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Missouri Speaker Says Scrutiny Of Medicaid Recipients' Incomes Led To Enrollment Drop

Tim Bommel | Missouri House Communications
House Speaker Elijah Haahr says an eligibility audit is behind the state's 100,000-person drop in Medicaid enrollment.

When Missouri officials announced earlier this year that more than 100,000 people, many of them children, had been dropped from the state Medicaid program, critics assailed the cuts as callous and unnecessary.

But House Speaker Elijah Haahr, R-Springfield, said Monday that the cuts largely resulted from a new computer system's ability to weed out enrollees who earned too much money to qualify for the program.

The state insurance program for low-income people and the disabled has purged enrollees since last year. That was when the state stepped up efforts to systematically re-certify enrollees with a new computer system.

Haahr issued an update after a briefing with Missouri Medicaid Director Todd Richardson and Rep. David Wood, R-Versailles, chairman of the House Appropriations subcommittee for Health, Mental Health and Social Services.

Previous administrations had let the program bloat, Haahr said.

“This correction in the rolls was going to have to happen because of these prior years of them not cleaning up the standard,” he said. “[The Department of Social Services] found there was a significant amount of people who weren’t eligible.”

More than 850,000 people were enrolled in the program as of July. That’s down from 953,000 in August 2018.

Haahr said the new process, along with decreased unemployment rates, a healthy economy and a decrease in Medicaid applications, has “precipitated a pretty lengthy decline.”

But others are skeptical of the claim that an improved economy is behind a decrease in eligibility. The state’s economy hasn’t improved enough in recent years to push so many recipients off the rolls, said Tim McBride, Washington University Health Economics professor.

“Most of those kids probably should be eligible for Medicaid unless their parents’ income doubled or tripled, but I don’t see evidence in other economic data to suggest that’s what’s going on,” said McBride, who until recently oversaw the state’s Medicaid Oversight Committee.

McBride agrees that the re-enrollment process is to blame for the drop. But he said that doesn’t mean that all the people who were targeted by the re-certification process deserved to be taken off the rolls.

“The re-certification process started looking at people’s records, and then it triggered a whole bunch of other potential problems,” McBride said.

People didn’t receive or respond to letters or weren’t able to get in touch with enrollment specialists on the state-sponsored help line, he said.

“I’ve heard numerous reports of people who think they were still on Medicaid and seeing their kids dropped from the program,” McBride said.

The state “aggressively” pursues enrollees who don’t respond to re-certification mailers, Haahr said. The Department of Social Services uses email and text messages in attempts to follow up with people who haven’t responded.

Certain providers in the state are able to offer presumptive Medicaid to patients, who can then get covered immediately at the doctor’s office. The Department of Social Services can also retroactively enroll those who incorrectly lost their Medicaid benefits, he said.

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Sarah Fentem is the health reporter at St. Louis Public Radio.