Missouri Has a Declining Medicaid Caseload. Is That a Good Thing?
This story was produced in partnership with the St. Louis Post-Dispatch
Missouri is seeing a bigger decline in its Medicaid rolls than nearly any other state, a ranking that the administration of Gov. Jay Nixon attributes to an improving economy and critics blame on application snafus.
A new federal report compares Medicaid enrollment in March to the average for the three-month period of July through September 2013. Missouri’s caseload declined 3.9 percent, a drop second only to Wyoming, which declined by 5.6 percent.
The Missouri Department of Social Services, which oversees Medicaid, attributed the decline to more people finding jobs.
“As the economy has improved, fewer Missourians are relying on assistance programs for support,” an agency spokeswoman said in an emailed statement.
The department has resolved a backlog that was delaying eligibility determinations, the spokeswoman said.
“The number of applications pending has returned to a normal volume, which is typically around 20,000,” the statement said.
Critics contend the state is making it harder for people to enroll or renew their coverage.
Nixon reorganized the department’s Family Support Division last year. The number of caseworkers at walk-in centers has been reduced and a new software system is being phased in for applications, which now are handled at remote processing centers.
Joel Ferber, an attorney at Legal Services of Eastern Missouri, ticked off these reasons for the enrollment decline:
“It’s the reorganization, it’s the staffing issues, it’s the new computer systems, it’s the slow pace, it’s the delays of getting through the backlog,” he said.
Rep. Jeanne Kirkton, D-Webster Groves, agreed. She said she heard frequent complaints from constituents.
“There are still some pretty major problems with people getting access in a timely manner,” she said. “They can’t talk to anybody” who can answer their questions and lost paperwork results in benefits being denied, she said.
Missouri is among 24 states that rejected an expansion of Medicaid that would have raised the income threshold to cover the working poor — adults making up to 138 percent of the poverty level, or $16,104 for an individual.
Nixon, a Democrat, supported the expansion. But the Republican-led Legislature opposed it, calling it unaffordable for both the federal and state governments.
Even so, most states that did not expand Medicaid saw increases in their enrollment — 2.6 percent, on average. That uptick is generally attributed to “the woodwork effect,” meaning people who were already eligible for Medicaid came out of the woodwork when publicity ramped up about the new health insurance mandate.
But that did not hold true in Missouri and six other states. Besides Wyoming, the other states that saw caseload declines were Alaska, Alabama, Louisiana, Nebraska and Wisconsin.
There were 829,585 Missourians on Medicaid in March, compared with the three-month average of 863,417 in July through September of 2013.
The data were compiled by the federal Centers for Medicare and Medicaid Services, which oversees the health care program.
According to the CMS report, more than 4.8 million people were added to the Medicaid and State Children’s Health Insurance Program rolls nationally during the period studied, an increase of 8.2 percent. The increase was 12.9 percent in states that expanded Medicaid.
March caseloads were compared with July through September 2013 because that period preceded the launch of the federally run marketplace where people can buy private insurance.
Low-income people who use the marketplace but are eligible for Medicaid are supposed to have their applications automatically routed to their states’ Medicaid programs in a seamless process.
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