Employment crisis could cost millions to lose to Medicaid coverage: The shots

Stacey Whitford applied for Medicaid for herself and her son in December. He needed cover for hearing aids, and they waited for months while Missouri officials processed thousands of requests.

Christopher Smith / KHN


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Christopher Smith / KHN


Stacey Whitford applied for Medicaid for herself and her son in December. He needed cover for hearing aids, and they waited for months while Missouri officials processed thousands of requests.

Christopher Smith / KHN

Korra Elliott tried to avoid seeing a doctor while waiting to go on Medicaid. He was worried that he would not be able to buy the bills without insurance. But in early March – five months, he said, after a petition and no decision was made on his application – a case of suspected illness was sent to his blood was rising so much that he landed in the emergency room.

The 28 -year -old mother of four from Salem, Mo., is among tens of thousands of unaccompanied Missourians waiting as the state slows down a growing number of applications for the state health insurance program. Missouri expanded the program last year after a long legal and political war, and is now covered by banks that make up 138% of the federal poverty level – in about $ 18,800 per year per person.

Missouri has nearly 72,000 Medicaid applications pending by the end of February and it has 119 days to process one, more than two of the 45 best search times. days permitted by federal regulations. Enrolling people in Medicaid is a daunting task, and jobs require training and knowledge. The program is open to a wide range of people – children, people with disabilities, the elderly, parents who are pregnant or have children, and some who do not have children. Different rules dictate what is right.

Missouri has no staff to care for. Last fiscal year, 20% of its employees who handled Medicaid applications left their jobs, said Heather Dolce, a spokeswoman for the Missouri Department of Education. And the average number of job applications received for each opening to the office’s Family Support Division – which handles enrollment – fell from 47 in March of 2021 to 10 in February of 2022.

Nearly every industry is struggling to find staff right now, but the shortage of staff at state Medicaid offices around the country comes at a difficult time. States must immediately evaluate the fitness of the tens of millions of people enrolled in the entire program – a Herculean process that began when President Joe Biden released the covid -19 health notice. If Missouri’s long -term application process is any indication, the nation is in a state of serious disruption to people’s rights – even for those eligible for insurance.

“If you don’t have people to actually handle cases and answer the phone, it doesn’t matter what policies you have in place,” said Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center. on Budget and Policy Priorities, a left -wing think tank in Washington, DC

Federal officials said they would give states 60 days before the health crisis is over, so it probably won’t end before the summer. When it does, registrants won’t be fired immediately: States can take up to 14 months to complete new projects, even though the funding pressure will require many to move quickly. A federal Medicaid grant to the states, provided by Congress through the covid retirement law in 2020, will end soon after the crisis is over.

Finally, employees need to answer questions, edit information that confirms someone’s Medicaid enrollment will be renewed, or find out if the person is eligible for another health care program – first benefits disappear and they become uninsured.

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State Medicaid officials say workers are one of the biggest problems they face. At a January meeting of the Medicaid and CHIP Payment and Access Commission, an external group of professionals studying in Congress, Jeff Nelson said 15% to 20% of the Department of Health’s employees are eligible. Utah lives. “We’ve got one -fifth of the workforce who don’t know what they’re doing,” said Nelson, who oversees eligibility for Utah’s Medicaid program.

The Texas Health and Human Services Commission has increased staff vacancies by about two years – 1,031 vacancies at the end of February compared to 260 on March 31, 2020, according to Kelli. Weldon.

Re -enacting Medicaid takes less work than previous applications, but it takes time before a qualified employee knows the ins and outs of the program, Wagner said.

“It’s months before you’re fully qualified,” said Wagner, who previously oversees the Illinois Department of Human Services’s office to determine the eligibility of applicants for Medicaid, Supplemental Nutrition Assistance. Program that provides food stamps, and other assistance programs.

Other community services may be included in the process because more staff will be handling applications for other projects. In addition to Medicaid, staff for the Kentucky Office of Community Services serve SNAP and child care assistance applications.

Consumer advocates are worried that connecting people to safety net programs that heavy workers can’t keep up with.

“It’s important for everyone,” said Miranda Brown, who helps people apply for benefits as an outreach coordinator for the Kentucky Equal Justice Center, a legal aid organization.

Brown said he called a state office for the seller at the end of the day. He waited only an hour to be told by the prosecutor that the office could not handle the cases that day.

“I was right there [phone] line that I go faster than the customer calling themselves, “he said.” If it’s hard for me, it’s really hard for customers trying to call their lunch at work. “

South Carolina plans to hire “two hundred employees” starting this spring to help drive innovation in the aftermath of the public health crisis, said Nicole Mitchell Threatt, Deputy Director. Administration of ownership, enrollment and membership services in the Department of Health and Human Services. The turnover among qualified employees was around 25% from July 2020 to June 2021, jumping from a figure of 15% in the last 12 months.

In Missouri, Dolce said his company hopes the pay increase will help retain more employees and improve employee morale and retention. The office is being sued for delays in signing up for SNAP benefits, which it maintains.

Kim Evans, director of the Missouri Department of Social Services ’Family Support Division, told the state Medicaid watchdog committee in February that her share would give her more time and pizza to speed up the process. processing of requests. But the agency enrolls more than 3,000 people each week, leaving tens of thousands waiting and extending their care.

At a school in Kansas City, M0., Stacey Whitford, 41, applied in December for Medicaid for herself and her 13 -year -old son. Her son needs hearing aids, which she says are $ 2,500 each without insurance. He also arranged for a support worker for the boy, who has autism, through the Department of Psychiatry, but was reportedly told that the worker could only start as soon as he was enrolled. her son on Medicaid.

“It’s like putting a gold ticket in front of you and saying, ‘Here, but you can’t touch it,'” he said in early March.

Whitford spent hours on the phone trying to sort out the status of their application, and then on March 31, embarrassed only four months after the application, they were approved.

“I’m so happy! We can run with the cut now,” he joked.

But Elliott, the mother of four in Salem, is waiting. He stopped calling the state Medicaid helpline after growing anger from spending hours on detention and disconnection because of the number of calls. Instead, he reviewed his application through the registration specialists at the office where he applied.

He was sent home from the ER with ibuprofen and Tamiflu and did not see a bill. If her Medicaid application is approved, her coverage will be returned the month she applied, possibly covering her ER trip. But if his application was denied, that cost would be added to his medical debt, which Elliott estimated was tens of thousands of dollars.

“I think it’s a joke,” Elliott said of the expansion of Medicaid in Missouri. “It’s like they’re just throwing in there to get all these people to ask for it, but they’re not really going to help anyone.”

KHN (Kaiser Health News) is a government news agency that publishes in -depth journalism on health issues. It is an independent editing program of KFF (Kaiser Family Foundation).

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