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Attorneys for Medicaid expansion say Missouri breaking federal law by delaying enrollment

Attorneys for Medicaid expansion say Missouri breaking federal law by delaying enrollment

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JEFFERSON CITY — The state’s decision to sit on applications for expanded Medicaid until Oct. 1 violates federal law, attorneys who sued this year to kick-start the voter-approved program said in a letter to officials on Thursday.

The attorneys said in addition to breaking federal law mandating the processing of applications within 45 days, the delay also “flies in the face” of a court order Circuit Judge Jon Beetem issued on Aug. 10 directing the state not to block enrollment for individuals in the expansion population.

The letter highlights frustration among Medicaid expansion proponents, who accuse Republican Gov. Mike Parson’s administration of dragging its feet on implementation even as the state has promised to abide by court rulings affirming the new program.

Jefferson City attorneys Chuck Hatfield and Lowell Pearson, as well as Joel Ferber of Legal Services of Eastern Missouri, sent the letter after the Post-Dispatch reported Monday that a state official said applications “will sit there” while the state makes software updates.

The attorneys represent three women suing for coverage under Medicaid expansion, which is open to adults ages 19-64 making less than 138% of the federal poverty level.

Kim Evans, director of the Family Support Division, said in a video dated Aug. 11 that “while people can start applying now,” and that while staff may verify application information, they would not be allowed to “run a determination” or “finalize” applications.

“We will let the system do that on October the first,” Evans said.

She said for those who applied for Medicaid between July 1, when the constitution said Medicaid expansion was supposed to take effect, and the day before the court order, staff will “reopen those applications.”

The staff will “rerun to see if they’re eligible for this new expansion group,” Evans said.

Kim Evans, director of the Family Support Division, says in this video to staff, dated Aug. 11, 2021, that “while people can start applying now,” for Medicaid and staff may verify application information, they would not be allowed to “run a determination” or “finalize” applications.

Asked if that meant those individuals would be enrolled before Oct. 1, Rebecca Woelfel, spokeswoman for the Department of Social Services, said the state would process the expanded Medicaid applications “consistent with the regular eligibility process by using the Missouri Eligibility Determination and Enrollment System (MEDES) once the system is ready on October 1.”

The Aug. 10 order said the state couldn’t treat expanded Medicaid enrollees differently than those who were already eligible.

Officials were also barred from prohibiting individuals eligible from enrolling.

“Refusing to enroll individuals eligible for the MO HealthNet program under” Medicaid expansion “until October 1 violates both of these directives,” the letter said.

“The federal Medicaid Act requires applications be processed within 45 days, with the exception of pregnant women and disabled individuals,” the letter said.

In 2016, Kansas faced a backlog of nearly 11,000 Medicaid applications languishing for more than 45 days, the Wichita Eagle reported at the time.

A nursing home provider sued the state in September that year, saying nearly two dozen patients were on the verge of being kicked out of its homes because the state hadn’t finalized their applications within the federally required timeframe.

The attorneys said they were aware “there are computer upgrades to be completed and staff trainings to do” but that the jobs “should not stop the Division from complying with the Court’s Order.”

The letter was addressed to Missouri Solicitor General John Sauer, and top Department of Social Services officials were copied. State officials did not respond to a request for comment.

The letter asks the state to answer a number of questions, including why it chose Oct. 1 as a “target enrollment date” and what specific upgrades were necessary.

It also asks whether the state intends “to enroll all individuals” who applied before “Oct. 1, 2021 on October 1.” If not, they asked when those applicants would be enrolled.

An Aug. 11 news release from Parson’s office noted the software update as well as a lack of adequate resources as bureaucratic obstacles, adding that staff would need to be reassigned to work through the caseload.

While the release said the update could take two months, it added “qualifying health care costs that are incurred by eligible Missourians between the time they apply and when DSS is able to verify their eligibility may be reimbursed at a later date.”

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