The handling of the problem could leave low-income Missourians without health insurance for months and necessary treatment delayed or ignored.
JEFFERSON CITY, Mo. — Missouri case backlog Applying for Medicaid Although it decreased in February, the average time taken to determine eligibility continued to exceed federal limits.
The median time it took for the Missouri Department of Human Services to process Medicaid applications for low-income Missourians in February was 77 days, a spokesperson for the agency told The Independent.
This means that half of the applications processed in February have been pending for at least two and a half months.
The federal Centers for Medicare and Medicaid Services requires Medicaid applications for the largest participant groups (low-income children, families, and adults) to be processed within 45 days.
Missouri’s three-month delay in filing violates federal regulations.
Median processing time in December was 49 days, increasing to 64 days in January. Median processing time is a metric that states are required to report to the federal government.
The handling of the problem could leave low-income Missourians without health insurance for months and necessary treatment delayed or ignored. And that affects not only new applicants, but also applicants who may lose coverage during the eligibility verification process and have to reapply.
Alistair Wylie Genevieve of St. has been trying to get back on Medicaid since January. She said she lost her insurance during her renewal process, even though she and her husband filed paperwork and continued to meet her income limits.
“It was just a living nightmare,” she said.
Since then, she says she endured several phone calls with wait times of at least two hours each, submitted a new application in January, and received confusing information about why her application was stuck . She said her officials could not give her an estimate of when her application would be processed.
Wiley had to ration or forget some medications, and her husband had to delay surgery, she said.
“I’m only taking half the dose I need to treat my severe depression, which makes it very difficult to keep track of this and fight for myself,” she said. Ta.
She also said she called several state hotlines but was unable to speak to anyone or direct her to check state portals, “even if they are difficult to access.” Stated. When she reached the humans, she said, some staff “didn’t seem to know what to do.”
“I feel like there are a lot of barriers to getting the help that you need in this state,” she says.
Federal data is slow, but one report found that as of November, Missouri had some of the worst processing delays in the nation. report It was published last month by the Centers for Medicare and Medicaid Services.
According to that data, only New Mexico, Missouri, Georgia and Washington, D.C. processed more than 40% of their claims in 45 days or more. As of November, 42% of all applications received by Missouri were processed in violation of federal limits.
Department of Human Services leaders said they are transitioning to a dedicated effort to overcome the backlog, and as a result, average processing times will soon be reduced.
The number of unclaimed applications in February decreased from 52,891 in January to 35,833.
Bailey Watts, a spokeswoman for the Department of Human Services, said that’s because the Missouri Division of Family Services has stepped up its efforts to remove duplicate applications and process more claims, adding: “We are working to utilize our staff.” ”
“We hope that these efforts will significantly reduce the number of pending applications and bring the median processing time back to acceptable numbers,” Watts said.
Missouri is required to report median processing times to the federal government, but publishes the average (what most people think of as average) in monthly public reports, Watts said. told the Pendent.Average posted to state report Although slightly lower, it still exceeds the federal limit. February had 57 days and January had 50 days.
The state has long grappled with processing delays and call center wait times, but in the summer of 2022 it was placed under a federal mitigation plan for average processing times. It reached 115 days.
At the quarterly MO HealthNet Oversight Committee meeting last month, Kim Evans, director of the Department of Family Support, said her agency was in contact with the federal government about pending applications. Stated.
“I actually had a call with them this morning,” she said at the meeting. “We plan to withdraw it by the end of February within the processing period.”
The ministry did not respond to several requests for clarification.
From November to mid-January, the state typically sees an increase in Medicaid applications during open enrollment season on the federal insurance market.That’s also in progress Reassess the eligibility of all Medicaid participants After a three-year hiatus due to the coronavirus pandemic, it will resume in earnest.
Evans told the MO HealthNet Oversight Committee that the state expects to see longer processing times during open enrollment each year.
“So this will be a normal process for us. It will be somewhere between November and February or March, depending on what the public offering period looks like,” she said. .
Typically, the same employees who process Medicaid applications also answer the phones and switch between these duties as needed.
According to the latest data up to the end of last year, obtained The average wait time for regular lines, which includes most Medicaid inquiries, was one hour and 45 minutes, according to The Independent.
State Sen. Tracy McCreary, an Olivet Democrat who serves on the MO HealthNet Advisory Committee, cited the Independent’s findings when she asked Evans about wait times last month. “I’m staying,” McCreary said.[s] “I’m concerned,” he said, asking what the state’s plan is to remedy that.
“It’s never our goal for individuals to wait this long,” Evans said. “But there are different levels of call centers,” she says, adding that user mistakes in choosing the correct phone line, or I went on to explain about forgetting to listen to automated responses.
She added that the department is asking Congress for funding to create “call center bots” to increase automation and reduce the need for typical call center staff.
Evans said the goal is to free up staff who are currently answering general inquiries calls and move them to Supplemental Nutrition Assistance Program interviews instead.the state is facing federal lawsuit Exceed SNAP call center wait times.
This story from missouri independent is published at KSDK.com under a Creative Commons license. The Missouri Independent is a nonpartisan, nonprofit news organization covering state government, politics and policy.
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