Bishop Eric Morrison, who serves as the lead pastor at Kingdom Word Ministries in Kansas City, fought for Medicaid expansion in Missouri because he had seen the costs to people’s lives when they couldn’t afford to go to the doctor and pay for medicine.
Then, half a decade ago, he saw the relief that came after voters changed the law to give more low-income Missourians access to the government health insurance program, known in Missouri as MO HealthNet.
He’s not about to let that be taken away when upcoming changes in federal law add work requirements and more frequent eligibility checks for some Medicaid coverage.
“That’s what the 911 is,” Morrison said. “Imagine someone who’s on blood pressure medication (losing coverage) and then having to wait before they can re-register. They probably aren’t going to make it.”
Morrison is a member of the Jackson County Benefits Information Network, a grassroots movement of religious, health and community leaders working to get the word out about the new federal requirements, which are expected to cause millions to lose coverage in the coming decade.
They have been meeting every other week to plan and strategize about how to mitigate the damage. And the group is not alone. The Kansas City Health Commission, Legal Aid of Western Missouri and hospitals and clinics that rely on Medicaid revenue are among those rallying to keep people covered.
With fewer than five months remaining until the state begins enforcing the new rules, efforts are shifting into high gear. The Jackson County network has held informational sessions for religious leaders, is planning community meetings and volunteer training and this week will release informational materials it hopes to distribute around the state.
A sense of urgency was evident during a July 10 network meeting at Macedonia Baptist Church on Linwood Boulevard. The challenge, participants said, is to do enough before time runs out.
Jackson County Legislator Donna Peyton, who co-founded the network with the Rev. Stan Archie, senior pastor of Christian Fellowship Baptist Church in Kansas City, said she fears many people will not get the message, open their mail and take steps to secure their Medicaid coverage. She worries “that we just miss somebody.”
“We don’t want to do that,” she said. “We want to reach everyone.”
New requirements apply to Medicaid expansion
The new work requirements and other changes to Medicaid became law last summer when President Donald Trump signed his sweeping tax cut and spending bill, which he touted as the “One Big Beautiful Bill.”
In order to slash federal Medicaid spending by $326 billion, the bill adds new administrative burdens, which could drive 10 million Americans out of the program over the next decade, many because they fail to jump through new administrative hoops.
| Activities that satisfy “community engagement” requirement |
|---|
| 80 hours per month of work, community service and/or “work program” participation. |
| Enrolled in education at least half time. |
| Any combination of minimum wage multiplied by 80 hours. |
| Seasonal workers with an average monthly income over six months of minimum wage multiplied by 80 hours. |
| Source: KFF |
Beginning Jan. 1, Medicaid recipients enrolled through the expansion program will have to document 80 hours of work, school or other “community engagement” for at least one month during a six-month period. In addition, participants will have to prove they qualify every six months, something that has only been necessary annually.
The new rules only apply to adults in the Medicaid expansion program, which came out of the Affordable Care Act as an option for states to expand health coverage to people 19 to 64 years old who make less than 138% of the federal poverty level. Traditional Medicaid is open only to certain groups, such as low-income families and people who are pregnant or disabled.
Roughly one-third of the 67 million people enrolled in Medicaid nationwide are receiving it through the expansion program, including approximately 365,000 Missourians. Since Kansas has not opted in to Medicaid expansion, the new work requirements and more frequent recertification checks do not apply in that state.
Notices coming in the mail
The Missouri Department of Social Services, which administers MO HealthNet, will begin mailing notices about the new regulations Aug. 1. The agency will stagger mailings throughout August and September to avoid overwhelming the state call center and other resources, a spokesman said. It also will communicate with participants about the changes through social media, email and “partner outreach.”
But community organizers in Kansas City worry about the message not getting through. If people don’t supply the state with an updated address and contact information, they won’t receive the state’s notice. And if they don’t pay attention and respond to state requests, they may have coverage canceled without even knowing it.
Evidence already exists that MO HealthNet participants struggle to keep up with paperwork. Of the 333,265 Missourians who lost Medicaid coverage last year, almost 92% were disenrolled due to procedural issues, meaning the state could not determine whether someone was eligible because of missing forms, incomplete information or other paperwork problems.
And the new paperwork facing people in the expansion group will be a complete surprise to many people, said Bob Theis, CEO of Samuel U. Rodgers Health Center, a safety-net clinic in Kansas City. Even many of the social service organizations in town that work with people receiving Medicaid aren’t aware of the coming changes.
“When other safety nets outside the healthcare industry don’t know, we’re all freaked out,” Theis said. “If they don’t know, I know that the Medicaid participants don’t know.”
A big concern is that Medicaid participants, already juggling work and family responsibilities, won’t have the bandwidth for the additional red tape.
“We know that a lot of our patients are on Medicaid, have very complicated lives now, and are dealing with a lot of different stresses,” said Charlie Shields, University Health’s president and CEO. “This will be one more complicating factor, and it may not be their top priority to solve.”
Even if participants do receive a notice about the changes, open it and read it, that doesn’t complete the challenge, said Jennifer Wagner, director of Medicaid eligibility and enrollment with the Center on Budget and Policy Priorities.
“It’s really complex,” she said. “Reaching people is half the battle, but actually getting them to understand what they have to do is huge.”
University Health, which has some 50,000 Medicaid patients in its payer mix, and community safety-net clinics like Sam Rodgers and Swope Health, which depend on Medicaid-covered patients to subsidize care for other patients who lack insurance, are ready to do anything they can to help their patients stay enrolled.
That includes doing their own outreach to be sure people are aware of the new requirements, and sitting down with them to sort through documents and fill out forms.
University Health is one of a handful of health providers in Missouri that the state has commissioned to handle the entire process, including enrollment verification. The hospital is hiring 10 additional employees who will handle eligibility determinations, bringing the total number to 22. Sam Rodgers, too, has been selected to do enrollments, but is only beginning the work to put that program in place.
Handling the enrollment in house, Shields said, can reduce the time it takes to get patients covered.
“Once we do the application,” he said, “we’ll know that we have all the data and the requirements for the application.”
Why is it so hard?
That cuts out some of the back and forth that sometimes happens when people have to ship everything off to Jefferson City. The process is tedious. Documents. Forms. Many questions that are sometimes unclear.
There is almost always something to iron out, said Jim Torres, program manager for health insurance services at Sam Rodgers. The process isn’t difficult, he said, but it requires time and patience, a burden that will double when twice-yearly reverifications take effect.
Back in March, Torres worked with a mother and her two daughters who came to Sam Rodgers to complete their annual renewal. The obstacles weren’t enormous, but each one required attention. The state had included a fourth person in the family, the children’s father who didn’t live with them and didn’t claim the children on his taxes.
“We had to help them write a letter and explain that,” Torres said.
And one of the daughters had turned 19, so her mother could no longer apply on her behalf.
“We told her, ‘You’ve got to do it yourself,’’’ Torres said.
But he isn’t sure if she ever came back in with all the paperwork she needed. It was another chance for someone to lose Medicaid.
“Any time people are going through annual renewal they are at risk of losing coverage,” he said.
If they don’t have the right documentation to show their income, or they are missing some other paperwork, the process can go sideways. And then, often, they show up at the doctor or end up in an emergency in need of medical care and find out they don’t have Medicaid.
“It’s constant churn,” Torres said. “People in and out, in and out.”
Unanswered questions
Advocates fear that the added burden of work requirements combined with the new requirement for people to go through the renewal process twice as often will only increase that churn.
They hope that some people will be automatically credited with meeting work requirements if they are paying state taxes, for example, and the state can verify their work status without requesting additional documentation.
But it is unclear, said Chris Moreland, communications director with the Missouri Department of Social Services, how many renewals will be handled through that process now that new requirements have been added.
“If requested,” Moreland said in an emailed response to questions, “the participant will have to provide verifications to DSS to show they are complying with community engagement requirements if DSS is unable to verify.”
There are also big unanswered questions about how states will be allowed to handle work requirement exemptions.
Although the law was signed last year, the federal government only released guidelines about how states should implement work requirements in June. And the state is still waiting on a final rule.
One of the biggest unknowns is how a “medical frailty” exemption will be defined. The June rule added a level of subjectiveness, requiring states to determine in each case whether a person’s level of impairment is great enough to earn the exemption.
“What does that mean? And how do you know?” said Brian Colby, vice president of public policy at the Missouri Budget Project. “We don’t know how the department is going to deal with that.”
Previously, if a patient had a certain diagnosis in the medical claims data, they would be granted an automatic exemption. But with the new federal guidance, that automatic verification will go by the wayside and patients will be responsible for providing additional documentation.
“This really blurs all of that,” Colby said.
Ultimately, it also adds to the level of concern among the community leaders working to get the word out to Medicaid patients about the changing legal requirements.
Everyone currently receiving Medicaid should make it a top priority to make sure that the state has their current contact information, advocates said. And they should not ignore any piece of mail that arrives from the state.
Missing a notice will bring the chance that someone who really needs access to a doctor and medicine will be left without Medicaid coverage to pay for it. And that’s why Morrison said he will continue doing what he can to spread the word.
“We know this is a Katrina coming,” Morrison said, “so we’re trying to do our best right now to secure that levee. Given that there may be some spillage that comes over it, we can ill afford to see people’s lives lost because of lack of preparation.”
What Medicaid participants should do now
- Update contact information with MO HealthNet.
- Watch for official notices by mail, email or text regarding eligibility and reporting requirements.
- Respond promptly to requests for information or documentation.
- Find help from community organizations, enrollment specialists, healthcare providers or local resources centers.
Source: Jackson County Benefits Information Network
This story was originally published by The Beacon, a fellow member of the KC Media Collective.
