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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Missouri lags behind other states as it tries to cut backlog in Medicaid applications

Sebastián Martínez Valdivia
The Missouri Department of Social Services has reopened many of its in-person offices across the state, which were shuttered during much of the pandemic.

Correction: An earlier version of this article incorrectly referred to the Oklahoma Health Care Authority as the state health department.

When Missouri voted to expand Medicaid eligibility in the summer of 2020, many in Saralyn Erwin’s community didn’t know what the change meant. Erwin is a a certified application counselor at the Northeast Missouri Health Council in Kirksville. Her job consists of helping people access social services, including Medicaid.

“There wasn’t a real push by any organization to really get the information out there what Medicaid expansion was,” Erwin said.

When Missouri eventually implemented Medicaid expansion in October 2021, it opened the public health insurance program to most Missourians making 138 percent of the federal poverty level or less — around 18,800 dollars a year.

Lately, Erwin's clients have been asking questions about the wait times. As of February, it was taking the state Department of Social Services 119 days on average to process applications.

Erwin says that average has dropped to 81 days in recent weeks, which is still nearly double the federal requirement of 45 days.

“Sometimes it can be pretty life-altering," Erwin said. "Some [clients] needed surgeries and had to put those off, so their conditions worsened."

When clients ask Erwin why it’s taking so long, the best she can do is pull up their application on the state’s database and see if anything is missing, or if the state has looked at it. The Department of Social Services says staffing shortages have contributed to the delays.

Timothy McBride studies health policy at Washington University in St. Louis, and served as chair of the oversight committee for Missouri’s Medicaid programs from 2012 to 2019. According to McBride, staffing is not a new problem for the department.

“We’ve historically paid our state employees about the lowest in the country and you know it just hasn’t grown very much," McBride said. "That problem [is] just going to perpetuate itself.”

Over the past week, DSS said it found many cases where clients who were receiving another kind of Medicaid, say for pregnant women, qualified for the expansion group instead.

That could help clear the backlog in applications, which sat at more than 70,000 in February. McBride said that change was overdue. "I think that could have been done a long time ago, closer to October, and I’m not exactly sure what took so long,” he said.

While DSS didn't reveal how many people were shifted to the expansion group, enrollment in Medicaid expansion jumped more than 45,000 between the first and second week of April. That was the biggest increase in enrollment since expansion started.

The jump brought enrollment in Missouri’s Medicaid expansion to 146,000 people. That total is still little more than half of the 275,000 people estimated to be eligible.

Missouri's numbers stand in stark relief with those in neighboring red state Oklahoma. Like Missouri, Oklahoma approved Medicaid expansion in the summer of 2020.

The state has enrolled nearly 270,000 people in its expansion group, well over the 190,000 estimated to be eligible. Emma Morris, a Health Care and Revenue Policy Analyst at the Oklahoma Policy Institute, chalked the success up to the state's Medicaid administrators and community organizations embracing the change.

“Our Medicaid agency — the Health Care Authority - really was committed to making sure that everyone who’s eligible was able to enroll in Medicaid expansion,” Morris said.

While Missouri’s legislature spent the months leading up to Medicaid expansion resisting the voter-approved expansion, Oklahoma’s legislature fully funded expansion.

Morris said that let the health department start collecting information to pre-enroll Oklahomans in the program. Instead of waiting months for a decision on applications, Oklahomans get an answer the same day they apply.

“People don’t have to wait — they fill out the application, so they know if they’re eligible or not, and then they can go see the doctor,” she said.

But for the tens of thousands of Missourians with pending Medicaid applications, the wait to go see a doctor will be much longer.