Most disturbing about the Post-Dispatch article “Missouri children are losing Medicaid coverage at rate that is alarming pediatricians“ (July 19) is that this is not a new situation.
Having served on the MO HealthNet Oversight Committee (overseeing Missouri’s Medicaid program) from August 2017 through the end of my state Senate service in 2022, I have seen and heard these failures repeated and defended for years.
Missourians’ health and lives are at stake and department leaders continue to be unsuccessful, unhurried or perhaps unmotivated in resolving the issues. Meeting minutes look much as they did when I served. Nothing is changing, except of course, who the consumers and the denied consumers are.
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Ineffective notification and outreach to potentially eligible Missouri citizens, inordinately lengthy phone wait times to get a question answered, denial of applicants due to correctable paperwork omissions or mistakes, an inefficient and unconnected technology system continue to plague the enrollment system. And all lead to the lack of health care access for thousands of our neighbors-in-need.
What has happened at the federal level since the implementation of Medicaid expansion under The Affordable Care Act (Obamacare) 10 years ago?
Prior to Medicaid expansion, parent(s) in a family of four would be eligible for Medicaid only if they earned under 19% of the federal poverty level ($5,928 per year in today’s dollars). Now, under expansion, a family (one parent, three children) can earn up to $43,056 and be eligible.
No wonder so many families, pre-expansion, waited until there was a dire emergency to see a doctor. The emergency room, which was required to stabilize them, seemed to be the only option financially.
Medicaid expansion passed at the federal level in 2010, and was fully implemented in 2014. States were offered support operationally and financially to cover the costs.
Under expansion, states would be provided $190 million per year for two years to update and integrate systems to help ensure the Medicaid program could run smoothly and efficiently. Yet the Republican-controlled Missouri Legislature refused to take the dollars. And it did nothing to update our decades-old antiquated systems.
Federal dollars would also cover 100% of the expansion costs from 2014 to 2016, reducing its share to its minimum cost-sharing amount of 90% beginning in 2020. In 2020, and in perpetuity, states would be required to pay only 10% of Medicaid costs for expansion patients.
The Missouri Legislature refused to pass Medicaid expansion for years. In 2020, the state’s voters finally sought and voted to approve Medicaid expansion through a citizen-led ballot initiative. Families earning up to 138% of the federal poverty level would have coverage. As of October 2021, Medicaid expansion was technically in effect. But roadblocks continued.
Dependent children, who have higher family income-eligibility levels, will often be eligible when parents are not. It is incumbent upon the parents to get their children signed up.
Low-income families tend to relocate often. A “sign up or lose coverage” letter mailed to a previously listed home may not reflect the family’s current address, and might not be received.
At work, especially for those working in low-paying jobs, there are simply not long stretches of time to wait on the phone during the workday. Incredibly frustrating is having 5:00 p.m. roll around and the parent’s “hold” becomes a “disconnect.”
These unacceptable customer-service failures in Missouri can be life-changing for a family with an asthmatic child or a school-eligible child needing a physical and a vaccine.
This has been going on in Missouri since the voter-led passage of expansion. For a state whose majority legislators generally call themselves “pro-life,” not fixing a system that provides the very children (and their parents) who live among us the opportunity to have access to health care when needed is contradictory and unconscionable.
Seeing the doctor before an illness or injury becomes an emergency is both cost effective and smart. Let’s help our kids get to school, learn, grow, do well and choose to contribute and keep Missouri as their home.
When will our legislators and government department heads lobby for making the citizens of Missouri healthier and stronger, in order to live, work and enjoy all Missouri has to offer?
When will we prioritize ensuring that the state’s Department of Social Services fulfill its stated Mission: “Empower Missourians to live safe, healthy and productive lives”?