Missouri struggles to process Medicaid applications

Missourians applying for Medicaid are now waiting nearly four months on average for those applications to be processed.

Since the state implemented the Medicaid expansion in October — opening the door to most Missourians making less than 138% of the federal poverty level — wait times have skyrocketed.

In February, Missourians waited more than two and a half times 45 days the federal government says states should take to determine if someone is eligible.

Timothy McBride, professor at the University of Washington spoke with KBIA journalist Sebastián Martínez Valdivia about the difficult state situation. McBride studies health policy and chaired the oversight committee for MO HealthNet — Missouri’s Medicaid program — from 2012 to 2019.



Sebastien Martinez Valdivia: How unusual are the wait times facing Medicaid applicants in Missouri right now?

Timothy McBride: Very unusual. In fact, I’ve been watching this for probably almost a decade and it’s the highest number of days pending I’ve ever seen. There was a time when I was chair of the Medicaid oversight committee where the number of days on hold was about 90, and we thought that was pretty high at the time.

Martinez Valdivia: And what do you think are the main factors contributing to the sharp increase in wait times?

McBride: Several factors unfortunately. I think when I looked at that there were probably 150,000 applicants over a period of about four months and a lot of them were from the federal market.

So if people end apply through the marketplace and then he tells them, ‘Well, you’re actually eligible for Medicaid.’ Then when the claimants come in, there are probably three or four issues that we face at the state level. They’re understaffed because they have a lot of turnover, and that’s probably because of pay issues and other issues. Then, actually, some people are out a lot because of COVID, so that’s another issue.

Martinez Valdivia: The state says staff turnover is a major contributor to the difficulties they face. You chaired the oversight committee of the MO HealthNet for many years: is this a new problem for the Ministry of Social Services?

McBride: I think it’s more acute now than it’s ever been – you know, I’m not here every day but from what I’ve heard. And I think we’ve historically paid our government employees about the lowest in the country and it just hasn’t increased much and this problem is going to continue. And obviously, that was a discussion that the Legislature was also having after the Governor proposed raising salaries. So I think that’s always been a problem and I remember hearing about it, but I think it’s become more of a problem now, especially as we come out of the pandemic.

Martinez Valdivia: Are there any immediate changes Missouri could make to speed up the process for applicants?

McBride: Well, there are several things that I think people have been coming up with for a while. And I think we’ve actually seen this week – every week the state releases a number of people enrolled in the Medicaid expansion and it’s gone from about 18,000 this week to over 100,000 enrollees now.

So what seems to be happening is that the state is now looking at people in a few categories, including the pregnant women category and the MO Healthnet category for families, and if they’re eligible for the expansion, they move them. Frankly, I think it could have been done a long time ago, closer to October, and I’m not exactly sure what took so long.

So to answer your question, I think there are well-known ways to handle this that other states have used that I’m not sure our state uses.

This story was originally published by the St. Louis Public Radio colleagues at KBIA in Columbia, Missouri.

Julio V. Miller