Korra Elliott tried to avoid seeing a doctor while waiting to go up to Medicaid. He worries that he can not afford more bills without any insurance coverage. But in early March – five months, she said, after she applied and had not yet decided on her application – a suspicious flu case soared her and led her to the emergency room. The 28-year-old mother of four from Salem, Missouri, is among tens of thousands of uninsured Missouri residents who are stuck waiting as the state overcomes a flood of applications for the state-federal health insurance program. Missouri expanded the program last year after a lengthy legal and political battle and now covers adults earning up to 138% of the federal poverty rate – about $ 18,800 per year per person. Missouri had nearly 72,000 pending Medicaid applications by the end of February and had an average of 119 days to process one, more than double the 45-day maximum processing time allowed by federal law. Adding people to Medicaid requires hard work and jobs require training and specialization. The program covers many populations – children, people with disabilities, the elderly, adults who are pregnant or have children and some without children. Different rules dictate who meets the requirements. Missouri just does not have the workers to keep up. Last fiscal year, 20 percent of its Medicaid-based employees quit their jobs, said Heather Dolce, a spokeswoman for the Missouri Department of Social Services. And the average number of job applications received for each opening in the department’s Family Support Department – which oversees enrollment – dropped from 47 in March 2021 to 10 in February 2022. Almost every industry is struggling to find employees now, but staff shortages at Medicaid government agencies across the country are coming at a difficult time. States will soon have to reconsider the suitability of the tens of millions of people enrolled in the program nationwide – a heroic effort that will begin as soon as President Joe Biden’s government puts an end to the COVID-19 public health emergency. . If long-term Missouri application delays are an indication, the nation is on track for a massive disruption to people’s benefits – even for those who still qualify for insurance. “If you do not have people who actually process cases and do not answer the phone, it does not matter what policies you have implemented,” said Jennifer Wagner, director of Medicaid Fitness and Enrollment at the Center for Budget and Policy Priorities. left thinking tank in Washington, DC Federal officials have said they will notify states 60 days before the end of the public health emergency, so it is unlikely to end before the summer. Once that happens, enrollment will not start immediately: States may need up to 14 months to complete the renewals, although budget pressures may push many to move faster. A blow to Medicaid’s federal funds in the states, provided by Congress through coronavirus relief legislation in 2020, will end shortly after the emergency ends. Ultimately, employees need to answer questions, process information that confirms that someone’s Medicaid registration needs to be renewed, or see if the person qualifies for a different health plan – all before the benefits expire and they become uninsured. Stacey Whitford applied for Medicaid for herself and her son in December. He needs coverage for hearing aids, but the family had to wait months before it was finally approved on the last day of March. “It’s just like hanging a gold ticket right in front of your face and saying, ‘Here it is, but you can’t touch it,’” Whitford said in early March as their wait was approaching 100 days (Christopher Smith / KHN). . State Medicaid officials have said that staffing is one of the top challenges they face. At a January meeting of the Medicaid Payments and Access Committee and CHIP, an outside group of experts advising Congress, Jeff Nelson said 15 to 20 percent of Utah Department of Health staff were young. “We have a fifth of the workforce that may not know what they are doing,” said Nelson, who oversees the suitability for Utah’s Medicaid program. Job vacancies on the Texas Committee on Health and Human Services quadrupled in about two years – 1,031 vacancies at the end of February compared with 260 on March 31, 2020, according to spokeswoman Kelli Weldon. Medicaid renewals are less demanding than initial applications, but it takes time for an eligible employee to know the details of the program, Wagner said. “Until you are fully operational,” said Wagner, who previously oversaw the offices of the Illinois Department of Human Services, which determines eligibility for Medicaid applicants, the Complementary Nutrition Assistance Program, which provides food stamps, and other assistance programs. Other social services may get stuck in the process because many employees also handle applications for other programs. In addition to Medicaid, Kentucky Community Services staff handle SNAP and childcare applications. Consumer advocates who associate people with security network programs worry that a busy workforce will not be able to keep up. “It will be a lot of work for everyone,” said Miranda Brown, who helps people apply for benefits as an approach coordinator for the Kentucky Equal Justice Center, a legal aid team. Brown said she recently called a government office on behalf of a client late in the day. She waited for an hour only for a case officer to tell her that the service could not handle any other cases that day. “I even have one [phone] “line I cross faster than a consumer calling on his own,” he said. “If it’s difficult for me, it’s very difficult for consumers trying to call their lunch break at work.” South Carolina plans to hire “a few hundred employees” this spring to help manage renewal at the end of a public health emergency, said Nicole Mitchell Threatt, deputy director of eligibility, enrollment and membership services at the Department of Health and Human Services. Human Services. . The turnover rate among eligible employees was around 25% from July 2020 to June 2021, up from 15% in the previous 12 months. In Missouri, Dolce said her department hopes a recently approved pay rise will help hire more employees and improve staff morale and retention. The department is suing for delays in registering for SNAP benefits, which it also oversees. Kim Evans, director of the Family Support Department of the Missouri Department of Social Services, told Medicaid’s oversight committee in February that her department offered overtime and even offered to buy pizza to expedite application processing. But the department registers less than 3,000 people a week, leaving tens of thousands to wait and delaying their care. In the suburbs of Kansas City, Missouri, Stacey Whitford, 41, applied for Medicaid in December for herself and her 13-year-old son. Her son needs hearing aids, which he said cost $ 2,500 each without insurance. She also recruited a support worker for the boy with autism through the Department of Mental Health, but said she was told the worker could only start when her son enrolled in Medicaid. “It’s just like hanging a gold ticket right in front of your face and saying, ‘Here it is, but you can’t touch it,’” he said in early March. Whitford spent hours on the phone trying to sort out her applications, and then, on March 31, just four months after they applied, they were finally approved. “I’m so excited! We can run with the scissors now,” he joked. But Eliot, a mother of four in Salem, is still waiting. He stopped calling the state’s Medicaid helpline after being frustrated by the hours of waiting and disconnection due to the high volume of calls. Instead, she checks her application through the registration specialists at the clinic where she applied. She was sent home by the ER with ibuprofen and Tamiflu and has not yet seen an account. If her Medicaid application is approved, her coverage will be rerouted in the month she applied, most likely to cover her trip to the ER. But if her application is rejected, this cost will be added to her medical debt, which Eliot estimates is already tens of thousands of dollars. “It makes me feel like a joke,” Elliott said of Medicaid’s expansion into Missouri. “It’s like throwing it out there to get all these people to apply for it, but they’re not really going to help anyone.” KHN (Kaiser Health News) is a national newsroom that produces in-depth health journalism. Along with Policy Analysis and Polling, the KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides health information to the nation.
