Missouri agency says it’s increasingly utilizing more efficient Medicaid renewal process

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(Missouri Independent) – Missouri’s social services department is increasingly using a more efficient method to process Medicaid renewal applications, officials said Thursday during a quarterly meeting of the health care program’s oversight board.

Preliminary data shared Thursday shows the state used a streamlined renewal process that doesn’t require enrollee action in 47% of all Medicaid renewal cases it evaluated in April. 

Missouri had long struggled to increase the number of applications processed in that streamlined way. 

That was up from “about 10%” of cases being evaluated that way pre-COVID, said Kim Evans, director of Family Support Division. 

Missouri has historically used this process, referred to as an ex-parte renewal, at a low rate, which many argued was contributing to procedural issues with participants losing coverage in years past. In January 2020, Missouri was one of seven states that processed fewer than 25% of renewals on an ex-parte basis.

Ex-parte renewals use existing data the state has, such as income information from other social services programs, rather than requiring enrollees complete forms or documentation themselves, which can introduce bureaucratic issues.

“I have been doing a happy dance around this,” Evans said, adding that it will “cut down on the churn” that occurs when participants lose coverage due to paperwork reasons and then must reapply.

“We’re very excited to see these preliminary numbers.”

The update comes as Missouri and every state nationwide begins checking the eligibility of every Medicaid enrollee on their caseload, after a three-year pandemic pause on verification checks. Officials have estimated 200,000 Missourians could eventually lose coverage as the pandemic policy ends.

Missouri is reevaluating every Medicaid participant over a 12-month period and is initiating the disenrollments later than many other states which have already begun.

Participants’ renewal date will generally be the anniversary month of when they originally enrolled in Medicaid. 

The earliest group is the June renewal group. In April, the state attempted to renew them using existing data. 

Then this month, the department mailed decision letters to that group, either rendering a decision or requesting more information with a form. 

States are required to send out forms to those they deem ineligible through the streamlined data process, or those from whom they need more information to make a decision.

Evans said the department sent out 37,000 forms in May, out of 71,048 households in total. That suggests that just under half, roughly 34,000 households, retained Medicaid without needing to take any action on their part.

Those who received forms have until June 30 to return the required information or will lose Medicaid. Evans did not provide data on how many of those participants the state found ineligible through ex-parte, versus how many it could not determine.

If someone with a June renewal date does not return the form by June 30, they will lose coverage on July 1.

They will then have 90 days to reopen their case, Evans said. After that, they would have to reapply.

Evans said the department has been working closely with managed care organizations for months to help inform patients about the renewal process and encourage them to return their paperwork, along with other forms of outreach.

The state has not posted any data publicly, but Evans said they will. 

“The plan is for us to make these public numbers,” she said. “For the first couple of months, we just need to make sure we’re pulling our reports correctly.”

Once the state submits data to the federal government in July about how the first batch of renewals went, advocates will particularly be looking for how many of the denials were based on procedural issues — meaning, for the most part, that the participant did not return the required information — versus those found ineligible.

Elsewhere in the country, where states have already begun removing people from the Medicaid rolls, the number of procedural removals has varied widely. Among those that have garnered concern among advocates include Arkansas and Florida: In Arkansas in April, 85% of denials were procedural, and in Florida, 82% of denials were.


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Clara Bates


Clara Bates covers social services and poverty for The Missouri Independent. She previously worked 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.