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Missouri Medicaid application delays exceed federal limits for third straight month

An illustration of the state of Missouri, colored orange, layered over a blue background. Semi-transparent Medicaid forms lay on top of the state.
Eric Harkleroad
KFF Health News
The median time it took Missouri’s social services department to process Medicaid applications for low-income Missourians in February was 77 days.

Missouri’s backlog of Medicaid applications dropped in February, but the average time it took to determine eligibility for them continued to exceed the federal limit.

The median time it took Missouri’s social services department to process Medicaid applications for low-income Missourians in February was 77 days, an agency spokesperson told The Independent.

That means half of the applications processed in February had been pending for at least two and a half months.

The federal Centers for Medicare and Medicaid Services requires that Medicaid applications for the largest group of participants — who are low-income children, families and adults — be processed within 45 days.

Missouri’s application delays have violated federal rules for three months.

In December, the median processing time was 49 days and it rose to 64 days in January. Median processing time is the metric the state is required to report to the federal government.

Processing issues can mean low-income Missourians go months without health insurance, delaying or foregoing necessary care. And it affects new applicants as well as those who may have lost coverage during the eligibility verification process and need to reapply.

Alistair Wiley, of Ste. Genevieve, has been trying to get back on Medicaid since January. She and her husband lost coverage during the renewal process, despite submitting the paperwork and continuing to meet the income limit, she said.

“It’s just been a living nightmare,” she said.

Since then, she says she’s endured several calls that were at least a two hour wait time each, submitted a new application in January, and received confusing information on why her application was stuck. She said workers couldn’t give her an estimate on when her application would be processed.

Wiley has had to ration or miss several medications, she said, and her husband has had to delay surgery.

“I am only on half of the dose I need to treat my severe depression, which has made keeping track of this and fighting for myself incredibly difficult,” she said.

On top of that, she said, she has called several state hotline numbers that don’t give the option to speak to a person and tell her to check the state portal, “even though it’s difficult to navigate.” When she reaches a human being, she said some staff “don’t seem to know what to do.”

“It feels like there are many roadblocks to receiving the help we need in this state,” she said.

Federal data lags, but as of November, Missouri’s processing delays were among the worst in the country, according to a report by Centers for Medicare and Medicaid Services published last month.

According to that data, only New Mexico, Missouri, Georgia and Washington, D.C., were processing over 40% of applications in more than 45 days. Forty-two percent of all applications Missouri received were processed in violation of the federal limit as of November.

Leaders of the Department of Social Services have said they’ve shifted to devoting efforts to overcome the backlog and that the average processing time will soon decline as a result.

The backlog of applications dropped to 35,833 in February, from 52,891 in January.

Baylee Watts, a spokesperson for the Department of Social Services, says that’s because Missouri’s Family Support Division withdrew duplicates and ramped up efforts to process more applications, in “an effort to utilize all available staff to process applications during the large majority of their work hours.”

“With these efforts we were able to largely reduce our pending application numbers and expect to see the median days to processing return to an acceptable number,” Watts said.

Missouri is required to report the median processing time to the federal government but publishes the mean — what most people think of as the average — in monthly public reports, Watts told The Independent. The mean posted in state reports is slightly lower but still exceeds the federal limit: It was 57 days in February and 50 in January.

The state has long grappled with processing delays and call center wait times and was put under a federal mitigation plan in the summer of 2022 for average processing times that reached 115 days.

At the quarterly MO HealthNet oversight committee meeting last month, Kim Evans, director of the Family Support Division, said her agency has been in contact with the federal government about pending applications.

“I actually had a call with them this morning,” she said at the meeting. “We’re on schedule to have them back down, under the processing time, by the end of February.”

The department didn’t respond to several requests for clarification.

From November to mid-January, during open enrollment season for the federal insurance marketplace, the state generally sees an uptick in Medicaid applications. It is also in the process of re-evaluating the eligibility of all Medicaid participants on its rolls after a three-year pause due to the COVID pandemic.

Evans told the MO HealthNet oversight committee that she expects the state to experience longer processing times every year during open enrollment.

”So this is going to be a normal process for us from November to somewhere February or March depending on what our open enrollment period looks like,” she said.

The same workers who process Medicaid applications are generally also the ones responsible for answering the phones, and they switch between those tasks based on need.

By the end of last year, the most recent data obtained by The Independent shows, the average phone wait time for the general line including most Medicaid queries was 1 hour 45 minutes.

State Sen. Tracy McCreery, a Democrat of Olivette who serves on the MO HealthNet advisory committee, cited The Independent’s findings when asking Evans last month about wait times. McCreery said she “remain[s] concerned” and asked what the state’s plans are to remedy it.

Evans said it “is never our goal for individuals to wait this long. But there are different levels of the call center,” she said, going on to explain user error in selecting the correct phone line, or failure to listen to the automated answers.

She added that the department is asking the legislature for money to create a “call center bot,” to increase automation and reduce the need for staff on the general call center line.

The goal, Evans said, is to free up staff who are currently answering the general questions calls to transfer them to Supplemental Nutrition Assistance Program interviews instead. The state is facing a federal lawsuit over its call center wait times for SNAP.

This story was originally published by The Missouri Independent, part of the State's Newsroom.

Clara Bates covers social services and poverty for The Missouri Independent.