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Missouri takes 99 days on average to approve Medicaid requests

Two women are seated at a small conference table in an office. They are both looking at the camera. One woman in the foreground is sharp and in focus, while the other woman is seated a little behind her.
Carlos Moreno
KCUR 89.3
Kimberly Johnson (right), a retired beautician, got help signing for Medicaid with help from Sharonda Hooker of Swope Health.

To many in Kansas City, Kimberly Johnson is known as a listener. As a beautician and a church member, people came to her with troubles, and she provided a sympathetic ear.

But painful arthritis forced Johnson, who’s 53, into early retirement from her job.

Today, she needs physical therapy to stay active, but it costs so much, she often often has to go without.

“It can be difficult,” Johnson said. “Like now, it's cold outside, and with my arthritis, I can’t get around as much, or really out the bed.”

Johnson was thrilled when she got a call from Swope Health telling her she likely qualified for health care coverage under Missouri’s recently expanded Medicaid program.

She was hopeful that Medicaid would cover her physical therapy, so in November, she eagerly signed up.

Johnson has been waiting for her application to get processed ever since.

Swope Health patient experience advocate Sharonda Hooker says many patients of the health center, which offers sliding scale payments, found themselves in the same boat.

“It can be very frustrating on us and on the patient,” Hooker said. “Because we’re crossed all of our t’s. We dotted all of our i’s. We’re just sitting there waiting.”

Missouri voters in 2020 approved expanding eligibility for Medicaid to include adults who don’t have children and make up to about $18,800 a year. The federal government pays for 90% of the expansion costs, under rules established by the Affordable Care Act, and the state got an additional $1 billion for expansion through the American Rescue Plan.

After a legal battle and a state Supreme Court ruling, Medicaid expansion finally got up and running this fall.

About 275,000 Missourians were expected to gain health care coverage in the first year, according to estimates used by the Missouri governor's office. But just over 62,000 people have actually signed up so far.

Jackson County was estimated to see the biggest enrollment of any county — more than 35,000 residents in the first year. But by the end of January, the county's total was a mere 8,600.

Critics blame the state of Missouri for the disappointing rollout. State officials have done little to no promotion of Medicaid expansion, and approval times are slow — potentially illegally so.

Missouri is processing each Medicaid application in an average of 99 days, more than double the 45-day maximum processing time allowed under federal law.

Jim Torres of Samuel U. Rodgers Health Center says few clinic patients have been aware that Missouri's Medicaid program has been expanded.
Alex Smith
Jim Torres of Samuel U. Rodgers Health Center says few clinic patients have been aware that Missouri's Medicaid program has been expanded.

The reasons for the slowdown are unclear, even to longtime observers.

“There have been a lot of people that ask that question and try to get an answer, and the answers we get are varied,” said Washington University health economist Timothy McBride.

Missouri officials said that the Department of Social Services workforce has been hit hard by COVID-19 cases in recent month, hampering application processing efforts.

However, McBride explains that the department also faces longer-term problems, including high turnover rate, long call center waits and the state's clunky, decades-old computer program.

The most recent state data showed 73,000 applications for Medicaid expansion were still pending. At the current rate of roughly 2,100 applications processed per week, the state won’t even get through its backlog until late summer.

“So, we’re moving along at a pretty slow pace,” McBride said.

Like in many Republican-led governments, elected officials in Missouri have long resisted Medicaid expansion — and continue efforts to defund it even now.But the state's slow pace of application processing is unusual even for red states.

Oklahoma, where expansion enrollment began in summer 2021, had already enrolled 200,000 people in its program by early November.

Missouri Department of Social Services spokesperson Heather Dolce told KCUR that the Family Support Division is pushing to work through the backlog of applications by offering overtime to employees, and they're prioritizing the oldest applications submitted.

Dolce says that, for applicants who need health care, coverage can be retroactive to pay for treatment up to three months before an application was submitted.

However, Jim Torres, program manager at Samuel U. Rodgers Health Center, says that the application delays can lead to some people to avoid seeking medical help.

“Because they don’t know if they’re going to have coverage,” Torres said. “And providers don’t know if they’re going to have coverage. So that leaves a lot of certainty in their health care.”

Despite the state’s problems, many health care groups have pressed ahead in their efforts to enroll Missourians. The nonprofits Health Forward Foundation, the Missouri Foundation For Health and others have sponsored promotions for the expanded Medicaid program.

Swope Health, Samuel U. Rodgers and University Health and other health organizations are offering assistance with signing up, and they encourage potential enrollees to not be scared away by the slow approval times.

“Even though the state is behind and there’s a delay, we don’t want that to stop you from applying. Go ahead and get that application in now,” said Cari Benshoof, director of patient access services at University Health.

Four months after she applied for Medicaid expansion, Kimberly Johnson says she’s still optimistic about getting coverage. But she’s holding off on physical therapy for her arthritis until she knows her application is approved.

“I really need the treatments — the extra stuff and everything that I could probably get through Medicaid,” Johnson says. “It’s really needed, so. The process is kinda making it a little slow for me.”

As her application sits in limbo, Johnson continues to struggle with pain that keeps her from the social life she loves.

Alex Smith
Alex Smith began working in radio as an intern at the National Association of Farm Broadcasters. A few years and a couple of radio jobs later, he became the assistant producer of KCUR's magazine show, KC Currents. In January 2014 he became KCUR's health reporter.