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New Missouri Medicaid applications won't be reviewed until October

Missouri's Medicaid expansion impacts 275,000 Missourians

ST. LOUIS — Eligible applicants can apply for health care under Missouri's Medicaid expansion, also known as MO HealthNet, but applications won't be processed until Oct. 1. 

In an internal video from Missouri's Department of Social Services (DSS), Family Support Division Director Kim Evans addresses the department on what comes next for the program.

Right now, the staff is providing training for all staff. 

"The applications will sit there until we have the eligibility piece in, which would be Oct. 1," Evans said in the video. "The plan is we’ll give instructions to you. Staff will go ahead and do the verification needed on the applications, but what we will do, we will not run a determination, we will not finalize these applications."

DSS staff will reevaluate the applications of Missourians who applied from July 1 to August 9 to see if they're eligible.

"There’s a lot of pieces to this," Evans said in the video. "There’s going to be overtime in this. DSS does not have the resources. That is true. That's because of the budget and things that happened through the session. We're working hard."

The Missouri Department of Social Services communications director sent this statement to 5 On Your Side:

"As Kim Evans, Family Support Division (FSD) Director, indicated in the video, at this time the Family Support Division (FSD) is verifying application information. Verifying information is a preliminary step FSD can perform now that will eventually expedite the processing of applications. FSD will process applications for expanded MO HealthNet eligibility consistent with the regular eligibility process by using the Missouri Eligibility Determination and Enrollment System (MEDES) once the system is ready on Oct. 1."

How we got here

In August 2020, 53% of Missourians voted in favor of Medicaid expansion. It was supposed to take effect on July 1, 2021.

In February 2020, Gov. Parson and DSS sent the Centers of Medicare and Medicaid Services a state plan explaining, the state would move forward with the expansion. 

DSS estimated the cost, and Parson included the suggested funds in his annual budget proposal to the General Assembly.  

However, several Republicans argued it would cause the state to pay for an expensive program and result in a financial blow for future budgets.   

Both the House and Senate voted to not fund it.                        

On May 7, 2021 the legislature did not include the funding for the expansion in this year's budget. That's when Governor Parson said, without the money, they couldn't expand Medicaid.

The Lawsuit

On July 1, 2021, three women who were newly eligible for Medicaid were refused. They filed a lawsuit.

Melinda Hille was one of the plaintiffs. She was diagnosed with diabetes five years ago and has been fighting for her life.

Credit: Melinda Hille

"I can’t remember a time when I physically wasn’t in pain anymore," she said.

Chuck Hatfield with Stinson Law in Jefferson City partnered with the Legal Services of Eastern Missouri, or LSEM, to help the women.

The Missouri Supreme Court agreed with the voter-approved plan to stay in place, claiming the money is there.

The state Supreme Court ruled it did not violate the Missouri Constitution because it "does not appropriate money and does not remove the General Assembly's discretion in appropriating money to MO HealthNet." 

On Aug. 11, a judge followed the ruling from the Missouri Supreme Court and issued an immediate injunction prohibiting the state from denying enrollment to the expanded population or treating them differently. 

That day, Governor Parson released a statement and said, 'My administration is always going to follow the law."

That press release said the system update is anticipated to take up to 60 days because of limited staffing and funding. 

It explained they are working through administrative hurdles, including adequate appropriations, staffing capacity, and computer software changes in order to begin enrolling the expanded population. 

Since the proposed funds were not included in this year's budget, DSS is limited to administering the expanded program without sufficient staffing or money.

In order to comply with the court order, DSS is reassigning existing employees from their current assignments in order to evaluate applications.

In addition, qualifying health care costs that are incurred by eligible Missourians between the time they apply and when DSS is able to verify their eligibility may be reimbursed at a later date.

"A lot of these people just simply don't have the money to come out of their pocket and pay for it, so it's not very helpful to say, we will pay you back later if you don't have the cash today," Hatfield said.

Hille is one of the people who doesn't want to rack up more bills. 

"There is no way I will be able to crawl out of this financial hole. I can’t afford hundreds of thousands of dollars that I’ve racked up over the years. A lot of people have put their health on the back burner they don’t want to run up their bills," she said. "The more they put this off, the more illnesses they get. Every day counts for a lot of people."

Even if the state will not review applications until Oct. 1, Hatfield wants to be clear: Get an application on file right now, if you are eligible. 

"It's going to be paid for by Medicaid even though you may not get your eligibility determination for a couple of weeks," he said. "The providers are going to go ahead and give you the treatment, knowing they're going to be paid by Medicaid. 

"Go into your clinic, your pharmacy or doctor, whatever it is, tell them you're Medicaid eligible and they'll help you through the process and make sure you get the care you need."

Hatfield said he is concerned about a potential backlog.

"If they get 100,000 applications, I don't think they're going to be able to flip a switch and have all 100,000 people determined to be eligible on that day," he said. "There are always issues with Medicaid applications. There is always a back and forth in the process to make sure the state has the right information. The cycle of waiting till Oct. 1, really for a lot of people means you're waiting until mid-October, or maybe even longer, as they work their application through the process."

Missouri's Medicaid expansion impacts 275,000 Missourians.

Those eligible include those earning up to 138% of the federal poverty level, including individuals ages 19-65 making less than $17,774 annually, or less than $37,570 for a family of four.

Apply on the DSS website.

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