Missouri’s Medicaid application backlogs exceed federal limits for the third month in a row

Processing problems can mean low-income Missourians go months without health insurance, delaying or forgoing needed care.

JEFFERSON CITY, Mo. Missouri’s backlog of Medicaid applications narrowed in February, but the average time it took to determine eligibility continued to exceed the federal cap.

The average time it took the Missouri Department of Social Services to process Medicaid applications for low-income Missourians in February was 77 days, an agency spokesman told The Independent.

This means that 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 Medicaid applications for the largest group of participants who are children, families and low-income adults to be processed within 45 days.

Missouri’s application delays have violated federal rules for three months.

In December, the average processing time was 49 days and rose to 64 days in January. Average processing time is the metric the state must report to the federal government.

Processing problems can mean low-income Missourians go months without health insurance, delaying or forgoing needed care. And it affects new applicants, as well as those who may have lost coverage during the eligibility verification process and must reapply.

Alistair Wiley, of Ste. Genevieve, has been trying to get Medicaid back since January. She and her husband lost coverage during the renewal process, despite filing paperwork and continuing to meet the income limit, she said.

It’s just been a living nightmare, he said.

Since then, she says she’s endured multiple calls that were at least two hours on hold each, filed a new application in January and received confusing information about why her application was blocked. She said the workers could not give her an estimate of when her application would be processed.

Wiley has had to ration or lose several medications, she said, and her husband has had to delay surgery.

I’m only on half the dose I need to treat my severe depression, which has made keeping track of it and fighting for myself incredibly difficult, she said.

In addition, he said, he has called several state hotline numbers that do not give the option to speak to a person and are told to check the state portal, even though it is difficult to navigate. When it comes to a human, he said some staff members don’t seem to know what to do.

There seem to be many obstacles to getting the help we need in this state, he said.

Federal data is lagging, but as of November, Missouri’s processing delays were among the worst in the nation, according to a Centers for Medicare and Medicaid Services report released last month.

According to this data, only New Mexico, Missouri, Georgia and Washington, DC, were processing more than 40% of applications in more than 45 days. Forty-two percent of all applications Missouri received were processed in violation of the federal cap as of November.

Department of Social Services leaders have said they have shifted efforts to overcome the backlog and that the average processing time will soon decrease as a result.

The backlog of applications fell to 35,833 in February, from 52,891 in January.

Baylee Watts, spokeswoman for the Department of Social Services, says that’s because the Missouri Division of Family Support removed duplicates and increased efforts to process more applications, in an effort to use all the staff available to process requests during the vast majority of their working hours.

Through these efforts we were able to greatly reduce our backlog numbers and we expect the average processing days to return to an acceptable number, Watts said.

Missouri is required to report the average processing time to the federal government, but it publishes the average of what most people think of as the average of monthly public reports, Watts told The Independent. The average published in state reports is slightly lower, but still above the federal limit: It was 57 days in February and 50 in January.

The state has long struggled with processing delays and call center wait times and underwent a federal mitigation plan in the summer of 2022 for average processing times that reached at 115 days.

At MO HealthNet’s quarterly 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, he told the meeting. They were about to download them again, within processing time, at the end of February.

The department did not respond to several requests for clarification.

From November to mid-January, during the open enrollment season for the federal insurance marketplace, the state generally sees an increase in Medicaid applications. It is also in the process of reassessing the eligibility of all Medicaid participants on its records after a three-year hiatus due to the COVID pandemic.

Evans told the MO HealthNet oversight committee that he expects the state to experience longer processing times each year during open enrollment.

So that will be a normal process for us from November to somewhere in February or March, depending on how our open enrollment period goes, he said.

The same workers who process Medicaid applications are often also responsible for answering the phones and switch between these tasks as needed.

At the end of last year, according to the most recent data obtained by The Independent, the average phone wait time for the general line, which includes most Medicaid inquiries, was 1 hour 45 minutes.

State Sen. Tracy McCreery, an Olivette Democrat who serves on MO HealthNet’s advisory committee, cited The Independents’ findings when she asked Evans last month about wait times. McCreery said he’s staying[s] concerned and asked what the states’ plans are to remedy this.

Evans said it’s never our goal for people to expect that much. But there are different levels of the call center, he said, explaining user error in selecting the correct phone line or failure to listen to automated responses.

He 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 currently answering general question calls to transfer them to Supplemental Nutrition Assistance Program interviews. The state is facing a federal lawsuit over its call center wait times for SNAP.

This story of the Missouri Independent is published on KSDK.com under the Creative Commons license. The Missouri Independent is a nonpartisan, nonprofit news organization covering state government, politics and policy.

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