Centers for Medicare and Medicaid Services (CMS)

Twenty states — including Missouri, Kansas, Iowa, and Nebraska — have joined a lawsuit suing the Centers for Medicare and Medicaid Services over a federal requirement increasing minimum staffing levels for nursing homes.

Around this time last year, a quarter of Missouri nursing homes hadn’t been inspected in at least two years. Now the number is closer to 3%, according to Centers for Medicare and Medicaid Services data.

A St. Louis nursing home’s overnight closure in late 2023 upended the lives of more than 170 residents and families. Advocates and politicians called for its directors to be held accountable, but a $56,000 fine from the federal Centers for Medicare and Medicaid Services could be the only penalty.

The federal government told Missouri it is concerned the state is not doing enough to “achieve and sustain” compliance with federal rules on Medicaid and CHIP. In Missouri, 72% of insurance applications took more than 45 days to process — the worst in the U.S.

A federal rule will require long-term care facilities to have a minimum number of nursing staff on hand at all times to take care of residents.

The federal Centers for Medicare and Medicaid Services requires that Medicaid applications for the largest group of participants — who are low-income children, families and adults — be processed within 45 days. In February, Missouri took an average of 77 days to process applications.

Missourians trying to enroll in or retain Medicaid — the government-run health insurance program for low-income Americans — are running headlong into the state’s increasingly-strained system. The result: lost and missing paperwork, indecipherable state notices and marathon call center wait times.

The U.S. Department of Health and Human Services said more than two-dozen states, including Kansas, failed to conduct renewal assessments properly and consequently disenrolled too many people. Officials say that Medicaid expansion — which GOP lawmakers in Kansas have repeatedly blocked — would have protected some of the patients.

Missouri’s share of children being disenrolled from Medicaid is third-highest among the states that report age breakouts. Nearly 40,000 kids total lost coverage — mostly for paperwork reasons — and it's not yet clear how many were able to cycle back or move to another program.

As Missouri and all states begin reassessing the eligibility of every Medicaid participant on their rolls, one major concern is that many are losing coverage due to paperwork issues rather than a lack of eligibility. Of those who lost coverage in June and July, three-quarters were for "procedural reasons."

The Centers for Medicare and Medicaid Services found that callers to Missouri's social services helpline waited an average of 48 minutes before reaching someone, and 44% of callers hung up before being helped.

During the height of the coronavirus pandemic, the federal government issued emergency protections that barred states from removing people from the government-funded health insurance program for low-income people and families. That changes this month.