The computer system the state implemented last year to handle Medicaid renewals is known as the Missouri Eligibility Determination and Enrollment System or MEDES. At multiple points in its workflow, it sends out forms asking for information like income, expenses and immigration status.
The state sent out 13,710 of these forms due by September 30, but received just 7,965 responses by October 2 - less than 60 percent.
Medicaid recipients and legal advocates have complained about the forms, citing instances where they were sent to outdated addresses.
Legal Services of Eastern Missouri advocate Joel Ferber says the number suggest a systemic problem. He says the state is leaning too heavily on the mailers, and needs to improve its automated or so-called “no-touch” renewals. "Missouri indicated back in April that they were doing only 11 percent of the cases through no-touch renewal," Ferber said. "About half the states do 50 percent or more through no-touch."
The Department of Social Services said it couldn't make anyone available for an interview, but Communications Director Rebecca Woelfel wrote in an email that the federal Centers for Medicare and Medicaid Services doesn’t track no-touch renewals, and therefore the DSS doesn't produce reports aggregating that data.
In a March letter to Missouri House Minority Leader Crystal Quade, Family Support Division Director Patrick Luebbering reported the state had been unable to locate more than 20,000 individuals. He further reported that 43,200 individuals had failed to return requested information and were removed from Medicaid programs.
Missouri has seen the biggest percentage drop in the country in child enrollment in Medicaid over the last year and a half, with an estimated 90,000 children - losing coverage. In the past state officials have chalked the decline up to improving economic conditions. Researchers and advocates have rejected that argument, pointing to the fact that Missouri's enrollment decline is well above the national average, while its economic growth has lagged behind the rest of the country.