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Missouri's Medicaid application wait times are among worst in nation, new federal report shows

Sunni Johnson, a certified application counselor at Affinia Healthcare in St. Louis, Missouri, files paper copies of the Medicaid applications she completed online. The absence of robust advertising by the state about Medicaid expansion means much of the outreach effort falls to clinics like Affinia. Johnson says she and her colleagues at the clinic complete about 20 Medicaid applications per day. (Bram Sable-Smith/KHN)
Bram Sable-Smith
Kaiser Health News
Sunni Johnson, a certified application counselor at Affinia Healthcare in St. Louis, Missouri, files paper copies of the Medicaid applications she completed online

The federal government requires states to process Medicaid applications within 45 days. But in Missouri, roughly four in every five applications took longer to process than that, eight times the national average.

A federal report released Thursday shows that Missouri ranks at or near the bottom nationally in terms of processing Medicaid applications in the federally-permitted time.

The report, issued by the Centers for Medicare and Medicaid, contains the first data covering the period since Missouri expanded Medicaid eligibility late last year. CMS used to release the reports annually but will now publish them on a quarterly basis.

Missouri had the highest portion of Medicaid applications processed in over 45 days in March among the 47 states reporting data, and was second only to Arkansas the previous month.

The federal government requires states to process applications within 45 days.

Roughly four in every five Medicaid applications in Missouri took longer than 45 days to process over this period, eight times the national average.

A year earlier, before the state expanded Medicaid, only around 2% of applications took longer than 45 days to process.

Wait times for Medicaid applicants in Missouri and Arkansas far outpaced every other state in the report.

The state regularly releases monthly average wait times, but only the federal reports provide distributional data, which reveals that the issue was not one of a few outlier applications: The majority of Missouri applications were processed in excess of the federal time limit.

The average period to determine eligibility for an application in Missouri was 81 daysin February 2022 and 83 days in March 2022.

The average wait time went on to peak at 115 days in June. Before Medicaid eligibility was finally expanded to include low-income adults last year, the average processing time in June was just eight days. As of last Friday, the average stood at around 90 days.

The long wait times have put the state on CMS’s radar.

In early 2022, CMS began working with the state to identify strategies to reduce processing times and high backlogs — at that point, the new report shows, the state was among the worst nationally.

By May, the federal government wasn’t satisfied with Missouri’s progress. CMS formally requested the state produce a mitigation plan in May, after identifying “multiple issues related to Missouri’s timely processing of applications.”

Last week, during a briefingwith reporters, Kim Evans, director of Missouri’s Family Support Division, which administers Medicaid in Missouri, downplayed the significance of the federal intervention.

“This is something that is normal,” Evans said. “It is not unique to Missouri and it’s not something we had to do because Missouri was just so far behind that we couldn’t save this.”

The state has until Sept. 30 to bring its average times within the guidelines. If it falls short of the plan laid out by CMS, the federal government could implement even more stringent compliance measures. Eventually, Missouri could face financial sanctions.

For applicants, a months-long wait time for Medicaid can prove untenable, causing them to delay necessary care and forego purchasing their prescriptions, said Tricia Brooks, research professor at Georgetown University’s Center for Children and Families.

This story was originally published on the Missouri Independent.

Clara Bates covers social services and poverty for The Missouri Independent. She previously wrote for the Nevada Current, where she reported on labor violations in casinos, hurdles facing applicants for unemployment benefits and lax oversight of the funeral industry. She also wrote about vocational education for Democracy Journal. Bates is a graduate of Harvard College and is a Report for America corps member.
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