JEFFERSON CITY, Mo. — Missourians who qualify for benefits under Medicaid expansion can begin enrolling, but it may take up to two months until they will find out if their eligibility has been verified and their application has been approved.

In a news release last week, Gov. Mike Parson announced that in response to a Cole County judge’s ruling, the Department of Social Services will begin accepting applications from the approximately 275,000 residents who qualify under voter-approved Medicaid expansion.

That includes 19- to 64-year-old adults whose household incomes are 138% of the federal poverty guideline or less, which ends up being $17,774 a year for a single person, or $36,570 for a family of four.

Cole County Circuit Court Judge Jon Beetem ruled last week that DSS officials cannot deny coverage to individuals in the expansion population and cannot impose greater restrictions on them compared to those previously eligible.

Attorneys for the state had argued before Beetem that DSS needed two more months to stand up more personnel and computer systems before enrolling applicants, and had requested a hearing to demonstrate that point. It was not granted.

During the past legislative session, lawmakers refused to appropriate the $1.9 billion in state and federal funds needed to finance Medicaid expansion, which also included funding to hire 75 additional employees to help administer the expanded program. As a result, a required update of MO HealthNet’s system to make eligibility determinations of new applications may take up to 60 days, the governor’s office said Wednesday.

“In order to comply with the court order and until the necessary funds can be appropriated, DSS will reassign existing employees from their current assignments and responsibilities in order to receive and evaluate MO HealthNet applications,” the news release read.

Lawmakers told The Independent on Wednesday that they were informed by DSS that applications would be processed beginning Oct. 1.

Lengthy delay?

Delays in getting coverage to eligible Missourians are inevitable because lawmakers did not appropriate the funds recommended, Parson said during a news conference Wednesday.

“It’s not something you can just flip on the switch and be able to bring everybody in the next day and say, ‘You’re qualified,’” Parson said.

Eligible Missourians may be able to be reimbursed for qualifying health care costs they incur between applying and when the department verifies their eligibility.

“The governor was clear that he’s honoring the constitutional requirement that people are eligible, and people are eligible now. So people should apply now,” said Richard von Glahn, the policy director for Missouri Jobs with Justice, an advocacy organization that was part of the coalition that campaigned for expansion’s passage.

Chuck Hatfield, an attorney who represented three women who qualified for Medicaid expansion and sued the state, said overall he finds it encouraging that eligible Missourians can apply and that health care costs may be reimbursed. However, he said he hopes updating MO HealthNet’s system will take less time than the governor’s office estimated.

“It is always the case that it takes a little bit of time to make eligibility determinations. That seems long,” Hatfield said, later adding: “I’m not troubled by that. But it’s something to keep an eye on.”

House Minority Leader Crystal Quade, D-Springfield, said in a statement Wednesday that “slow-walking implementation” was unacceptable.

“Medicaid expansion has prevailed both at the ballot box and in the courts. No more excuses. No more delays,” Quade said. “The administration has a constitutional duty to do whatever it takes to enroll the expanded population immediately.”

Rep. Sarah Unsicker, a Shrewsbury Democrat, said the 60-day timeline is frustrating.

“They should have been working on that already, I believe — at least since the court decision came down from the Supreme Court to say that they do have to expand Medicaid,” Unsicker said.

The potential 60-day delay and need to reassign DSS staff is a symptom of a broader issue of a lack of funding for public programs, von Glahn said.

“This is what happens when you routinely underfund and deprioritize the public infrastructure,” he said. “You’re not ready to serve the public in the way that you need to.”

Following the law

In May, DSS submitted a proposed rule change that would allow qualified hospitals to make presumptive eligibility determinations for the expanded Medicaid population.

Presumptive eligibility allows MO HealthNet benefits to be temporarily provided to individuals who are determined to be eligible based on preliminary information while they submit and await approval on their application for MO HealthNet benefits.

In Wednesday’s news release, Parson vowed to follow the law, but stressed long-term funding for the expanded Medicaid program still needs to be addressed.

“The necessary funding to cover the health care costs of the expanded population remains the issue,” Parson said in a statement. “We will continue to work with the General Assembly and DSS to chart a path forward to comply with the court order and keep the MO HealthNet program solvent.”

Eligible Missourians can apply for the state’s Medicaid program at mydss.mo.gov. Von Glahn encouraged Missourians who have questions or need assistance applying to contact the Cover Missouri hotline at 800-466-3213.

Missouri Independent is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a public charity. It can be found at missouriindependent.com. The Independent’s Rudi Keller contributed to this story.

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