Attorneys argue Missouri is violating federal law, courts on Medicaid expansion delays
State officials said eligible individuals would not be enrolled until Oct. 1 due to system updates
Demonstrators stand outside of the Governor’s Mansion in Jefferson City on July 1, 2021 and hold signs urging Gov. Mike Parson to fund voter-approved Medicaid expansion (Tessa Weinberg/Missouri Independent).
Attorneys who successfully sued to force Missouri to enact voter-approved Medicaid expansion argued in a letter to state officials Thursday that delays in implementation not only violate the court order but also federal law.
The plaintiffs’ attorneys, Chuck Hatfield and Lowell Pearson, joined with Joel Ferber, director of advocacy for Legal Services of Eastern Missouri, in a letter to the attorney general’s office questioning why the Department of Social Services would need until Oct. 1 to begin enrolling eligible individuals.
The letter argued that refusing to enroll newly eligible individuals until Oct. 1 while previously eligible individuals continue to have their applications processed “is not treating these populations equitably” as the court ordered.
The letter noted plaintiffs expect individuals to be enrolled in a timely manner and that the federal Medicaid Act requires applications be processed within 45 days — with certain exceptions.
“Not only is Family Support Division’s decision to hold all applications until Oct. 1 in violation of the court’s order, but also a violation of federal law,” the letter read, which was also sent to top DSS officials.
A spokesman for the Attorney General’s Office declined to comment. A spokeswoman for DSS did not immediately respond to a request for comment.
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Earlier this month, Cole County Circuit Judge Jon Beetem ruled that DSS could not deny the approximately 275,000 newly eligible residents that qualify for benefits under Medicaid expansion from enrolling or impose greater restrictions on them.
Attorneys for the state had argued the department needed two more months to put the necessary staff and computer systems in place. Despite the court’s order, the state still said it would take up to 60 days for the necessary system updates to determine eligibility of applications.
The Independent previously reported that lawmakers were told by DSS officials that applications wouldn’t be processed until Oct. 1.
This week, the St. Louis Post-Dispatch reported on an August 11 video of Family Support Division Director Kim Evans telling employees that applications would “sit there” until that date as system upgrades were underway.
Later in the video, Evans also goes on to say, “we have turned off the auto-deny, because we have to accept those applications now.”
KJ McDonald, the organizing director and a Joplin organizer for Missouri Health Care for All, said she has spoken with a handful of Missouri residents who qualify for benefits under Medicaid expansion and applied between July 1 — the date Medicaid expansion would have gone into effect — and before Beetem’s ruling came down Aug. 10. Of those, some applications have been denied, while other applications are still pending, McDonald said.
“I think it’s pretty inconclusive what’s been happening at a larger scale,” McDonald said.
McDonald said it’s created confusion for residents about whether they need to reapply and anxiety for those who are waiting on having benefits in place before seeing a doctor to have a medical condition looked at.
Ferber said it was his understanding that because there was no mechanism in place to approve residents eligible under Medicaid expansion prior to the court’s order, applications received would have been denied.
“For the expansion people, I think it probably would have benefited them,” Ferber said of DSS holding applications until the court’s decision instead of issuing denials. “It’s always better not (to) get denied, because that creates confusion.”
“I think the bottom line from what I’ve heard from folks is that people really need Medicaid,” McDonald said, “and they need it as soon as possible.”
Rebecca Woelfel, a spokeswoman for DSS, did not confirm that the department had been automatically denying applications like Evans indicated in the video. Woelfel said the Family Support Division would “reopen” applications received since July 1 and begin running determinations on eligibility starting Oct. 1.
“Those applicants do not need to do anything,” Woelfel said. “The Family Support Division is currently verifying information as a preliminary step that will eventually expedite the processing of applications.”
Woelfel did not immediately respond to a request for comment on whether the division has sent notices to any denied or pending applicants to make it clear that no action is needed on their part.
Evans said during a MO HealthNet Oversight Committee meeting last week that the department is exploring offering eligible applicants who apply through Oct. 31 automatic retroactive coverage to July 1.
Evans also said the division is working to identify and verify the information of current recipients of Medicaid services who may also be eligible for coverage under Medicaid expansion. On Monday, a memo was posted outlining that the division would be advising potentially eligible individuals they would be evaluated for benefits under Medicaid expansion when applications begin to be processed.
In Thursday’s letter, attorneys said they were prepared to apprise the court of the developments. They asked state officials to elaborate on their decision to choose an Oct. 1 enrollment date and provide any communications documenting that decision.
They also asked the state to lay out its compliance with the court’s order, illuminate what the process will be for enrolling individuals and explain whether state plan amendments have been resubmitted to federal regulators.
In a Tuesday MO HealthNet provider update, the division noted it had posted the order and judgment to its website.
Last week, Kirk Matthews, the interim director of MO HealthNet, said the state has not yet resubmitted its state plan amendment, and is working through questions the Centers for Medicare & Medicaid Services had on the state’s initial plan before it was withdrawn in May.
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