Todd Richardson, Director of MO HealthNet, Kim Evans, Director of Family Support Division, and Robert Knodell, acting director of Department of Social Services, present to the media in Jefferson City on March 28 about upcoming Medicaid renewals. (Clara Bates/Missouri Independent)
As a pandemic policy expires and Missouri begins rechecking eligibility of around 1.6 million people on Medicaid, social services department leadership pledged Tuesday to make the process “as seamless as possible for as many people as we can.”
Over the last three years, states have stopped reverifying whether Medicaid recipients on their rolls are still eligible. That’s because of a federal emergency policy that gave states enhanced funding to provide continuous Medicaid coverage to those enrolled even if their income fluctuated to exceed the maximum threshold for benefits.
In the meantime, Missouri’s Medicaid participation has swelled.
When the public health emergency began in March 2020, there were around 900,000 enrollees. Now, there are around 1.6 million enrolled — which Todd Richardson, director of Missouri’s Medicaid program, on Tuesday called an “all-time historic high watermark.”
That increase was a result of the federal continuous coverage rules during the pandemic, as well as Missouri’s voter-approved eligibility expansion in late 2021. There are now over 300,000 enrollees in the adult expansion group.
But April 1, states will begin the herculean task of reassessing the eligibility of every enrollee — and they only have up to a year to do it.
200,000 Missourians estimated to lose Medicaid as eligibility renewals resume
Nationally, millions will likely lose coverage, either because they are no longer eligible or because they are still eligible but fall through the cracks due to administrative issues, such as missing the form that is mailed to them. Before the pandemic, during regular renewals, recipients cycling on and off Medicaid due to administrative errors was common.
In Missouri, around 200,000 could lose coverage, Richardson estimated in February.
At a press conference Tuesday, Missouri Department of Social Services leadership said they are working to ensure enrollees are aware of the upcoming renewals, including by collaborating with health care providers and managed care organizations to perform outreach, and to ensure participants return their forms.
“We don’t want to see anyone who’s eligible to continue as a Medicaid participant to lose that eligibility or have that interrupted,” Robert Knodell, acting director of Department of Social Services, said Tuesday.
“At the same time, we do have obligations based on the guidance and provisions from our federal partners as well as state statutes that determine eligibility,” he added.
The department says it has worked to upgrade its renewal process and expand outreach, including by producing a website, outreach materials and posting its plan publicly.
“I just feel very comfortable with the fact that we are doing everything that we can to reach out to the participants,” said Kim Evans, director of the DSS Family Support Division, which is responsible for eligibility determinations.
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Missouri has a 12-month plan to reassess each enrollee in its caseload. That is more cautious than a handful of states, like Texas, which plan to complete the assessments in a shorter amount of time.
Participants’ renewal date will be the anniversary month of when they originally enrolled in Medicaid, or the same month in which they previously did their yearly renewals, if they participated pre-pandemic.
States are required to attempt to renew participants’ eligibility using existing data, called ex-parte renewals, before contacting enrollees to complete forms or documentation themselves.
Missouri has historically used this streamlined renewal process at a low rate, and has been singled-out for its bureaucratic hurdles to renewal before — driven in part by the predominantly-manual renewal process.
In 2019, the state came under scrutiny for significant enrollment declines. Missouri Budget Project, a liberal public policy think tank, determined that families were often kicked off Medicaid despite being eligible for coverage because of challenges with the annual renewal process, including that they did not receive the proper paperwork or submitted the paperwork only for it to be lost or not processed.
In January 2020, Missouri was one of seven states that processed fewer than 25% of renewals on an ex-parte basis.
DSS has worked to expand the electronic sources that will be used for verification, Evans said, though she has not yet provided an estimate of what portion of renewals will be complete this way.
“We will try to verify everything we can, we will try to complete the annual renewal without the participant’s participation,” Evans said. “We may have to have some clarifying questions, and if you get a form from us that says you need to complete this, please get it back to us in time.”
For an enrollee in the earliest renewal group — with a June renewal date — the department in April will start using electronic verification sources to attempt to verify eligibility without needing information from the participant.
In May, the department will mail a decision letter, if the automated information was sufficient to render a decision, or send a form to request more information if it was not. If the state sends a form, the participant will need to return the information by June 30.
The earliest someone could be kicked off Medicaid is May, Evans said: If they are in the June renewal group and return a form in May that deems them ineligible. If someone with a June renewal date does not return the form, they would lose coverage July 1.
If the enrollee misses the deadline, their coverage will be closed and they have 90 days to reopen their case, Evans said. After that, they would have to reapply.
“We don’t want any breaks in coverage, so you run the risk, if you don’t get that in timely, of having a break of your coverage,” Evans said.
For those who are no longer eligible, due to income change or circumstance, the state will work to connect them to other forms of health insurance, Knodell said, including through the Affordable Care Act. Managed care organizations will collaborate with the state to help inform participants of alternative coverage, he said.
“There will undoubtedly be people who have participated in the program that are no longer eligible to do so, but we want that process to be a smooth process as well,” Knodell said.
“And we want those individuals to be aware of coverage options available to them, so that they can continue to have health care coverage even if it’s not under the MO HealthNet umbrella and again, making this process as seamless as possible for as many people as we can.”
Evans said she hopes a customer service portal, which will go live in May, will help enrollees keep up with the renewal process.The state will launch an online portal for Medicaid participants to access information about the timing of their renewals, and how far along the state is in terms of processing their information, Evans said — which she hopes will be a form of “self-service” that could reduce the burden on the Medicaid call centers.
According to a Kaiser Family Foundation report, 44 other states already have online portals with these capabilities, such as allowing a participant to view notices and renew coverage.
The state has committed to publicly posting monthly data, including the number of cases closed, call center statistics and number of ex-parte renewals they complete, Evans confirmed on Tuesday.
DSS leaders urged participants to update their contact information with the state, create an account with the portal when it goes online in May, and then, DSS Director of Communications Heather Dolce said, “being mindful of watching their mail and responding to any important documents.”
Richardson said the task of working through around 1.6 million redeterminations in a year “is certainly work at a scale that we’ve never had to take on as a department before, but we do feel…very confident about the state’s position to make this process go as smoothly as possible.”
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