(Missouri Independent) – Missouri has begun checking the eligibility of everyone on its Medicaid rolls — a review process that was paused for three years because of pandemic-era federal protections.
Many advocates hope to continue to get the word out about how to navigate what is, for many, an unfamiliar process, will help those who are eligible retain coverage.
About one-quarter of the state’s population was enrolled in Medicaid as of June, the government health insurance program for low-income residents, called MO HealthNet in Missouri.
In June, the state had 1.5 million Medicaid enrollees on its books, up from around 900,000 in March 2020 — in part because Missouri implemented voter-approved Medicaid expansion for low-income adults in late 2021 and in part because of the federal rules providing continuous coverage.
Hundreds of thousands are projected to lose coverage in the state. Nationally, more than 3.7 million enrollees already have been stripped from the rolls.
“A lot of people got Medicaid during the public health emergency during COVID that had never had it before, so they’ve never had to go through the annual renewal process,” said Brandi Linder, community health coordinator at Missouri Ozarks Community Health, a federally-qualified health center that assists with Medicaid renewals.
Linder said the focus has been ensuring that those who are new to the renewal process understand the stakes: “That if they don’t do it, they could possibly lose their coverage.”
Here are some of the things advocates and state officials want participants to know.
1. Renewal month is typically the anniversary month of first enrollment.
Missouri’s process of evaluating the eligibility of each person on its caseload will unfold over one year — the state began in June and will end with those due in May 2024.
Participants can view their renewal date on the Department of Social Services’ new online portal, but need a smartphone and an active email address to sign up for the required multi-factor authentication.
2. Participants should update their contact information with the state, especially mailing addresses.
The social services department “strongly encourages” all participants to do the following to “ensure they maintain coverage for anyone in their family who is eligible,” said spokesperson Caitlin Whaley:
- keep their address up to date — notifying the state if they’ve moved in the last three years;
- check the mail regularly;
- and/or verify the renewal date in the Family Support Division Benefit Portal.
Participants can update their contact info online, in person, or by phone.
3. The participant will likely need to return paperwork to the state.
In the first month of renewals, the agency renewed around one-third of those evaluated without needing to contact the participant for information, using existing data. Even those renewed in this streamlined way should get a letter from the state informing them they were renewed: Everyone in their renewal month should expect a letter.
The majority in the first group of renewals, though, needed to respond to paperwork. If the state doesn’t have sufficient data to renew a participant’s coverage, the participant will need to provide additional information.
That paperwork will be sent to the participant by mail and will be a yellow form.
The participant should receive the form 55 days before their annual renewal is due.
The state sends forms already partially completed with information it has about the participant.
The participant should, in addition to filling out any blanks in the form, be sure to do the following, said Geoffrey Oliver, program director of Connecting Kids to Coverage at Legal Services of Eastern Missouri, which provides free assistance to low-income children, pregnant women and families with children navigating Medicaid:
- Review the pre-populated information the state filled out;
- Cross out anything that is not accurate and correct it;
- And be sure to sign the document before submitting it.
4. Participants could benefit from submitting the paperwork, even if they believe they’re no longer eligible.
Being removed from Medicaid due to being found ineligible — rather than simply not returning the form — could help a participant access other insurance, Oliver said.
That’s because the state is supposed to help facilitate a participant’s transition into subsidized coverage through the Affordable Care Act’s health insurance marketplace if they find them ineligible for Medicaid.
“Even if you’re not eligible, it’s to your benefit to get that eligibility denial versus a procedural denial,” Oliver said, “because it’ll get you more assistance with regards to enrolling in a marketplace plan if that’s the best option for you.”
Additionally, he said, even if a parent is no longer eligible, children are often still eligible due to higher Medicaid income limits for kids.
Adults could fall into one of the groups qualifying for Medicaid at a higher income level, too, such as Medicaid for pregnant women or postpartum coverage. Missouri recently extended the duration of postpartum Medicaid coverage from 60 days to one year.
Participants can submit the renewal information by mail to the address shown on the letter, in person to a local Resource Center, online through the portal, or by phone.
5. If there are paperwork issues, eligible participants could lose coverage.
The state can end coverage for two reasons.
If the participant is found to be ineligible — because their income exceeds the allowed maximum, for instance, they will be deemed ineligible and lose coverage.
A participant can also lose coverage for what are called “procedural” reasons, meaning the state couldn’t determine the participant’s eligibility, generally due to paperwork issues.
For instance, a participant could be procedurally disenrolled if they did not return the required paperwork, or did not receive the paperwork — perhaps because of a change in address or lack of a stable address.
Oliver said his office has met with two families unsure whether they received the initial notice by mail and were then disenrolled — “The first they heard about it was the denial” letter, he said.
For another family, the notice was sent to the wrong address because the head of household changed.
Legal Services of Eastern Missouri helped the families submit the paperwork to get coverage reinstated, Oliver said.
In June, the first month of reviews, more than 32,000 Missourians – half of them children – lost Medicaid coverage.
As is the case nationally, Missouri has, so far, had a high rate of terminations due to paperwork issues — 72% of terminations in June were due to procedural reasons. That means around 23,000 Missourians disenrolled were not directly found ineligible but their eligibility couldn’t be determined. (According to the health policy nonprofit KFF, that places Missouri around average nationally.)
6. But participants can regain coverage if they act within 90 days of termination.
If a participant loses Medicaid but believes they are still eligible, they should act quickly, Oliver said.
Enrollees have 90 days after the termination to submit required paperwork for reconsideration — rather than filling out an entirely new application for Medicaid. If they’re found eligible, they can get coverage reinstated.
It’s “very important to turn that paperwork in as soon as possible,” Oliver said. “It’s not too late.”
Medicaid will retroactively cover care during that lapse, Whaley said.
Submitting the information within those 90 days allows participants to stay on the same health plan — retaining the same doctors, for instance. After the 90 days have passed, the participant needs to start from scratch and reapply for Medicaid.
7. The participant should be covered until they receive official notice of continued coverage or disenrollment.
If a participant has submitted paperwork by the deadline but not yet heard back from the state with a decision, they may wonder whether they still have coverage.
In the first month of renewals, around 34,000 determinations remained pending, or 29% of those who were due for renewal. Whaley said at least some of those pending were renewal forms submitted near the deadline which the agency was still processing.
Even if the deadline has passed and a participant hasn’t heard back with a determination, they should still have coverage.
“Coverage will remain in effect” until the determination is made, Whaley said.
They can also check their eligibility on the portal, she said.
8. Those who lose coverage may be eligible for plans through the Affordable Care Act.
States are supposed to help those who lose Medicaid due to ineligibility transition to the Affordable Care Act’s health insurance marketplace, by transferring their information over.
There is a special enrollment period for those who lose Medicaid which lasts from March 31, 2023, to July 31, 2024.
