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The Capitol Building in Jefferson City

Gov. Mike Parson waves to the crowd after he addressed a joint session of the legislature on Monday, June 11, 2018, at the capitol building in Jefferson City. At left is Speaker of the House, Todd Richardson. Photo by J.B. Forbes, jforbes@post-dispatch.com

JEFFERSON CITY • Amid a stunning drop in the number of Missourians enrolled in Medicaid, top officials in Gov. Mike Parson’s administration are defending a new system that checks eligibility for the health care system for the poor and disabled.

The Missouri Department of Social Services came under fire this week after a report said more than 70,000 Missouri residents — 56,000 of whom are children — dropped off Medicaid enrollment in the last year.

The 7 percent enrollment decline was the state’s most significant annual decrease since 2006, when lawmakers created tighter eligibility levels for certain groups, said Timothy McBride, a health economist at Washington University in St. Louis who heads the MO HealthNet oversight committee.

The notification system, implemented last spring, sends out an initial letter instructing Medicaid recipients to renew their eligibility within 30 days. If the department does not receive a response during that first month, several warning notices, spanning 144 days total, are mailed out, said Patrick Luebbering, director of the agency’s Family Support Division.

He said the system had sent out about 15,000 notices each month since July.

The department increased outreach efforts by contacting managed care providers, circulating reminders on social media and setting up automated calls to recipients several times in the first month.

“We tried to think of everything that was available to us without having access to an actual advertising budget to communicate with people and do it timely,” said Caitlin Whaley, director of legislation and communication for the Department of Social Services.

Kim Evans, the director of income maintenance programs at DSS, said that in the past the department had sent fewer notices and did not implement many outreach efforts.

In a oversights committee hearing Friday, Dr. Bridget McCandless tagged the automated phone calls “a waste of time,” saying that many people didn’t answer unknown callers and that even if Medicaid recipients tried to return the message, the line didn’t allow it.

Sen. Jill Schupp, D-Creve Coeur, said the entire enrollment process, including each future alert, should be outlined for recipients in the first letter so they are aware of the timeline.

When asked why the drastic drop in enrollment happened in the first place, Luebbering said it was partially due to the state’s strong economy. He said that when the economy was doing well, the state often saw a drop in those needing assistance programs such as Medicaid.

Luebbering noted that the state’s food stamp program, known as SNAP, also saw a significant decrease in enrollment last year. He said the decline in both programs indicated there was an environmental effect on enrollment.

“If we saw a 70,000 drop in (Medicaid) and I saw nothing in SNAP, we would be having a different conversation,” he said. “The problem is, we saw a 50,000 caseload drop in SNAP that has nothing to do with the new (Medicaid alert) system.”

McBride said he struggled to accept the financial explanation, noting that other states did not have as significant an enrollment drop despite their healthy economies. He pointed to Tennessee as the only state with a bigger drop-off — topping Missouri’s reduction with a 9 percent decline.

Luebbering added that the Missouri department had not sent out annual renewal letters to all Medicaid recipients since about 2015. Part of the drop-off could be credited to the state’s need to catch up for those few years. Other states already had automated systems in place.

McBride pushed back, asking Luebbering how sure he was that all 70,000 Missourians who were no longer enrolled didn’t need Medicaid anymore.

The state’s Medicaid director, former House Speaker Todd Richardson, said that was an “impossible question” to answer. He said the state wouldn’t be able to know with 100 percent certainty how many of those 70,000 residents would have been put back on the roll unless they had responded.

Sen. Scott Sifton, D-Affton sent a letter to Richardson asking for answers about the number of children affected by the drop off earlier this week. Both Sifton and Schupp said they’re waiting for further explanation at a Senate press conference Thursday.

“Our first priority needs to be that we are that assured anyone who was removed from those rolls that shouldn’t have been, is reinstated and gets the access that they need quickly and easily,” Schupp said.

Luebbering told the oversight committee DSS is currently undergoing a federal review of the entire eligibility system.

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