Missouri to accept Medicaid expansion applications. Full approval likely weeks away

Lawmakers were informed by the Department of Social Services on Wednesday that applications would be processed beginning Oct. 1

By: - August 11, 2021 4:07 pm

Missouri Gov. Mike Parson delivered his State of the State address on Jan. 27, 2021 (photo courtesy of Missouri Governor’s Office).

Missourians who qualify for benefits under Medicaid expansion can begin enrolling, but it may take up to two months until they will find out if their eligibility has been verified and their application has been approved.

In a news release Wednesday, Gov. Mike Parson announced that in response to a Cole County judge’s ruling, the Department of Social Services will begin accepting applications from the approximately 275,000 residents who qualify under voter-approved Medicaid expansion.

That includes 19 to 64-year-old adults whose household incomes are 138 percent of the federal poverty guideline or less, which ends up being $17,774 a year for a single person, or $36,570 for a family of four.

Cole County Circuit Court Judge Jon Beetem ruled Tuesday that DSS officials cannot deny coverage to individuals in the expansion population and cannot impose greater restrictions on them compared to those previously eligible.

Attorneys for the state had argued before Beetem last week that DSS needed two more months to stand up additional personnel and computer systems before enrolling applicants, and had requested a hearing to demonstrate that point. It was not granted.

However, this session lawmakers refused to appropriate the $1.9 billion in state and federal funds needed to finance Medicaid expansion, which also included funding to hire 75 additional employees to help administer the expanded program. As a result, a required update of MO HealthNet’s system to make eligibility determinations of new applications may take up to 60 days, the governor’s office said Wednesday.

“In order to comply with the court order and until the necessary funds can be appropriated, DSS will reassign existing employees from their current assignments and responsibilities in order to receive and evaluate MO HealthNet applications,” the news release read.

Lawmakers told The Independent Wednesday that they were informed by DSS that applications would be processed beginning Oct. 1.

Delays in getting coverage to eligible Missourians are inevitable because lawmakers did not appropriate the funds recommended, Parson said during a press conference Wednesday.

“It’s not something you can just flip on the switch and be able to bring everybody in the next day and say, ‘You’re qualified,’” Parson said.

Eligible Missourians may be able to be reimbursed for qualifying health care costs they incur between applying and when the department verifies their eligibility.

“The governor was clear that he’s honoring the constitutional requirement that people are eligible, and people are eligible now. So people should apply now,” said Richard von Glahn, the policy director for Missouri Jobs with Justice, an advocacy organization that was part of the coalition that campaigned for expansion’s passage.

Chuck Hatfield
Attorney Chuck Hatfield answers questions from members of the media outside the Cole County Courthouse in Jefferson City on Aug. 6, 2021. (Photo by Tessa Weinberg/Missouri Independent)

Chuck Hatfield, an attorney who represented three women who qualified for Medicaid expansion and sued the state, said overall he finds it encouraging that eligible Missourians can apply and that healthcare costs may be reimbursed. However, he said he hopes updating MO HealthNet’s system will take less time than the governor’s office estimated.

“It is always the case that it takes a little bit of time to make eligibility determinations. That seems long,” Hatfield said, later adding: “I’m not troubled by that. But it’s something to keep an eye on.”

House Minority Leader Crystal Quade, D-Springfield, said in a statement Wednesday that “slow-walking implementation” was unacceptable.

“Medicaid expansion has prevailed both at the ballot box and in the courts. No more excuses. No more delays,” Quade said. “The administration has a constitutional duty to do whatever it takes to enroll the expanded population immediately.”

Rep. Sarah Unsicker, a Shrewsbury Democrat, said the 60-day timeline is frustrating.

“They should have been working on that already, I believe — at least since the court decision came down from the Supreme Court to say that they do have to expand Medicaid,” Unsicker said.

The potential 60-day delay and need to reassign DSS staff is a symptom of a broader issue of a lack of funding for public programs, von Glahn said.

“This is what happens when you routinely underfund and de-prioritize the public infrastructure,” he said. “You’re not ready to serve the public in the way that you need to.”

In May, DSS submitted a proposed rule change that would allow qualified hospitals to make presumptive eligibility determinations for the expanded Medicaid population.

Presumptive eligibility allows MO HealthNet benefits to be temporarily provided to individuals who are determined to be eligible based on preliminary information while they submit and await approval on their application for MO HealthNet benefits.

In Wednesday’s news release, Parson vowed to follow the law, but stressed long-term funding for the expanded Medicaid program still needs to be addressed.

“The necessary funding to cover the health care costs of the expanded population remains the issue,” Parson said in a statement. “We will continue to work with the General Assembly and DSS to chart a path forward to comply with the court order and keep the MO HealthNet program solvent.”

Parson said during Wednesday’s press conference that the general revenue allocated to the Medicaid program will run out “in three to four months” but he did not anticipate calling lawmakers into special session to appropriate more money.

Legislative leaders said Tuesday that they anticipate a special session to allocate additional funds will likely not be necessary. Instead, the approximately $12 billion appropriated for the state’s Medicaid program will be sufficient to cover eligible Missourians until lawmakers can return, they said.

But Sen. Bob Onder, a Lake St. Louis Republican who opposed Medicaid expansion, argued lawmakers should not appropriate any additional funds and instead go against the court’s directives and hold a special session to exclude the newly-eligible population.

Eligible Missourians can apply for the state’s Medicaid program at mydss.mo.gov. Von Glahn encouraged Missourians who have questions or need assistance applying to contact the Cover Missouri hotline at (800) 466-3213.

The Independent’s Rudi Keller contributed to this story. 

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Tessa Weinberg
Tessa Weinberg

Tessa Weinberg covered education, health care and the legislature with the Missouri Independent. She previously covered the Missouri statehouse for The Kansas City Star and The Columbia Missourian, where her reporting into social media use by the governor prompted an investigation by the Attorney General’s office. She also covered state government in Texas for The Fort Worth Star-Telegram.