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Missouri officials say Medicaid applications are finally being processed within federal deadline

James Dickerson (left) learned he could be eligible for Medicaid from a flyer on the door of Affinia Healthcare in St. Louis, where he sought care for an ear infection. Within about five minutes, Dickerson supplied application counselor Sunni Johnson with all the information she needed to submit his Medicaid application online. (Bram Sable-Smith/KHN)
James Dickerson (left) learned he could be eligible for Medicaid from a flyer on the door of Affinia Healthcare in St. Louis, where he sought care for an ear infection. Within about five minutes, Dickerson supplied application counselor Sunni Johnson with all the information she needed to submit his Medicaid application online. (Bram Sable-Smith/KHN)

Missouri officials said Wednesday Medicaid applications are now being processed within the federally-mandated timeline of 45 days, a step towards bringing the state into compliance with a mitigation plan to address a backlog of applications.

Robert Knodell, the acting director of the Department of Social Services, broke the news to lawmakers Wednesday during a hearing of the House Subcommittee on Appropriations.

“I’m pleased to tell you today that that backlog is no more and we are now processing current Medicaid applications within the federal requirement of 45 days,” Knodell told lawmakers, later adding: “Thankfully, now that backlog we are putting, as of this week, in the rearview mirror.”

In an interview following Wednesday’s hearing, Knodell clarified that there are applications older than 45 days, but in those instances the department is still waiting on the applicant to provide additional information.

“Nobody has an untouched Medicaid application older than 45 days, as of today,” Knodell said.

The state has a Sept. 30 deadline to wrangle its backlog of applications, after the Centers for Medicare and Medicaid Services (CMS) took the unusual step of requiring a mitigation plan to get the state’s processing time — which averaged 115 days in June — down to a maximum of 45 days.

A spokesperson for CMS did not immediately respond to a request for comment Wednesday.

In an interview, Kim Evans, the director of the Family Support Division, credited increased flexibility through the mitigation plan, like using information previously verified in other benefit programs, with helping process Medicaid applications as well as the work of department staff.

“They’ve really dug in, and just really they’ve given us overtime,” Evans said. “They’ve just really worked very hard.”

Evans told reporters late last month that the average time it took to process a Medicaid application was between 85 to 90 days, compared to the average of 106 days in July. A federal report released last month showed that roughly four in every five Medicaid applications in Missouri took longer than 45 days to process at the beginning of this year — eight times the national average.

Since July 1, 2021, the state has received over 280,000 applications for Medicaid, Evans said, with around 12,000 applications still pending as of Wednesday. As of Sept. 9, 236,677 individuals have been enrolled into the expanded Medicaid group, according to the state’s caseload counter.

Rep. Sarah Unsicker, D-Shrewsbury, said she was glad to see the state had reduced its backlog, but stressed that the federal guidelines need to be a baseline.

“I hope they’ll continue to bring it down. In a lot of states it’s less than a week on average to process Medicaid applications,” Unsicker said, later adding: “They need to aim higher.”

Timothy McBride, a health policy analyst, professor at the Brown School at Washington University in St. Louis and former chair of the MO HealthNet Oversight Committee, said he recommends the state try to keep almost all the strategies in place that it’s implemented under the mitigation plan, especially with the open enrollment period beginning in November and the looming end of the federal public health emergency.

“It’s taken until now for them to catch up. We don’t want them to get through it now,” McBride said of the backlog. “And then have it start all over again.”

Staffing shortages have been a persistent issue that has contributed to the lengthy backlog of applications, and officials said those challenges still exist.

“We’re looking to fill positions, use creative strategies to recruit candidates, job fairs, workforce development pipelines, the usage of overtime when available within the confines of our system,” Knodell said. “So it remains a challenge.”

On average, Evans said around 30 to 33 employees are leaving each month.

As part of the state’s mitigation plan with CMS, Evans said that any applications received prior to Aug. 16 needed to be completed to be within the 45-day timeframe. Evans said the state has a few remaining pieces of pending information to complete before the state can submit to CMS that it is compliant.

“They want us to be under 45 days as of September 30. We will be,” Knodell said. “We’re happy to be there today. And we will be there on September 30 and moving forward.”

Copyright 2022 KCUR 89.3. To see more, visit KCUR 89.3.

Tessa Weinberg