A Missouri lawmaker who oversees the state’s Medicaid budget says thousands of children recently removed from the rolls were likely still eligible for coverage.
In recent public comments, Rep. David Wood, R-Versailles, blamed much of the contradiction on children’s parents failing to refile paperwork to get their kids back on the rolls, something he said couldn’t be put on any single government official or action.
But in an interview this week, Wood also said doing that paperwork is “horrendous” and that the state could do a better job helping people navigate the application process. He also outlined how the state enrolled the children in such a way that set the stage for later problems.
Wood’s comments challenge previous explanations of why more 100,000 people have been removed from Missouri’s Medicaid rolls in the past two years.
A year ago, when the decrease stood closer to 60,000, Gov. Mike Parson’s top budget writer described it as the result of an improving economy, according to the St. Louis Post-Dispatch.
As the decline continued into the summer and Democrats’ calls for an investigation ramped up, House Speaker Elijah Haahr, R-Springfield, spoke with Wood and the state’s Medicaid director and offered additional explanations.
In a statement, Haahr said the decrease was the fruit of an improving economy as well as a change in federal law and an upgrade to the system that vets people’s eligibility.
The system hadn’t worked properly from 2014 to 2018, Haahr said, but the upgrade was powering “a needed cleanup of those who are not eligible for Medicaid benefits.”
Wood said that by last fall, state data told him something else was going on, too.
Between 2014 and early 2017, a Medicaid program designed for families with extremely low incomes had added tens of thousands of adults and children to the rolls, he said.
Wood found that odd since it’s so difficult to qualify for that program: a family of three can’t make much more than $300 per month and stay on.
But Wood noted the increase came during those years when the state wasn’t vetting applicants correctly, leaving the doors open to people who didn’t really qualify.
Wood pointed out that after the state began properly vetting incomes in 2018, state data show significant drops in enrollment — roughly 27,500 parents and 44,000 children from January 2018 to December 2019.
Wood didn’t dwell too much on the parents. But he said the children removed at the same time likely still qualified for programs with higher income limits if their parents had been directed to apply for Medicaid in the first place.
Wood shared his conclusions with his budget subcommittee overseeing the agency in charge of the state’s Medicaid program late last month.
With Democrats listening closely, Wood said his theory explained why one social services group in St. Louis said it got 300 children back on the rolls after they were removed.
“That is very possible under this family coverage,” Wood said, “because most of the children that dropped would qualify on their own.”
The problem, Wood said, is that their parents didn’t apply for them.
“When they got the notification that they were no longer eligible, they didn't reapply under a different category,” he said.
Democrats weren’t quite on board with that.
Rep. Deb Lavender, the top Democrat on Wood’s subcommittee, welcomed Wood’s broader comments as proof her party wasn’t simply “making political hay” when it called for the Republicans who control the government to investigate whether anyone had lost coverage despite being eligible.
But Lavender said Wood was wrong to blame parents for their children losing coverage.
She said if the state kicked someone off who was eligible for benefits, it should fix that mistake without asking any more of them.
“We should be able to fix our error without putting it on the backs of these parents,” she said in an interview.
Wood didn’t see it, though.
Wood acknowledged that notices sent to parents may not have mentioned other coverage options and that getting help from a state call center to fill it out paperwork has been a challenge for years.
But he said that ultimately, “I've got to put some responsibility back to the family.”
It wasn’t clear whether the state could fix the issue without parental input.
In an email, a Department of Social Services spokeswoman said that when the state is verifying eligibility, it “must explore each individual’s eligibility,” and if individuals “fail to return a renewal form or requested verification,” their case will close.
“For parents who are found to be ineligible, the agency will continue to explore eligibility for each child," the spokeswoman, Rebecca Woelfel, added.
Asked if the state should be doing more to help in that process, Wood was noncommittal.
“To go on out and find these families and say ‘Hey, you need to reapply’ takes a lot of staff,” Wood said. “Could (the department) do it? Possibly. Do they have the staff right now to add that to their list, I'm not sure.”
He said private companies the state pays to manage children’s care should also be reaching out simply to keep their revenues up, if for nothing else
House Minority Leader Crystal Quade, a Springfield Democrat who has been one of the more prominent voices on the issue, said the state should be better than that, though.
She said the state should partner with private companies on outreach if possible, but couldn't ignore the need to pay for its own outreach and better technology that doesn't create unnecessary problems.
“We can't just say we know we messed up and we're just going to leave it at that," she said. "That's unacceptable."
She also expressed frustration that Republicans took until now to acknowledge genuine issues with the decrease in enrollment.
"With health care, these are life and death situations," she said. "We should be trying to figure out what’s going on as quickly as possible, not just denying it until we can no longer deny it. It shouldn't always be about politics."
Austin Huguelet is the News-Leader's politics reporter. Got something he should know? Call him at 417-403-8096 or email him at firstname.lastname@example.org. You can also support local journalism at News-Leader.com/subscribe.