Missouri Takes Months to Process Medicaid Applications — Longer Than Law Allows - Kaiser Health News

Aneka French applied for Medicaid in October, not long after Missouri became the 38th state to expand eligibility for the program.

But her application sat for months in a backlog with tens of thousands of others. While she waited, French, 45, an uninsured medical technician from St. Louis, paid out-of-pocket when she was treated at a health clinic for a knee injury last fall.

For nearly a decade, Missouri’s Republican political leaders resisted expanding eligibility for Medicaid, the state-federal health insurance program for people with low incomes. It took effect in summer 2021 after a voter ballot initiative passed in 2020. Now, Missouri has more pending applications for MO HealthNet — the name of the state’s Medicaid program — than people enrolled through the expansion. While 64,210 people have been approved as part of the expansion, nearly 73,000 applications were pending as of early February.

In the state’s most recent report, it said it was taking an average of 70 days to process typical applications — longer than the 45 days allowed by federal law.

“This means that in the midst of a raging pandemic, people who are finally able to get health coverage are being left out of the system and are left waiting and waiting,” said Melissa Burroughs, associate director for strategic partnerships at Families USA, a consumer advocacy group. “This is a complete injustice to those hit hard financially and healthwise by the pandemic.”

By contrast, most other states are processing Medicaid applications within a week, with many cases taking less than a day, according to federal data from 2021.

Kim Evans, director of the Missouri Department of Social Services’ Family Support Division, told the MO HealthNet Oversight Committee in February that the delay is due to a shortage of workers that has become more acute because of the pandemic. She also said the agency was stretched thin in the fall when it had to handle applications submitted during open enrollment in the Affordable Care Act’s marketplace, where people sign up for private coverage but can be redirected to Medicaid if they qualify.

Before expansion, Missouri’s Medicaid program did not cover adults without children. Now, Medicaid is available to all Missourians with incomes below 138% of the federal poverty level, or about $18,800 per year for an individual. Those whose applications are approved will be eligible for coverage retroactive to the month they applied, and possibly up to three months before then.

But Tricia Brooks, a research professor at Georgetown University’s Center for Children and Families, said people waiting to have their applications approved typically keep acting as if they are uninsured, delaying needed care and avoiding preventive services such as health screenings. If they do seek care, they will face large medical bills if their application is later denied.

French, the St. Louis medical technician, was notified in January — three months after she applied — that her Medicaid application had been approved. She said that if she had been approved sooner, she might have gone to an emergency room for her knee injury but didn’t because she was worried about getting stuck with a large bill. Instead, she went to a community health center that charges uninsured patients on a sliding fee scale based on their income.

Missouri is not the first state to experience such delays. When 26 states expanded Medicaid in 2014 under the ACA, many struggled to keep up with the demands of applications. For example, California in June 2014 had a backlog of 900,000 applications, prompting a lawsuit by health advocates.

Patient advocates say Missouri had years to get ready to expand Medicaid. And, they note, Missouri’s delays in processing applications have been an ongoing problem that worsened after expansion.

“At the very least, they are starved for resources, and, at worst, they are doing this on purpose,” Burroughs said.

Brooks said Missouri has consistently taken more than 45 days to process applications. She said that more than 40% of applications in 2018 needed more than 45 days to process and that the number rose above 50% in 2019 and to 60% in 2020.