Paperwork issues meant more than 16,000 Missourians lost Medicaid coverage in July

In June and July, the first two months of resumed Medicaid eligibility checks, nearly three-quarters of those who lost coverage lost it for procedural reasons rather than determined ineligibility

By: - August 18, 2023 7:00 am

39,973 of 54,160 Missourians who lost coverage in the first two months of resumed eligibility checks lost coverage for procedural reasons — not because they were found ineligible. 18,355 of those procedural losses were kids (Getty Images).

When Rebecca Uccello got a call that her daughter’s Medicaid coverage was in jeopardy, she said it “sent me into a tailspin.”

Her 13-year-old daughter, Izabella, has been on Medicaid since age two because of severe developmental disabilities, including a birth defect which prevents her spinal cord from properly developing and a neurological condition which causes fluid build-up in the brain. 

Uccello, of Springfield, said she received renewal paperwork to verify Izabella’s eligibility on July 7 by mail. She signed, scanned and uploaded it to the state’s website the next day. 

Roughly a month later, her daughter’s caseworker delivered the news that the Department of Social Services never received her paperwork and Izabella was in danger of losing coverage.

Izabella Uccello, 13, has been on Medicaid since she was two years old, qualifying because of developmental disabilities — but her coverage has been in jeopardy three times due to paperwork issues (photo submitted).

Uccello’s shock quickly gave way to panic and anger, she said.

“It’s terrifying as a parent to even think that medical coverage could be lost over paperwork,” Uccello said.

For three years, federal pandemic-era protections paused states’ annual Medicaid renewal processes, barring states from removing participants in almost all cases. 

Those protections expired earlier this year. 

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.

And that concern appears to be well-founded: Uccello says this is the third time in the last decade she has needed to scramble to protect her daughter’s Medicaid coverage due to paperwork issues. 

“What is there to prove that she needs Medicaid renewed? She’s permanently disabled,” Uccello said. “I understand they’re trying to make sure that all their ducks are in a row, and that there’s no fraud…But on the flip side, knowing that there’s nothing that’s going to make her ineligible except for death, it’s frustrating.” 

Missouri’s process of evaluating all 1.5 million Medicaid recipients on its rolls began with renewals due in June and will take a year. Of those who lost coverage in June and July, three-quarters lost it for what are called procedural reasons rather than being determined ineligible. 

According to the health policy nonprofit KFF, that places Missouri around average nationally for its rate of procedural disenrollments.

The social services department has said it is working to increase the rate of automated renewals, as well as performing outreach to educate participants about the process — and has said it is working to avoid disruptions in coverage for eligible participants.

When Uccello realized her daughter’s health care coverage was in danger, she reached out to her state representative, a tactic that she said worked when Izabella was four and paperwork issues nearly cost her coverage. 

A spokesperson for Missouri’s Department of Social Services said in an email to The Independent that this is the first we have heard of that issue” regarding paperwork submitted online potentially being lost.

Izabella’s caseworker resubmitted the paperwork on her behalf, and this time it was a success. Izabella’s Medicaid coverage was reinstated.

It was a relief, Uccello said, but only until the renewal comes around again next year. 

“What do you do?” she said. “How else can you submit paperwork and make sure that they get it?… It’s terrible that parents who have medically fragile and medically complex children also have to deal with the heartlessness of this system.”

74% of losses were procedural in first two months

Todd Richardson, Director of MO HealthNet, Kim Evans, Director of Family Support Division, and Robert Knodell, acting director of Department of Social Services, presented to the media in March about Medicaid renewals (Clara Bates/Missouri Independent).

Procedural disenrollments refer to a variety of paperwork-related issues that prevent the state from determining a participant’s eligibility — including that the state never received the completed paperwork or the participant never received the form. 

For instance, a participant may not receive the paperwork if they lack a stable address or changed addresses, or may not return it if they received but didn’t understand the forms. 

Around 40,000 of the roughly 54,000 Missourians who lost coverage in the first two months lost it for procedural reasons.

Kim Evans, Director of Family Support Division, which oversees the eligibility side of Medicaid, said at last week’s quarterly meeting of the MO HealthNet oversight committee that she could not yet single out specific factors contributing to the procedural denials. 

“Right now, we really haven’t had a chance to really dig in to see where everything is landing. We’re starting to look at that now,” she said.

Enrollees have 90 days after termination to submit the required paperwork for reconsideration and can be reinstated — rather than needing to fill out an entirely new application for Medicaid. 

(Photo courtesy of the Missouri Department of Social Services)

Because Uccello resubmitted the paperwork within the 90 day grace period, Izabella’s coverage loss was brief, she said, likely lasting from Aug. 3 to Aug. 7. (And because she was found eligible within 90 days, Medicaid would retroactively cover that lapse.) 

In the first two months of renewals, just over half of the individuals reviewed, or 116,418 people, were determined still eligible. 54,160 Missourians lost coverage. 52,142 are still pending. 

Evans said it’s generally too early to extrapolate trends in the data — in part because the 90-day window of reconsideration is still open for all those who have been disenrolled, so they could still cycle back on.

We still feel like we still need another month of data in the books before we can really dig into the deep analysis and start to say okay, this is why this is what an average looks like for us,” Evans said.

Children make up half of those who lost coverage 

(Getty Images).

Even if parents lose coverage, children are often still eligible due to higher income limits for kids. But they sometimes fall through the cracks. 

Half of all Missourians who lost coverage in June and July were children, or 27,085 children.

Missouri’s share of children being disenrolled is third-highest among the 14 states that report age breakouts, according to KFF — after Kansas and Idaho.

Sixty-eight percent of the kids who lost coverage in the first two months lost it for procedural reasons — making up 18,355 of the 27,085 kids who were dropped from the rolls.

Sen. Tracy McCreery, D-Olivette, voiced concern at last week’s MO HealthNet oversight meeting about children losing coverage.

“I am concerned that there are kids being kicked off that quite possibly are still eligible, and it’s because they’re dependent on adults getting the paperwork or getting all the forms turned in,” McCreery said.

Evans responded that it “is a process that we really watch very closely” and that the state has held off on terminating some participants, keeping them as pending renewals, “because we wanted to go in and check those cases to ensure that we have done that correctly.”

Evans said the department is working on publishing any changes in the outcomes of pending cases in future months.


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Clara Bates
Clara Bates

Clara Bates covers social services and poverty. She previously wrote for the Nevada Current, where she reported on labor violations in casinos, hurdles facing applicants for unemployment benefits and lax oversight of the funeral industry. She also wrote about vocational education for Democracy Journal. Bates is a graduate of Harvard College and a member of the Report for America Corps.