Missouri Medicaid director slated to return as state prepares expansion implementation

After a months-long leave of absence, the director of Missouri’s Medicaid program is expected to return to his position next month as his division gears up to handle an anticipated influx of applications under voter-approved Medicaid expansion.

At a Thursday meeting of the MO HealthNet Oversight Committee, Kirk Mathews, the interim director of Missouri’s Medicaid program, told attendees that Todd Richardson would be returning in mid-September.

“I’m sure there will be a lot of folks happy with that,” Mathews said, “but probably none more so than me.”

Richardson, a Poplar Bluff Republican and former House speaker, temporarily left his role as director of MO HealthNet, the state’s Medicaid program, to spend more time with his family, the St. Louis Post-Dispatch reported in late February.

The position pays $233,000 a year, and Richardson last received a paycheck from the state on April 15, according to the state’s accountability portal.

Richardson was also a key official helping the state formulate and execute its pandemic response. His departure came as Missouri continued to grapple with COVID’s spread and as lawmakers debated whether to appropriate the necessary funds to pay for voter-approved Medicaid expansion.

Since then, the courts have ordered the state to enact Medicaid expansion.

Last week, Cole County Circuit Judge Jon Beetem ruled that the Department of Social Services could not deny the approximately 275,000 newly eligible residents that qualify for benefits under voter-approved Medicaid expansion from enrolling or impose greater restrictions on them.

In August 2020, 53.3 percent of voters passed a constitutional amendment to expand Medicaid coverage to 19 to 64-year-old adults whose household incomes are 138 percent of the federal poverty guideline or less.

That ends up being $17,774 a year for a single person, or $36,570 for a family of four.

The issue ultimately wound up in the courts after lawmakers refused to allocate the $1.9 billion in state and federal funds needed to finance Medicaid expansion. In May, the state ultimately withdrew a plan it had submitted to federal regulators as a result.

While the state must now move forward with implementing Medicaid expansion, DSS officials reiterated Thursday that the process will still require several months of fine-tuning and updates until applications can be approved.

Part of the delay is attributed to a system update that is necessary to properly process eligibility of new applicants. The Family Support Division with DSS is currently testing the system to ensure it works properly, said Kim Evans, the director of the division.

“When we add new code to the system, not only does it affect this new expansion group, but it also affects all of the groups that we already have…” Evans said, later adding: “So we want to make sure that we’re thoroughly testing this, because it’s very important as we go through and add new programs that we are getting this right.”

However, residents eligible for coverage under Medicaid expansion can currently apply. Applications won’t be processed until the system tests are complete, which Evans estimated won’t be until late September. 

Lawmakers said they were previously told by DSS officials that applications would begin being processed Oct. 1.

The Family Support Division has seen an increase in applications, with about 4,200 pending MO HealthNet for Families applications. Of those, about 1,200 came in over the weekend online, Evans said.

However, Evans stressed the division does not have a way to determine if those are strictly from individuals applying under Medicaid expansion. She noted the department expected to receive an increase from the federal Health Insurance Marketplace and start of the school year when families tend to enroll.

Evans said the department will explore offering eligible applicants who apply through Oct. 31 automatic retroactive coverage to July 1. Starting in November, applicants would need to request retroactive coverage of the prior quarter, which would go back to August, Evans said.

Individuals have up to one year to request coverage be applied to the prior quarter, Evans said.

Oversight committee members also raised questions about how and when providers will be reimbursed for services already being provided to residents potentially eligible for coverage under Medicaid expansion.

The Family Support Division is also working to identify and verify the information of current recipients of Medicaid services who may also be eligible for coverage under Medicaid expansion, Evans said.

A new streamlined application that was being developed to apply for safety net programs, including Medicaid, will also be delayed until early 2022, Mathews said. That’s, in part, because of the changes the department is working through with Medicaid expansion, the public health emergency and more.

“We were afraid that the introduction of the new streamlined benefit application would get lost in everything that was happening,” Evans said, “So we really want this to be a positive.”

Another outstanding question is the cost of Medicaid expansion and when appropriated funds will run out.

Mathews said MO HealthNet’s budget staff has been working with the Office of Administration, the state agency that oversees budgeting and purchasing, “to run every scenario we can” to assess when funds may run out.

“I’m not really prepared to give you a timeline,” Mathews said. “But we do know we’re not going to shut our doors tomorrow or next month or anything. But there is a finite amount of money to cover both existing and expansion populations.”

Legislative leaders previously told The Independent they anticipated a special session would not be necessary. They said the approximately $12 billion appropriated for the state’s Medicaid program will likely be sufficient to cover eligible Missourians until lawmakers can return in January and pass a supplemental budget.

Mathews said the state has not yet resubmitted its state plan amendment to federal regulators, and is working through questions the Centers for Medicare & Medicaid Services had on the state’s initial plan before it was withdrawn in May.

“When we filed it initially CMS had a lot of questions. We want to make sure we have all those addressed before,” Mathews said. “We want to file it once correctly. Once it’s approved, we live by it.”

Mathews said there is not a set date by which the state will resubmit its state plan amendment, but stressed the state was committed to maximizing as much federal funds as possible to pay for Medicaid expansion — something the constitution requires under the amendment passed by voters.