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Sept. 27, 2023 |  By: Clara Bates - Missouri Independent

Nearly half of all Missouri Medicaid terminations in last three months have been children

children

By Clara Bates - Missouri Independent

Another 12,833 children were removed from the state’s Medicaid program in August  — more than three-quarters of whom were terminated because of paperwork issues rather than being determined ineligible.

August was the third month of the state reassessing the eligibility of every Medicaid participant, after a three year COVID-era pause on the practice. The process will take place over a year. 

Around one-quarter of the state’s population is enrolled in Medicaid, the government health insurance program for low-income residents, called MO HealthNet in Missouri.

According to newly-released data from Missouri’s Department of Social Services, nearly half — 49% — of all terminations from June through August were terminations of children’s Medicaid coverage. Missouri’s share of children being disenrolled is third-highest among the 16 states that report age breakouts, according to health policy nonprofit KFF.

Over the first three months, nearly 40,000 kids total lost coverage. It’s not yet clear how many of those children were able to cycle back onto Medicaid or moved to another program. 

“[Missouri] needs to look closely at why so many kids are being terminated,” said Joel Ferber, director of advocacy at Legal Services of Eastern Missouri.

And the state should “closely consider a pause on terminations while it evaluates the data,” Ferber added — an option offered by the federal government that some states such as Michigan and South Carolina have voluntarily taken up.

Caitlin Whaley, spokesperson for the Department of Social Services, said because children make up around half of the Medicaid caseload in Missouri, “their disenrollment rate has been roughly proportionate to their share of the overall MO HealthNet population.”

But the income limit for kids to be on Medicaid is higher than it is for adults. Even if parents lose coverage, kids may still qualify, though they sometimes fall through the cracks.

Missouri has said it does not have a glitch some other states have received federal scrutiny for, in which the eligibility determination is made at the household rather than individual level. So it is not yet clear why Missouri has a high rate of children losing coverage. 

“We do recognize that children are a particularly vulnerable population and are refocusing targeted messaging efforts,” said Whaley, “as well as working with partners to reach parents and guardians in Missouri to make sure they know the importance of completing the annual renewal form.”

After kids, the group with the largest rate of coverage loss is low-income adults who became eligible after Medicaid expansion in the state, making up 33% of coverage losses.

77% of all terminations in first three months were procedural

Advocates nationwide have been especially concerned with overall rates of procedural disenrollments.

Procedural disenrollments refer to a variety of paperwork-related issues that prevent the state from determining a participant’s eligibility — including that the state never received the completed paperwork or the participant never received the form. 

For instance, a participant may not receive the paperwork if they changed addresses, or may not return it if they received but didn’t understand the forms. 

Seventy-seven percent of all coverage losses in Missouri in the first three months were for procedural reasons. That is slightly higher than the national average, according to KFF, of 73%.

Over the three month period, an average of 71% percent of kids’ coverage losses were due to procedural issues.

Whaley said some of the procedural terminations are people who would have been determined ineligible had the participant returned their paperwork, because the state’s process of using other data sources found them to be “likely ineligible.”

In August, more than 23,000 Missourians lost coverage for procedural reasons, while 4,590 lost coverage because they were determined to be ineligible. That means around 84% of all terminations were procedural, higher than both June and July.

The state has not yet broken down the sources of procedural issues, which some advocates say could help them target their outreach strategies. Whaley said “the state is regularly looking at data to identify opportunities to improve communication and outreach.”

Ferber said the state should continue to try to “streamline” its largely-manual process. 

States are required to attempt to renew participants’ eligibility using existing data before contacting enrollees to complete forms or documentation themselves — a process called ex-parte renewals that Missouri historically used at a low rate.

In August, the percent of total cases renewed ex-parte was 41%, down from 54% in July. The social services department has said it is working to increase the rate of automated renewals.

‘Not seeing significant amounts of churn’

The state’s overall Medicaid caseload has fallen, over the three months, by 30,664 people, according to the caseload counter updated at the end of every month. That’s less than the total 82,211 who have been terminated, but that case count data lags behind the renewal data, which “goes to explaining why the drop in overall caseload isn’t as drastic,” Whaley said. Over half (56%) of the drop in enrollment by the net measure was for children.

The regular stream of new Medicaid applications could offset some of the terminations — for instance, from eligible people moving to Missouri or newly-eligible Missourians applying for the first time — and some of those terminated could be added back onto the program.

Enrollees have 90 days after termination to submit required paperwork for reconsideration and to be reinstated if eligible. After 90 days, they need to fill out a new application to be enrolled.

“Churn is something the state will look into over the course of this process,” Whaley said, referring to the temporary loss of coverage after an enrollee is terminated and then re-enrolls in a short period. “We have not conducted an exhaustive analysis at this time, but we are not seeing significant amounts of churn thus far.” 

There are over 1.4 million people, as of the end of August, on Medicaid in the state.