An article in today’s St. Louis Post-Dispatch points to a serious issue facing Missouri’s Medicaid program.  As the article points out, enrollment in the Medicaid program (called MOHealthNET in Missouri) has been dropping in the state for several months.  As reported by the Centers for Medicare and Medicaid Services (CMS) in their latest reports, with data through July, Medicaid enrollment is down -4.4% in Missouri since last year (from about 866,000 to about 830,000). This is the second largest drop in the country over that period. 

What is quite perplexing, as the report shows, is that even in other states that have not expanded Medicaid enrollment is growing (by an average of 4%), admittedly much lower than the growth rate of 18% in expansion states. 

What explains why Missouri is going backward while the rest of the country is going forward?  It is not entirely clear what explains these trends, but there is now evidence of a significant backlog in applications in processing applications.  A couple of graphs seem to illustrate the problem dramatically. These data come from the Medicaid enrollment reports the state puts out.  This first graph shows that by January 2014 roughly 46% of the Medicaid applications were taking 30 days or more to process, yet in August 2013 and earlier well less than 20% of applications were being processed in 30 days or less.


[Source: Missouri Family Support Division, MO HealthNet Division, "MONTHLY MANAGEMENT REPORTS", Table 10, July 2010-January 2014.]

Another indicator of this trend seems to be the average number of days it takes to process a Medicaid application.  In August 2013 MOHealthNET was reporting an average of 21 days to process an application but now is reporting an average of 42 days, as the graph below shows.


{Source: Missouri Family Support Division, MO HealthNet Division, "MONTHLY MANAGEMENT REPORTS", Table 10, July 2010-January 2014.]

Given these trends it is not a surprise that reports from MOHealthNET that the “backlog” of people waiting for Medicaid coverage grew rapidly in late 2013 and early 2014.  In addition, at hearings of the MOHealthNET Oversight Committee in recent months we have heard reports of individuals having to wait several months before they have been able to obtain Medicaid coverage.  This is important because delays can lead to significant worries about bankruptcy, stress, and health consequences.