Nearly 200,000 Missouri children lost their Medicaid coverage between June 2023 and May 2024, according to a recent report from the Missouri Foundation for Health.
During the pandemic, states were limited by federal law from disenrolling people from Medicaid. But in June 2023, at the close of the COVID-19 public health emergency, Missouri began its 12-month “unwinding period,” during which it began to reevaluate the eligibility of Medicaid recipients for the first time in several years.
More than 400,000 of the state’s nearly 1.4 million Medicaid recipients lost coverage during the process, almost half of which were children — one of the highest rates in the nation.
“It's not really clear what made Missouri different during that period, but clearly more kids are getting dropped from coverage here than in a lot of other states,” said Sheldon Weisgrau, vice president of health policy and advocacy for the Missouri Foundation for Health.
According to the report, almost two-thirds of the children’s cases were closed for procedural reasons, such as paperwork and processing issues. As a result, thousands of children who lost coverage are likely still eligible for Medicaid, Weisgrau said.
“The unwinding period was difficult for every single state in the country. There was no state where it went really smoothly. Every state had procedural terminations,” Weisgrau said. “Missouri had more than most, and that's probably reflective of several things that have been going on in Missouri for many, many years.”
Weisgrau said the high number of procedural terminations was caused by a combination of confusing instructions for families and inefficiencies in the Department of Social Services — which oversees the state’s Medicaid program.
If the state cannot verify income independently, it will mail a letter requesting verification. But Weisgrau said people fall through the cracks when this happens.
“'The state doesn't necessarily have up-to-date addresses for everybody in this system," Weisgrau said. "The letters can be confusing and hard to understand, and people may not understand what they're being asked for when they get them."
Weisgrau said much of the low-income Medicaid population is more transient. If they don’t consistently update their information, the state may have a hard time tracking them down, he said.
“There are also problems at the state level,” Weisgrau said. “We've heard of a lot of cases of people who sent in their information, and it never got recorded by the state.”
Also detailed in the report is the Department of Social Services’ long call center wait times — until recently, Missouri was ranked worst in the nation, and it remains in the bottom five, Weisgrau said.
Additionally, Weisgrau said the federal government requires all applications for Medicaid be processed within 45 days. Though Missouri currently averages exactly 45 days, it has historically taken much longer to process applications.
The Missouri Department of Social Services did not respond to a request for comment on this story.
“Medicaid has really always been that safety-net health program for children,” said Casey Hanson, deputy director of Kids Win Missouri. “It covers children up to a much higher eligibility level, so even when the parents aren't eligible, children will be eligible.”
Hanson said the Missouri Department of Social Services has recognized some of its issues in the new legislative session by requesting a budget for many new eligibility specialists and supervisors.
“I think that will be really critical until we have the technology that can work a little bit better and does a better job of not losing participants in the process,” Hanson said.
Katie Blount, a pediatrician in Columbia and chair of the legislative committee for the Missouri chapter of the American Academy of Pediatrics, said maintaining healthcare coverage for children is critical, even in general wellness checks.
“And then you have other children who have chronic medical conditions," Blount said. "They might have seizures that require daily seizure medication. Or (there are) kiddos who have had a heart transplant who need daily medications.”
“If they lose coverage, they're going to lose those medications that are literally saving their lives every day,” she added.
Blount said her clinic — and most others — will routinely check their patients' healthcare coverage before an appointment. As a result, it is often the clinic staff that break the news about losing Medicaid to patients.
“For most of them, it's a surprise," Blount said. "They don't know."
By September 2024, the number of Missouri children who had lost Medicaid coverage had risen to nearly 243,000.
Note: The Missouri Foundation for Health is a financial supporter of KBIA’s Health & Wealth Desk. The story was produced and reported independently by the KBIA newsroom.
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