Missouri Among States With Kids At Highest Risk Of Losing Health Coverage

For the past two years, states have been barred from removing anyone from the Medicaid rolls under a public health emergency declared during the COVID-19 pandemic. They were given additional federal funds to pay for the coverage.

When the emergency ends, the federal government has given states one year to undertake the massive task of re-evaluating the income and eligibility of all Medicaid recipients.

A report released Thursday by Georgetown's Center for Children and Families found Missouri is one of six states where, during the re-evaluation process, children specifically are most at risk of losing coverage that they've been receiving continuously for two years.

In Missouri, Medicaid rolls have swelled to a record high of nearly 1.2 million. Health care advocates have been concerned about the end of the emergency, worried that many will lose coverage either due to income changes or from falling through the cracks when asked to provide updated personal information to the state.

"Given the considerable housing instability for low-income families and changes in employment patterns and child care due to the pandemic, there has likely been a great deal of movement and changes for these families over the past two years," the report stated. "Any gap in coverage is problematic for children and families as they are exposed to large medical bills in the event of a child becoming sick or breaking a bone."

The concerns come at a time Medicaid recipients and applicants face hours-long wait times on the phone with short-staffed Missouri Department of Social Services call centers.

Advocates and lawmakers have been especially wary since 2019, when more than 90,000 children were dropped from Missouri's Medicaid rolls. Part of the cause then, advocates said, was that many families never received renewal notices and were unable to report their information to the state.

Among the factors flagged in the report include a Missouri policy not to provide continuous Medicaid coverage to children for 12 months despite monthly fluctuations in a family's income.

Another is the premiums the state charges in the Children's Health Insurance Program, which covers children whose families make too much to qualify for Medicaid. They could deter a low-income family that no longer qualifies for Medicaid after the re-evaluation.

The public health emergency is set to end in April, though it appears likely to be extended to July. The Biden administration this week did not give a promised 60-day notice to states that the emergency would end.

One factor imperiling children's coverage in Missouri, according to the Georgetown report, is the state's low rate of automatic Medicaid renewal based on income data and other information already available.

The state's Department of Social Services has said it is aiming to accomplish just that in preparation for the end of the emergency. It could not be reached for comment on Thursday.

Kim Evans, director of the DSS Family Support Division, told a House budget committee last month the department has lined up agreements with electronic data sources that can check residents' income and renew them without the need to wait for recipients to report the information.

The department is seeking $16.8 million, mostly federal funds, in the fiscal year that begins July 1 to conduct the re-evaluations and $6.8 million for the third-party data sources. The state has not said how many recipients it expects will lose coverage.

"We have electronic sources in place ... before we even contact the participant," Evans said of the upcoming emergency's end. "Our hope is we can start to move through a one-touch renewal ... Unless we have conflicting information we will not have to reach out to the participant at all."

But the Georgetown report's authors also warned about the dangers of relying on third-party data during the re-evaluation. It cited Missouri's use of a contractor to conduct address checks, revealed this month in a report by The Star, that ensnared eligible residents in removal from health coverage.

The state has sent notices to 5,800 families intending to terminate their coverage over the contractor's reports linking them to out-of-state addresses. Out-of-state residency is one of the few reasons Missouri is allowed to remove recipients from health coverage during the emergency.

It's not clear how many in-state residents have been linked incorrectly to addresses that don't belong to them. DSS has paused the benefits cutoffs until at least the end of the month to investigate the discrepancies.

"Data sources can be great," said Tricia Brooks, research professor at Georgetown University and one of the report's authors. "If we really want to promote continuous coverage, particularly for children, we need to make sure that we're not using data in a way that really is going to drive" a cutoff of benefits over procedural issues.

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