Missouri’s social services department will resume conducting Medicaid eligibility renewals on April 1 — allowing the state to once again remove people from its rolls after a three-year pause during the COVID-19 state of emergency.

Since March 2020, states have been barred from removing enrollees from Medicaid during the federally-declared public health emergency in exchange for enhanced federal funds, except in narrow instances, such as in the case the participant moved out of state or requested their coverage be terminated.

Previously, states had been required to renew the eligibility of each participant, typically annually. 

A provision in the federal spending package passed last month set the April 1, 2023, date for states to begin conducting redeterminations, regardless of when the public health emergency ends. Missouri will conduct renewals over the course of a year.

The enhanced federal funds will be gradually phased down, with several standards states must meet in the process of conducting eligibility redeterminations.

Medicaid participants in the state should “keep an eye out for an official letter from the Family Support Division” acting Department of Social Services Director Robert Knodell said in a press release last week, adding: “We cannot stress enough how imperative it is to make sure your address is up to date before April 1.”

States are required to attempt to renew participants’ eligibility automatically, which are called ex-parte renewals, before contacting enrollees to complete forms or documentation themselves. Ex-parte renewals use existing databases to confirm details like participants’ income and assets.

Missouri has generally used this streamlined renewal process at a low rate, which has placed increased importance on families receiving the mailed letters and returning required materials before their deadlines. In January 2020, Missouri was one of seven states that processed fewer than 25% of renewals automatically

In January 2022, Missouri was one of just eight states that was not processing ex-parte renewals — many states processed them during the pandemic even though they couldn’t remove anyone, so as to reduce the backlog when verifications would resume. 

Social services leadership has said the department is working on expanding data sources to provide the necessary information to staff to allow for more ex-parte renewals.

In an email to the Independent, Department of Social Services spokesperson Heather Dolce said Family Support Division is “currently in development to automate access to electronic data that will be used in the ex-parte process” and that it “should be complete by April 1.”

Director of Family Support Division Kim Evans said in an August MO Healthnet meeting that the number of people who fall on and off Medicaid due to procedural issues, referred to as churn, will decline once they introduce more automated verification.

“A lot of churn happens because individuals do not get the information back to us,” she said.

It is not yet clear what portion of renewals the social services department expects to be completed on this streamlined, automated basis.

National studies have found that many of those who lose Medicaid coverage during the unwind period will remain eligible but will be dropped off the rolls due to administrative issues. A federal projection released last summer estimated around 45% of those disenrolled from Medicaid once the continuous coverage provision is lifted will still be eligible but will be disenrolled because of procedural reasons, such as missing documents or forms. 

Missouri has been singled-out for its bureaucratic hurdles to renewal in years past. 

In 2019, the state came under scrutiny for significant enrollment declines. Missouri Budget Project, a liberal public policy think tank, determined that families were often kicked off Medicaid despite being eligible for coverage because of challenges with the renewal process, including that they did not receive the proper paperwork or submitted the paperwork only for it to be lost or not processed. 

A Georgetown study last year warned Missouri was among the six states most likely to erroneously strip children of coverage during the unwind of the continuous coverage policy because of factors like the state’s low rate of automated renewals. 

The state says it will send a letter to every Missourian enrolled in Medicaid between May 2023 and April 2024. The letter could be a form and/or request for documentation, or, in the instance that the state has automatically completed the determination through existing data, the letter could be an immediate renewal or rejection. 

Participants will likely receive the letter around the anniversary of when they originally enrolled in Medicaid, according to the department’s newly-posted frequently asked questions page. For instance, if they enrolled in May 2020, they’d likely receive renewal paperwork in May 2023. But there are “some exceptions” so the “best thing participants can do is watch their mail,” per the new site.

Participants will be able to submit the form and any verification documents by mail, fax, in-person, online, or over the phone to a dedicated line, Dolce said by email. 

Dolce said the Department of Social Services does not have an estimate of the portion of their Medicaid participants they project could be deemed ineligible once renewals resume. 

In March 2020, there were just over 900,000 Missourians enrolled in Medicaid. As of November 2022, the Medicaid population had swelled to more than 1.4 million enrollees. The adult expansion population, the group of qualifying low-income adults who were allowed to enroll after the voter-approved initiative went into effect in late 2021, is now around 287,000.

“There are a lot of Missourians who qualified for Medicaid coverage for the first time during the public health emergency or through adult expansion who have never had to complete an annual renewal before,” Kim Evans, director of the Family Support Division, said in the press release. 

Evans added that the department “want[s] to ensure that everyone who is still eligible for…MO HealthNet can keep that coverage” and to “make sure participants understand how this process works and what is required of them.”

Nationally, most adults in Medicaid-enrolled families are not aware their services will be renewed again soon, an Urban Institute study last November found, posing challenges to states to reliably communicate the coming shift. 

Missouri’s social services department is working with managed care providers to update patients’ contact information in their eligibility system, as well as performing outreach with community partners and online to encourage enrollees to update their contact information, Dolce said. 

Last summer, the state adopted several federal flexibilities designed to reduce their Medicaid application backlog in advance of needing to renew the entire caseload, which could ease verification hurdles during the unwinding period. One measure, which focuses on applications received through the federal marketplace, allows the state to accept the federal information rather than needing to re-verify it. The state has also said it will continue to offer overtime to Family Support Division staff on an as-needed basis. 

Missouri Independent is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com. Follow Missouri Independent on Facebook and Twitter.