The paring down of Medicaid rolls in Missouri smells like a fish carcass left to rot for a week.
More than 120,000 people have been dropped from coverage in Missouri since 2018, the majority of them children.
Gov. Mike Parson’s administration explains the decrease as a result of Missouri’s great economy. Patrick Luebbering, director of the Family Support Division of the Department of Social Services, has said 41,000 fewer people applied for coverage from 2015 to 2018. The administration also points to falling unemployment, an improving economy and the removal of the federal mandate requiring people to carry health insurance or face a tax penalty.
But that doesn’t hold water. The unemployment rate dropped less than a percentage point, meaning fewer than 20,000 people were back on the job. Though the economy is better nationwide, Missouri is cutting Medicaid rolls far faster than most other states, according to a report by Kaiser Health News. Missouri cut rolls nearly 11%, while the average enrollment drop nationwide was around 2%. Further, Missouri is not seeing a similar drop in those qualifying for welfare and the SNAP (food stamp) program.
Could something else be responsible? The state has implemented new software, the Missouri Eligibility Determination and Enrollment System, to verify that enrollees qualified for coverage. The system’s stated purpose — to purge ineligible recipients — appears to have been overdone. It seems to be kicking qualified people off and then making it difficult to get benefits restored.
Federal law requires that the system check income information against other social welfare programs such as food stamps when reviewing coverage. MEDES hasn’t been, and that appears to contribute to the removal of qualified recipients. Though the system sends out notices before dropping enrollees, recipients say the letters look like junk mail and many may have thrown them out. Further, many Medicaid recipients move frequently and may not have received the notices. Many find they are no longer covered when they go for medical care and are turned away.
Those no longer covered are telling horror stories of unanswered phones, hours spent on hold and resistant, unhelpful call center staffers who seem disinclined to return calls or resolve problems. They say they are required to fill out reams of paperwork to try to reestablish eligibility. Often those who have managed to get coverage restored say that was accomplished by seeking legal aid or help from sympathetic lawmakers.
Another matter that fails the smell test is the removal of Timothy McBride, who was chairman of the MoHealthNet Oversight Committee — the committee that oversees Missouri's Medicaid program — after McBride started asking questions about the decrease in enrollment. The administration says the replacement was not connected, of course, but the disclaimer fails to fan away the odor.
Conservatives have long sought to reduce Medicaid costs and coverage. That is a valid political position worthy of open argument on the floor of the Legislature. Stealth cuts through software shenanigans and bureaucratic foot-dragging are not an appropriate way to accomplish that goal.
The stench can be ignored no longer.