the issue.

A spokesperson for the Missouri Department of Social Services did not respond to a request for comment. 

Those guidelines include using the child’s “preferred name and pronouns,” along with establishing a supportive environment and providing “physically and emotionally safe and supportive care and resources regardless of one’s personal attitudes and beliefs.”

The Department of Social Services is part of the administration of Missouri Gov. Mike Parson, and the guidelines were in place the entire time Bailey was serving as Parson’s general counsel — the second highest ranking job in the governor’s office.  

Asked whether he raised any objections to the guidelines during his tenure with Parson, Bailey’s spokesperson said he “had no involvement in crafting [the Department of Social Services’] ‘best practices’ as general counsel.”

AG arguments

The 19 attorneys general contend the federal rule would “remove faith-based providers from the foster care system” because of their “religious beliefs on sexual orientation and gender identity.”

They cite Fulton v. City of Philadelphia, a U.S. Supreme Court case that ruled a public agency couldn’t force private, religious foster agencies to allow same-sex foster parents.

The proposed rule itself also acknowledges the Supreme Court case and alleges that by not requiring religious foster-care providers to welcome LGBTQ children, it is complying with the court’s precedent.

But the attorneys general do not believe this is enough. Their letter argues the proposal violates freedom of religion because those unwilling to support LGBTQ foster children “would be excluded from providing care to as many as one-third of foster children ages 12-21.”

“In addition to discriminating against religion, the proposed rule will harm children by limiting the number of available foster homes, harm families by risking kinship placements, and harm states by increasing costs and decreasing care options,” the letter says.

The rule would “discourage individuals and organizations of faith from joining or continuing in foster care,” the attorneys general argue, and “reduce family setting options.” Without faith-based foster parents, the attorneys general say, children would be more likely to be placed in congregate settings.

They also say the rule could disqualify family members who volunteer as placement, or kinship care, if the family member does not agree to support the child’s sexuality or gender identity with age-appropriate resources, as the rule entails.

This story was updated since it was first published.

Bread at the Schnuck’s grocery story in Columbia marked as permitted to be purchased through Missouri's WIC program, which provides supplemental foods, nutrition education and referrals to health care, at no cost, to low-income pregnant, breastfeeding and postpartum women, infants, and children up to age 5 who are determined to be at nutritional risk (Jason Hancock/Missouri Independent).

Missouri has one of the lowest participation rates for a federal program that provides food for low-income women and young children, a recent report found.

The report, from the U.S. Department of Agriculture’s Food and Nutrition Services, also noted that Missouri is one of 17 states with “coverage rates consistently lower than national rates across all categories and age groups.”

In Missouri, the Women, Infants and Children, or WIC, program, is operated through the Department of Health and Senior Services and delivered by local health agencies.

A spokesperson for the department, Lisa Cox, said the overall participation rate in WIC has “decreased over the last several years and decreased sharply during the pandemic when it was difficult to access WIC benefits in person at times.”

The department is planning to move to an online processing system “before the end of 2024” to improve accessibility — a shift which began in 2021.

The report found that only 39.5% of eligible Missourians participated in WIC in 2021. Roughly 215,000 people in the state were eligible for the program and only 84,900 participated.

The WIC program provides supplemental food, nutrition education and referrals to health care to low-income pregnant, breastfeeding and postpartum women, infants, and children up to age 5 who are determined to be at nutritional risk.

It’s a federal program but participation rates are far from uniform across the country: The rates of the eligible population participating in WIC ranged from a low of 35% in Arkansas to high of 72% in Vermont. States administer and oversee the program.

The other six states with coverage rates below 40% were Arkansas, Illinois, Louisiana, New Mexico, Ohio, and Utah. 

The report comes as the state health department works to overhaul its burdensome system which stymies participants’ access to benefits.

The federal report appears to be the first to measure participation in terms of eligibility for 2021. It did not give reasons for the varying rates of coverage, but a report last year pointed to the differences in delivery systems, outreach and coordination levels, and staff capacity. 

Unlike almost every state, Missouri lacks a system to remotely and automatically reload benefits onto participants’ cards.

Missouri participation in public benefits program WIC fell sharply during pandemic

Instead, as of last year, Missouri was one of just nine states which uses a WIC system that requires participants to bring their benefits cards to the local agency office when loading benefits — what’s called  an “offline” system for reloading benefits. Those benefits can then be used at grocery stores to purchase eligible items.

Most other states operate “online” systems capable of remotely and automatically reloading benefits.

There are economic and transportation barriers to accessing benefits in person, researchers have found. One participant told The Independent she has to “request off work just to come load the card.” 

The state is “actively pursuing technology updates to improve access to WIC services and benefit redemption processes,” Cox said. The department is working to improve outreach and remove some barriers to remote service, which is “expected to have a positive impact on WIC participation.”

Missouri chose an offline system based on an analysis conducted roughly a decade ago, Cox previously told The Independent. When, during COVID, “it became apparent that an online system would be more user friendly,” Cox said, “Missouri WIC was unable to change that decision mid-implementation.”

From October 2022 to September 2023, the rate of participation increased by around 8%, Cox added. The state doesn’t measure participation in terms of the eligible population in the same way the federal data, which lags, does. 

The department data shows 93,050 people participated in WIC in September of this year. 

A Planned Parenthood Reproductive Health Services Center in St Louis (Michael B. Thomas/Getty Images).

The Missouri Supreme Court on Wednesday heard arguments over whether the state’s move to block Planned Parenthood from receiving Medicaid reimbursements was constitutional — the second time in three years the issue has reached the state’s highest court. 

After the state legislature voted to block Planned Parenthood from receiving Medicaid reimbursements last year, the organization sued. In December, Cole County Circuit Judge Jon Beetem concluded the state couldn’t deny access to funds available to other health care providers. 

The attorney general’s office appealed on behalf of the Department of Social Services, which oversees Missouri’s Medicaid program, arguing the “entire purpose of the appropriations process is to prioritize funds.”

“I can’t stress this enough,” said Joshua Divine, solicitor general in the attorney general’s office. “A ruling for Planned Parenthood on the constitutional issue would create catastrophic aftershocks that would wreck the appropriation process that has been used for decades.”

Planned Parenthood argued that the appropriations bill conflicts with statute, so the state would only be constitutionally permitted to zero out the funding if they changed the statute.

“The $0 appropriation is an appropriation bill that changes the substantive law to deny an eligible provider with a contract access to Medicaid funding,” said attorney Chuck Hatfield, representing Planned Parenthood, “and that you cannot do.”

In a similar case in 2020, the Supreme Court struck down language in a budget bill that excluded abortion providers or their affiliates from receiving Medicaid reimbursements, calling it a “naked attempt” to legislate through a budget bill. 

“Here we go again,” Hatfield said, “with a long line of cases where this court has met its responsibility…to advise the legislature on the limits of its authority when it comes to appropriation.”

Debate over proper procedure to restrict funds

Last year’s appropriations bill included a line to spend $0 for Medicaid-covered services if the provider also offers abortions or is affiliated with an abortion provider. That blocked reimbursements to Planned Parenthood for reproductive health services including STI screenings, cancer screenings and contraceptives. The state’s Medicaid program has long banned funding for abortion, with limited exceptions, and since last year’s U.S. Supreme Court decision overturning the constitutional right to an abortion, abortion is banned in the state.

Medicaid serves low-income and disabled Missourians. 

Planned Parenthood and its defenders characterize legislative attempts to restrict the organization’s funding as a broader attack on access to reproductive health care. Anti-abortion advocates contend the state should not use taxpayer dollars to subsidize abortion providers.

In his December ruling, Beetem agreed with Planned Parenthood that efforts to “deny access to funds that are otherwise available to other MO HealthNet providers is ineffective and/or unconstitutional.” 

The hearing Wednesday centered on whether Planned Parenthood should have first taken the matter to the Administrative Hearing Commission, as well as whether Planned Parenthood had contractually waived any claim to funding or had the legal ability to sue. 

The state argued Planned Parenthood “ran straight to court” when they should have gone to the administrative hearing commission, while Planned Parenthood called those arguments “meritless procedural roadblocks.” The courts were the correct venue because the questions at hand were constitutional, the organization argued. 

The judges asked questions about the point of the administrative hearing commission and whether the appropriations were being used to amend substantive law — whether the process the state used to exclude Planned Parenthood was constitutional.

Divine said this case differed from the 2020 case because lawmakers made a “literal front-end appropriation,” which provided zero dollars for Planned Parenthood.

“There has never been any dispute that the legislature can constitutionally restrict Medicaid funds from Planned Parenthood if it wants to do so,” Divine said. “It just has to go through the proper procedures.”

In 2020 the legislature “tacked on this additional language at the end,” after already appropriating the funds, Divine said, but in this case, the two categories of funding for organizations receiving Medicaid funds “simply exclude Planned Parenthood, just like they exclude many other organizations.”

Asked by a judge if any other providers were excluded, Divine said “I don’t think the record makes that clear.”

“…Here the legislature said what we’re excluding from the $60 million pot is abortion providers and their affiliates,” Divine said, “so the Planned Parenthood providers are clearly in that but I think other affiliates, some other organizations that might not be before this court would also be excluded.”

Hatfield said the way to exclude Planned Parenthood from Medicaid reimbursements constitutionally  would be for lawmakers to amend the statute and said that’s what the Supreme Court concluded in 2020.

“What you said is if you want to change who an eligible provider is under Medicaid, you must change the statute: You told them very clearly how to do this,” he said, “And by the way, the legislature has the votes, in my view, this is my opinion — if they want to go change the statutes and exclude providers, they can do that. And that’s what you told them very clearly.”

The issue itself has been around for decades: Missouri lawmakers have been attempting to restrict public funds from going to Planned Parenthood since the mid-90s.

A family enters the Missouri Department of Social Services resource center in Columbia (Clara Bates/Missouri Independent).

More than 52,000 Missouri children have been kicked off of Medicaid in the first four months of renewed eligibility checks, though the state isn’t sure how many of those kids have managed to re-enroll.

At Tuesday’s quarterly meeting of the board that oversees Missouri’s Medicaid program, the MO HealthNet oversight committee, concerns about the number of children losing coverage were raised. According to research by the health policy nonprofit KFF, the proportion of children disenrolled in Missouri is higher than all but two of the 20 states that publicly report data. 

Sen. Tracy McCreery, a Democrat Olivette who serves on the committee, asked Tuesday why “so many kids are losing coverage during the unwinding process.”

“My concern is that there are kids out there that are dependent on adults to get the forms filled out properly,” McCreery said, “and in the meantime it’s a kid that’s losing coverage.”

End of public health emergency could cause spike in uninsured Missouri children

Kim Evans, director of the state’s Family Support Division, told the committee that one culprit is that Missouri has a “high rate of self employment,” specifically mentioning professions like beauticians, Uber drivers and landscapers.

She said that can make it hard for the state to get renewal paperwork back from those individuals, and “unfortunately, sometimes, you know, the children are in the household. They’re some of our largest groups, and when it’s that self-employment, then we have trouble getting that information.”

The income limit for kids to be eligible for Medicaid is higher than adults — meaning even if parents lose coverage, kids may still qualify but sometimes fall through the cracks. Children make up roughly half of the overall Medicaid caseload in the state.

Due to a federal policy change, children will soon have one full year of coverage once they’re approved or renewed for the program — unlike adults, who can lose coverage in the months between yearly checks if, for instance, their income changes. But that policy change has little bearing on the current renewal issues which stem from the required, one-a-year eligibility check.

Paperwork issues are the main reason most in Missouri lose coverage — not lack of eligibility. 

Over the first four months, 79% of those who lost coverage in Missouri lost it for procedural reasons, which is slightly higher than the national average of 71%, according to KFF.

September, the most recent month for which data is available, was the fourth month of the state reassessing the eligibility of every Medicaid participant after a three year COVID-era pause on the practice. The process will take place over a year. 

Around one-quarter of the state’s population, or over 1.5 million people, were enrolled in Medicaid in June when the process began. On Sept. 30, there were 1,459,399 people on the program — it’s not yet clear the breakdown of new applicants to Medicaid versus those who lost coverage and then cycled back onto the program.  

Over the first four months of eligibility checks, one-quarter of those reviewed lost coverage. Over half remained eligible and 22% of renewals were still pending.

‘Distressing cases’

As is the case nationally, Missouri has, so far, had a high rate of terminations due to paperwork issues. Procedural disenrollments refer to a variety of paperwork-related issues that prevent the state from determining a participant’s eligibility — including that the state never received the completed paperwork or the participant never received the form. 

Enrollees have 90 days after termination to submit required paperwork for reconsideration and to be reinstated if eligible. After 90 days, they need to fill out a new application to be enrolled.

The state has not yet broken down the sources of procedural issues.

Elizabeth Larsen, attorney and program director of advocates for family health at Legal Services of Eastern Missouri, said she and colleagues are seeing a variety of issues.

Some of the common causes of procedural denials, she said, include people who did not receive the renewal form; received it but are confused and so don’t complete it; and people who submitted it on time and submitted more information as requested, but are nonetheless denied because their information isn’t processed in time by the state. 

In the latter case, Larsen said the denial could be because the state’s document processing can sometimes take “days and we’ve even seen a week” — so the state’s computer system closes out the case and automatically denies coverage while the documents are still waiting to be processed. 

“To me, those are the most distressing cases,” Larsen said, “because there is literally nothing else the person could have done. They did everything that was requested of them and they’re still losing coverage.”

The Department of Social Services, which oversees the Medicaid program, didn’t immediately respond to a request for comment and the specific causes of procedural denials didn’t come up in the Tuesday meeting.

Processing delays

Missouri last year came under scrutiny for its long processing times for new Medicaid applications. The average processing times have been ticking upward since the renewals began and the workload for staff has expanded.

For the Medicaid group which includes the majority of participants, the average time to process a new application went from 15 days in July to 24 days in September. Federal rules say the wait should be no longer than 45 days.

As of the September report, there was a backlog of 12,205 of these applications awaiting determination, up from 4,266 in July and 8,686 in August. 

Many other states make these determinations near-instantaneously, automatically verifying through electronic data sources.

For the aged, blind and disabled Medicaid group, the average wait, up to 87 days in September from 54 in July, is just under what federal rules allow. The federal rule is a maximum of 90 days.

As of September there was a backlog of 9,588 of these applications pending determinations, compared to 8,906 in July and 10,210 in August. 

There has been a rise in new applications, which Evans attributed to  open enrollment, the period when the federal marketplace is open to new applicants, which began Nov. 1 and lasts until Jan. 16. She said some of the increase can also be attributed to new residents in Missouri. 

There have been reports of high wait times for those calling for assistance with their renewal, too, but Evans attributed the issue to individuals selecting the wrong phone line.

“One thing that we’re hearing from some of our stakeholders…is that participants are having trouble getting through the phone,” Evans said. “What we found is that the individuals are not going to the Medicaid call center so they’re not taking that option to get themselves to the call centers.”

Evans said callers are mistakenly going through the general questions line and urged those at the meeting to educate participants: “They’re not choosing that option to take them to Medicaid.”

On a “really positive note,” Evans said the division’s longstanding staffing issues have ebbed. During job fairs, the family support division has had “more applicants than we have positions” in several places in Missouri. 

“That’s really going to help us,” she said, “as we talk to some of these numbers and all the work that we have in front of us right now.”

Logan Yandell, pictured in 2009, was sexually abused at Kanakuk Kamps from by its former director, Peter Newman. Yandell's family settled with the camp in 2010 — the subject of an ongoing lawsuit (Photo submitted).

A Branson-area Christian summer camp accused of covering up years of sexual abuse of its students is suing its insurance company, claiming it threatened to deny coverage if information about abuse was made public.

Kanakuk Kamps filed a cross claim last month against ACE American Insurance Co. as part of a 2022 lawsuit filed by a former camper who says his family was tricked into signing a “fraudulent” settlement agreement after he was sexually abused by a camp director.

The insurance company “threatened to deny Kanakuk coverage” if the camp were to disclose the abuse of former director Peter Newman to families, Kanakuk’s attorneys argue in the cross claim.

If the former camper, Logan Yandell “has suffered damages as alleged,” Kanakuk’s cross claim argues, “….such damages were caused by [ACE American Insurance Co.] and not by Kanakuk.”

Yandell called Kanakuk’s argument, “blame-shifting.”

“Our lawsuit has forced them to tell the truth, but instead of actually taking accountability…they’re trying to shift the blame to their insurance company as if an insurance company, I mean, held a gun to their head,” he said in an interview Monday. “An insurance company doesn’t make them do anything.”

The underlying case revolves around the abuse of Yandell, now 28, who sued the camp — one of the largest Christian summer camps in the country — along with its insurance company.

The case hinges on whether Kanakuk leadership knew in advance that Newman was abusing campers. 

Yandell was sexually abused from around 2005 to 2008 by Newman. His family settled for a confidential amount in 2010 and signed a non-disclosure agreement after camp leadership told the family they hadn’t known about the abuse and deemed it an isolated incident, according to the complaint.

But if the family had learned of camp leadership’s prior knowledge of Newman’s sexual misconduct, Yandell’s lawsuit says, they wouldn’t have agreed to it.

Newman, who Kanakuk refers to on its website as a “master of deception,” pleaded guilty in 2010 to seven counts of sexual abuse, and is serving two consecutive life sentences plus thirty years. The prosecutor in his case estimated that Newman’s victim count might be in the hundreds.

Yandell’s lawsuit cites evidence that Kanakuk did know of Newman’s behavior earlier: According to an affidavit of Newman’s former supervisor, Kanakuk leadership received reports of Newman engaged in nude activity with campers as early as 1999. Newman’s supervisor recommended he be fired in 2003, after receiving reports that Newman swam and played basketball with children while he was nude, but that decision was not taken up by CEO Joe White, according to the lawsuit. Newman stayed on for six more years.

In the recent cross claim, Kanakuk argues that if they did have advanced knowledge, the lack of disclosure was the fault of their insurer.

A cross claim is a claim brought by a party against their co-party — in this case, one of the defendants, Kanakuk, versus another defendant, ACE Insurance.

According to the recent filing, Kanakuk in June 2010 “drafted two letters with information regarding Newman’s activities” and planned to email them to “approximately 8,000 families of Kanakuk campers.”

But when Kanakuk sent the letters to the insurance company, ACE threatened to deny the camp coverage.

“Such disclosures threaten to expose Kanakuk to greater liability,” an ACE adjuster allegedly told Kanakuk in a letter that month, as quoted in the cross claim, “and may interfere with ACE’s contractual right to defend claims and to have Kanakuk’s cooperation in that defense.” 

“We strongly recommend that you do not send out the proposed public disclosures about Mr. Newman’s misconduct at camp and Kanakuk’s response to that conduct,” the insurance adjuster continued, as quoted in the filing.

Neither the attorney for ACE nor a representative from their parent company could be reached for comment.

Kanakuk said by email that they do not comment on litigation.

“In the meantime,” Kanakuk wrote, “we continue to pray for all who have been affected by Pete Newman’s behavior.”

Brian Kent, one of the attorneys representing Yandell, said the cross claim supports the argument that the camp and insurance company acted in a “concerted effort to misrepresent information to victims.”

“This was both parties acting together to defraud the victims, despite their knowledge of Pete Newman’s abusive history,” Kent said.

“It’s just incredibly unfortunate that a company as large as ACE and a camp which had responsibility for the safety of thousands and thousands of children over so many years,” Kent said, “just chose, in order to just try to save money and try to save their reputation, to lie to individuals and families who had been through something horrific.”

“It’s abuse upon abuse,” Kent said.

He added that in Yandell’s case, the camp’s CEO Joe White “flat-out lied” to Yandell’s parents regarding whether leadership knew about Newman’s behavior prior to Yandell’s abuse. 

Kanakuk’s cross claim will be litigated in the same lawsuit as Yandell’s, but as a separate claim.  Discovery is underway for Yandell’s claims, Kent said. Trial is scheduled for January 2025.

Treasure Dowell and three of her five children (photo submitted).

Treasure Dowell has called Missouri’s social services department three times a day for nearly a month and has yet to speak to a human being.

Sometimes she is automatically disconnected hours before the call center closes because it has reached capacity for the day. Other times she waits hours, her phone on speaker atop the kitchen counter, playing the hold music and occasional queue updates, while she watches her kids, only for the line to disconnect. 

When she hears that the queue numbers in the hundreds, she usually hangs up and tries again later. 

At stake is the $1,339 in monthly food benefits she relies on to help feed her five children — three of whom are special needs and have restricted diets.

“I’m scared I’m not going to be able to afford food,” she said.

An in-person or phone interview is required to enroll or be re-certified in the Supplemental Nutrition Assistance Program, formerly known as food stamps — a federal program administered by the states which provides grocery benefits to low-income people.

Dowell has struggled to find child care that would allow her to drive to the nearest resource center, which is more than 20 minutes away and she is hesitant about bringing her kids — four of whom are under the age of five.

Without getting through the call center for an interview, Dowell couldn’t be re-certified when her case came up for renewal in September and she lost the benefits she would’ve received in October. She submitted a new application but didn’t get through for an interview in October either.

“It’s very upsetting,” she said. “The point is for help to be available.”

“I understand waiting a little bit but people who work normal jobs can’t wait on hold for four or five, six hours.” 

Missouri’s troubled call center became the subject of a federal lawsuit in February 2022. The lawsuit, which is ongoing, alleges that barriers to obtaining a SNAP interview, primarily because of the state’s “dysfunctional” call center, violate federal law and deprive eligible Missourians of benefits. 

Those barriers — including the system automatically hanging up on people before they get through and long wait times which lead people to abandon the calls  — have persisted, data obtained in discovery and published in court filings shows.

One of the attorneys representing the plaintiffs suing the state, Katherine Holley, senior attorney at Legal Services of Eastern Missouri, said 20 months into the litigation the state still has “extreme access problems.” 

“[The Department of Social Services] has been on notice for quite a while that these problems are going on,” Holley said. “And it’s a shame because that means people who are doing everything that they can to get SNAP are not getting them.”

‘At the mercy of a broken system’ 

In the federal lawsuit, plaintiffs argue the state is denying benefits to eligible low-income Missourians, along with failing to provide reasonable accommodations to those with disabilities to apply. The lawsuit asks the court to order the social services agency to make procedural changes that would bring the state into compliance with federal law.

Plaintiffs describe subsisting on little food while using up prepaid phone minutes waiting on hold for an interview, and, due to disability, struggling to understand the application forms but being unable to get through the call center for help. 

Those plaintiffs eventually received benefits after the litigation was filed, but they argue they’ll be at the “mercy of [Department of Social Services’] broken, unlawful system” once their yearly renewals come up. 

Callers to the state’s SNAP interview phone line waited an average of 51 minutes before being connected to a representative, according to the most recent data, from July. 

And that’s evidence of improvement, the state has argued: The agency has made “significant strides to make interviews more widely available and reduce wait times,” an attorney for the Department of Social Services wrote in an October filing.

The average wait time has ranged from around 30 minutes to three hours since January 2022.

U.S. District Court Judge M. Douglas Harpool last year called a wait time of 56 minutes “still unacceptably long and particularly burdensome for financially struggling Missouri citizens in need of SNAP benefits.”

The wait time provides only part of the story: Many, like Dowell, don’t make it through to a representative at all. 

Some callers to the state’s SNAP interview line are immediately rejected because the center stops accepting calls when it calculates that, with the wait times and queue, additional calls cannot be answered during the remaining business hours.

Dowell said she has experienced that automatic rejection, usually when she calls sometime after noon, around 3 or 4 p.m. — an automated message plays a list of suggestions, including to visit a resource center or the state’s website, then disconnects. (The call center officially closes at 6 p.m.)

Fifteen percent of all calls in July were automatically disconnected for that reason, or 64,053 calls, according to data obtained in discovery and laid out in a September filing. 

Those who do make it through to join the queue often do not have the time to wait. 

Nearly one-third (32%) of those in the queue in July abandoned their calls before being connected to someone, and they waited an average of 21 minutes.

Dowell said she has “sat on hold until they closed” before, waiting over two hours just to be disconnected. 

Without interviews, SNAP applications and renewals are automatically denied after 30 days — even if applicants have tried and been unable to get through.

Around half of all SNAP denials in the state are due to failure to complete an interview, according to data obtained in litigation.

The state has previously said wait times are lower when applicants answer the state’s call made from an automated system for an interview. But the state usually only makes one such call. 

And according to the federal lawsuit, those calls are “inconsistent,” and applicants often miss them because they do not know when to expect them, at which point they must go to an in-person office or use the call center.

Using the state’s in-person resource centers, plaintiffs argue, is also not a solution for many of the call center users because many offices already have limited staffing that couldn’t “handle the additional demand of numerous SNAP applicants,” plaintiffs wrote. Some have inconsistent and limited hours: Thirteen resource centers in the state have only one staff member, for instance, according to a late-October filing, limiting hours and availability. And many applicants or participants may lack transportation or be unable to go in-person due to disability, plaintiffs argue.

‘Each applicant’s responsibility’

Harpool is now considering a motion for summary judgment, meaning discovery is complete and he will decide whether any or all of the issues can be resolved without a trial.

A trial is scheduled for early next year.

The Department of Social Services did not respond to a request for comment or for call center data since July. 

In court filings, the state has argued they’ve made substantial efforts to remedy the call center issues, which it says arose from staffing issues during COVID.

Those efforts include attempts to hire and train more staff and provide overtime, use outside vendors to handle Medicaid calls so more workers are free for SNAP interviews and create a scheduling system. The state is in the process of creating a virtual interview program but hasn’t provided a timeframe for its completion.

The plaintiffs’ lawyers call those efforts “meager,” and say the data shows there are still high rates of rejection born out of failure to complete an interview.

The efforts “do not solve the persistent dysfunction in [the state’s] SNAP operations,” the plaintiffs’ attorneys wrote. The agency “has not changed any of the systemic flaws that resulted in Plaintiffs’ inability to complete the eligibility process.”

“Ultimately,” the attorney general’s office, which is representing the department, wrote in an October filing, ”it is each applicant’s responsibility to follow program rules for interview completion” — pointing to examples where the plaintiffs disconnected rather than continue to wait on the line. 

Piecemeal relief

On Thursday — after trying to secure an interview since September, and ramping up her calls to several times a day the last few weeks — Dowell finally received an interview. She said she was approved for benefits.

But it wasn’t because she got through the phone line herself: Holley, one of the attorneys in the federal lawsuit, stepped in to help.

Early in federal litigation, the Department of Social Services and Legal Services of Eastern Missouri agreed to set up a system so that Holley could refer clients facing interview hurdles to a quicker path to an interview. Holley said the goal was to ensure the attorneys didn’t have to keep adding plaintiffs to the case.

Holley made a referral that allowed Dowell to schedule an interview appointment within days.

Dowell has been “very frugal,” she said, limiting her driving and restricting purchases to the necessities, but she is “down pretty close to 80 bucks.”

“So it will be a tremendous help to me and the kids,” she said.

Two of her kids have been diagnosed with autism and only eat a few foods, like chicken nuggets, crackers and tater tots, “so being able to buy things that fit into their realm of foods that they eat — that there’s no texture aversions to — will be a big relief,” Dowell said, adding that those are “not cheap items.”

Without the referral, Dowell said, November would be the third month of “going through this exact same thing.”

Community organizations also refer clients to Holley for expedited assistance.

But the piecemeal approach is not a systemic solution, said Christine Woody, food security policy manager at Empower Missouri, a nonprofit advocacy organization that’s also a plaintiff in the lawsuit. She has referred several people to Holley in recent months.

“It’s great that we have a direct line to someone that can help,” Woody said, “but that’s not changing the process for the thousands of other people.”

“That’s not the answer.”

This story was updated after Dowell was approved for benefits on Thursday.

Main Street in Noel, Missouri, on Sept. 23, 2023 (Clara Bates/Missouri Independent).

NOEL, Mo. — On a Sunday afternoon in rural southwest Missouri, dozens of friends and family gather at a modest one-story home to sing and celebrate in the language of their homeland, more than 8,000 miles away. 

Some arrive from church, crowding into a living room to celebrate two brothers — one turning 7 and the other 17. Speeches and blessings are delivered in a mix of English and Karen, the language of the Myanmar refugees who make up most of the partygoers. 

Years ago, they escaped persecution in Myanmar, where the government has targeted various ethnic minorities for decades.

They’ve constructed tight-knit communities in Noel — and the town is all that many of the children have ever known. Kids bounce on a trampoline outside the party in the crisp fall air, the 7-year-old’s clip-on tie dangling haphazardly as a rendition of “Happy Birthday” breaks out. 

But an air of anxiety coexists with the revelry.

A 10-year-old guest talks about all he’ll lose when his family has to move — pointing to the hill where he loved going sledding every winter.

“I’m kind of sad,” he says between bites of noodles off a paper plate. “I’ll miss my friends from school.” 

In one corner, the birthday boys’ father huddles with a church volunteer, ticking through questions on a job application, some of which he doesn’t understand. 

“Computer skills?” the volunteer asks.

For three decades, migrants have been drawn to the town to work at the Tyson poultry plant, which offered jobs that didn’t require English proficiency at higher-than-minimum-wage pay. Immigrants from Mexico arrived in the 1990s, followed years later by refugees and migrants from countries in Africa, Asia, Central America and the Pacific Islands.

They came to Noel — which had a population of 2,124 people in 2020 —  in search of a better life. But with the plant now shuttered, many of its 1,533 workers are scrambling to find new jobs.

Job prospects in the remote surrounding areas are slim for many of those laid off in the plant closure. For the migrants who call Noel home, they can seem even slimmer. Many have already begun moving away, scattering across the country.

Pastor Joshua Manning, who helped organize multilingual Christian church services for the last seven years, speaks of the plant closure with despondency. 

He provided space in the Community Baptist Church for services in three different Micronesian languages and Spanish. He led an English-Karen service himself.

Manning wondered whether the birthday party was doubling as a goodbye party.

“It’s like watching a family member die,” Manning says. “There’s mourning, grief.”

‘The American Dream’

Tucked in the hills of the Ozarks near Arkansas and Oklahoma, Noel is a summer tourist destination that spans just two square miles. 

The Elk River winds through it, attracting canoers and rafters. A small main drag features an ice cream shop, Mexican restaurant and African store. Wedged between the river and stark bluffs, beneath a limestone overhang, is a stretch of highway long considered the most scenic in the region. 

And just off the highway, over a bridge, is Tyson — the economic hub of the town whose population numbered in the hundreds until 1980 and just recently surpassed 2,000. 

“The county has kind of grown up around that plant,” Mayor Terry Lance said, “and it’s basically in the middle of everything now.” 

Several former workers interviewed by The Independent said they learned about the closure on Facebook or in the media before Tyson informed them. Rep. Dirk Deaton, a Republican who grew up in Noel, said the company gave no indication it was planning to close the facility, and even spent money last year on renovations. 

“They’re here for the long haul,” he remembers believing. “So there was really no indication that it was coming or that’s what was going to happen until — until it was.”

The decision to close the plant, which was announced in August and effective this month, was made to cut costs amid falling profits, Tyson said. It was among six plants the company announced it is closing this year to make operations more efficient. 

Of those six plants, the Noel plant employed the most people.  

The poultry plant transformed the makeup of a small, nearly all-white town in the span of just three decades. More than one-third of Noel’s overall population is now foreign-born, 36%, which is nine times higher than the state’s average.

What began in 1959 as what the Los Angeles Times called a “modest little country factory” morphed by the turn of the century into a massive industrial operation.

Then-giant meatpacker Hudson Foods bought the plant in 1972 and set out to ramp up production. With the advent of industrial practices to breed chickens and automate processing — the rise of “big chicken” — came reduced prices and soaring demand nationally.  (“America Goes Chicken Crazy,” the New York Times proclaimed in 1984.)

Americans ate 40 pounds of chicken in 1970; by 2000, that number had nearly doubled, to 77 pounds. 

Hudson needed more workers to keep up. They said the jobs couldn’t be filled in a town that then had just over 1,000 residents — in an industry the company characterized as too hazardous and difficult for most American workers to do.

So the company recruited immigrants from Mexico to the town, at first putting them up in roach-infested hotel rooms. Over time, families joined and set down roots.

Reports of the ‘90s and early aughts portrayed a difficult arrival: The homes of migrants being tagged with graffiti and kids not being allowed to play on sports teams were some examples University of Missouri Extension gave in a 2002 report. Over time, though, accounts became more positive.

Tyson acquired Hudson in 1997.

There were seven Hispanic students at Noel Elementary School in 1992, making up less than 2% of the student body. A decade later, there were 240 — half of all students. 

“Most people are going to Noel,” the report said, “in search of the American dream.”

‘On the run’

On a late Sunday afternoon last month, a group of Somali men were the only patrons at Paisa’s Mexican Food, a sit-down restaurant on Noel’s main drag. Around the corner, the Karen-English church service had just let out. 

Around 15 years ago large groups of more far-flung migrants began arriving in Noel, from Somalia, Micronesia, Myanmar and elsewhere.

Some, especially the Somali and Karen, came to the country as refugees, eligible for resettlement because they were persecuted or feared persecution in their home country. 

One of them was Pwe Loe, from the Karen (“kuh-ren”) ethnic minority in Myanmar, formerly called Burma — a now 39-year-old single mother of five children, whose singing opens the weekly services at the Community Baptist Church, run by Manning. The white congregants sing in English in tandem with congregants singing in Karen.

Pwe Loe, who has an expressive face and wears her black hair pulled back into a ponytail, said her life in Myanmar was characterized by constant flight.

She was “on the run all [the] time,” she said, fleeing Burmese soldiers in the jungle with other members of her village. The Karen have been persecuted for decades, along with other ethnic minorities in Myanmar.

In 2011 she made it to a refugee camp in neighboring Thailand — an improvement, she said, because she no longer had to run.  But there was no work, and refugees relied on humanitarian aid groups for food. After qualifying for refugee resettlement in the United States that July, she was moved to Austin, Texas, but said it was hard to find work. 

Two years later, she says a friend told her Tyson was looking for workers, so she and her family moved to southwest Missouri. She relied on the network of Karen people in town to help her adjust and came to like Noel. 

Refugees are free to move around the country and many do. They must apply for lawful permanent resident status after one year and can apply for citizenship after five years (Pwe Loe is a citizen). 

Refugees are expected to be self-sufficient after just 90 days in the country, when federal direct assistance, including help paying for food and rent, ends. Support services to help refugees find and maintain employment are available for the first five years they’re in the country. The government doesn’t track secondary resettlement. 

Pwe Loe worked on the poultry line deboning chicken thighs — slicing out bones using a knife, on an assembly line, which involves highly repetitive movements for hours on end.

At Tyson, the starting wage was $16.35. 

Many of the Karen migrants said it was a job they were proud to have — a job that, while difficult, enabled them to support their families. 

Several Karen churchgoers in September wore Tyson merchandise they’d been gifted: A camouflage baseball cap with the red oval logo, a smattering of red t-shirts. In the living room of the family that hosted the party, a “5 Years of Service” silver plaque bearing the Tyson logo was hung up on the wall, still in its plastic protective wrapping.

‘Everything has an ending’

Manning will step down as pastor of the Community Baptist Church on December 1, to go full-time with his current job at the post office, he said.

Hundreds of migrants have passed through the church in his seven years leading and organizing services — the size of services ebbing and flowing as some moved away and others arrived.

The essential fact of new arrivals, though — and the need to provide space for them to worship — remained steady. Some, like the core group of Karen families at the party, stuck around.

Now, he said, the church will take another form, reinventing itself.

The town will change too.

In the span of three weeks — from late September to October — “for sale” signs in Noel seemed to proliferate. At least one store on Main Street, which coordinated sending remittances home to Somalia, closed.

Three suitcases are near the entrance to a Somali-run store on the same stretch, called Sky Grocery. One of its owners, a young Somali woman who was born in Kenya because of the civil war in Somalia, said she moved to Noel just five months ago from Minnesota to help run the store.

She expects it will soon close. 

“The majority are moving,” she said of other Somali refugees, “to different states.”

“Everything has an ending.”

Most white residents of Noel got along with their foreign-born neighbors and appreciated their contributions to the local economy, according to Mike Newman, executive director of RAISE, a nonprofit which provides refugee services in Southwest Missouri.

“But there was certainly a minority,” Newman added, “that said they would be fine if all the immigrants and refugees left Noel —  and now we’re going to see if that’s going to be a good thing for them.”

Around 250 workers, or 16% of the workforce, plan to relocate to other Tyson facilities, said Derek Burleson, the company’s spokesperson, who added that the company held hiring events after announcing the closure. (The company offered them a $5,000 transfer bonus and up to $5,000 for moving expenses, Burleson said.) 

Tyson provided a $1,000 bonus for those who’d stay until the closing date. Some of the church volunteers at the birthday party speculated that workers may have been hoping for the best, or unsure how to proceed in applying for new jobs while they were still working.

Now that the end has arrived, they’re scrambling for work or leaving. The town’s mayor said Noel could lose 20% of its population.

Their final paycheck arrived last Friday. A church-run food pantry has seen “increased need,” said Chloe Pfrimmer, who helps run the pantry and estimates around 70 families came to the most recent one.

Deaton, the state representative for the area, said the federal government should do more to help the refugees who came to Noel for jobs.

“They have something of an obligation, you know, to not leave those people just in limbo,” he said.

But government assistance to refugees is limited and short term, said Emily Frazier, assistant professor of human geography at Missouri State University in Springfield, who studies refugee resettlement. 

The system is designed to integrate refugees, especially economically, and bring them to self-sufficiency quickly. They’re subject to the same challenges any American faces when losing a job, like the concurrent loss of health insurance: a more “systemic” American problem, Frazier said.

“Losing your job,” she said, “means losing benefits, security, possibly housing — especially in states like Missouri…There’s just not a social safety net for anyone, let alone refugees.” 

Migrants’ language proficiency varies widely — many of the Karen adults, like Pwe Lo, speak limited English, which constrains job options. The federal government’s quick timeline for refugees to become economically independent, Frazier said, can “often supersede their ability to really learn English or…get their GED or get higher education.” 

Refugees have to work quickly after arriving in the U.S., in jobs that require little English, and are then swept up in that difficult, time-intensive work.

Brittany Martin, who teaches English as a second language, said few of her adult students worked at Tyson because the company “works a lot of overtime and so kept their employees very busy.”

Tyson is accepting bids for the plant, but it isn’t clear yet what will replace it. 

Pwe Loe is getting worried. She is surprised to hear, at the party, news that many of the Somali have already moved away for work.

She said she would apply to a nearby plant, Simmons Foods, in Southwest City, but worries, because she’s heard it doesn’t have many open positions. 

Those who stayed on until the closure were, Pwe Loe among them, promised an extra $1,000. But other plants in the area may have filled their openings, and the time it takes to find a new job could quickly eat up the bonus.

Pwe Loe worries about taking her children from school and their friends. Three of her sons are school-aged — 14, 13 and 9. She also has an 18-year-old daughter who attends a nearby college and a one-year-old son. 

If they stay in Noel, she said, she may not be able to pay their bills. But if they leave, it will be “so difficult for my kids.” Sinking into the couch in the entry room of her home, baby asleep in the next room, she looks around with apprehension.

Last month, there were 253 awaiting treatment and the wait time was eight months. The Department did not provide an updated wait time Thursday (Annelise Hanshaw/Missouri Independent). 

There are currently 260 people in Missouri jails waiting to be transferred to a hospital for mental health treatment — a slight uptick from last month, as state officials work to develop plans for the “jail-based competency restoration” program approved by the legislature this year.

Those 260 people were arrested, deemed unfit to stand trial and ordered into mental health treatment. 

They are supposed to receive rehabilitative mental health services that allow them to stand trial, a process called competency restoration. But they languish in jails, often for months, without having been found guilty of any crime because there are no hospital beds available to transfer them to.

The monthly update came from Nora Bock, director of the Missouri Department of Mental Health’s Division of Behavioral Health, during a mental health commission meeting Thursday.

Last month, there were 253 awaiting treatment and the wait time was eight months. The Department did not provide an updated wait time Thursday. 

Missourians wait an average of 8 months in jail for court-ordered mental health services

The state has long struggled to transfer people from jails into mental hospitals once they are found to be incompetent to stand trial, in part because of a lack of hospital beds, staffing issues within the department of mental health and an increase in referrals. 

Bock said many of the agency’s staffing issues persist, noting that “our vacancy rates are better, but we still have significant turnover. 

That, Bock said, means “training over and over.”

Vacancy rates for social workers in particular “are very, very high, with 70% (licensed clinical social worker)  positions either vacant or they’re filled with a non-licensed mental health professional,” Bock said.

And more people in need of treatment are in the pipeline: The department will add 55 people who have been evaluated and determined incompetent to stand trial once they receive the court’s order to do so. It expects around 136 people with open pre-trial evaluations (half of the 273 evaluations open) will be found incompetent to stand trial and need treatment, Bock said.

“So that makes it very important that we are launching and getting ready to launch the jail-based competency restoration along with community outpatient competency restoration,” Bock said.

A law passed this year gives the agency the authority to treat arrested people within jails, called jail-based competency restoration, or on an outpatient basis if the person can be safely released and treated. 

“We continue to develop the curriculum and connect with the jails that are designated for that,” Bock said, “And we’ll continue to get that up and moving.”

This year’s budget set aside $2.5 million for the jail-based competency programs to be established in jails in St. Louis, St. Louis County, Jackson County, Clay County and Greene County.

Services in jail-based competency restoration will include room and board, along with medical care for 10 slots at each jail, contracted staff from a local behavioral health organization, and psychiatric care from DMH’s “mobile team practitioners.” The agency hopes to reduce wait times through the program. They have not provided a timeline for when it will be up and running.

Elsewhere, there have been recent high-profile lawsuits against long wait times in jail for those needing mental health services in states including Indiana, Kansas and Pennsylvania, arguing that long wait times are unconstitutional because they deprive people of due process. 

Missouri's Department of Mental Health building in Jefferson City (Annelise Hanshaw/Missouri Independent).

The federally-funded organization responsible for protecting the rights of people with disabilities in Missouri believes a proposed change in how the state pays for at-home care could violate the law. 

Missouri Protection and Advocacy Services, which was established in 1977, said in a letter to the Centers for Medicare and Medicaid Services that it is “investigating the proposed changes and believes they may be in violation of federal law protecting people with disabilities against discrimination.”

The letter, sent last week by one of organization’s attorneys, Will Hack, argues the proposed changes are “harmful to Missourians.”

The proposed changes at issue involve the self-directed supports service within the Department of Mental Health, part of a Medicaid-funded program available to Missourians with developmental disabilities to directly hire their own care staff.

There are currently 3,031 Missourians relying on self-directed supports to fund their at-home caregivers. Without it, they would require inpatient care.

The state moved this summer to change the way if funds self-directed supports, to delink it from the rate it pays home health agencies and paying self-directed supports families based on last year’s lower rate instead of this year’s. The state will initiate a rate study this fall to determine future funding levels.

Families who use the program have decried the proposed changes as lacking transparency and potentially threatening their ability to provide competitive wages to their caretaking staff. 

Advocates also question why a rate study didn’t precede the decision to change the rates — and say it’s not a given that they should get less money than their agency equivalents.

The changes need approval from the Centers for Medicare and Medicaid Services, where they are now awaiting action. The state expects to receive a response sometime this fall.

The state proposed to amend the rate to last year’s level in July. Hack’s letter frames those proposed changes as “hidden” and “buried on page 301” of the document.

With the new wording freezing the rates at last year’s level, the rate can’t “increase to meet the needs of Missourians,” he wrote in his letter to the federal Medicaid agency.

“This will effectively discourage people with disabilities from directing their own services, and push them towards provider-based services,” Hack wrote.

On Aug. 4, the Missouri Department of Mental Health filed public notice of its intent to change state regulations to remove the requirement that self-directed supports rates be comparable to provider rates.

“These changes are a coordinated effort to turn people with disabilities away from (self-directed supports),” Hack wrote. 

Self-directed services are part of a national trend over the last few decades away from institutionalization and toward community-based support and integration — based on the belief that decisions about an individual’s care are best made by those closest to them. 

Missouri advocates decry proposed change to at-home disability care funding

Someone called a designated representative, often a family member, is in charge of overseeing staff.