Christopher Smith / KHN
Korra Elliott tried to avoid seeing a doctor while waiting for Medicaid. She is worried that she will not be able to afford more bills without insurance coverage. But in early March – five months, he said, after applying and still not making a decision on his application – a suspected flu case raised his blood pressure and took him to the emergency room.
The 28-year-old mother of four of Salem’s children, Md., Is among thousands of uninsured Missourians waiting to receive state slogans amid a flood of applications for the state-federal health insurance program. After a long legal and political battle, Missouri expanded the program last year, and it now covers adults who earn up to 138% of the federal poverty level – about $ 18,800 a year per person.
At the end of February, about 72,000 Medicaid applications were pending in Missouri, with an average of 119 days to process a process, more than double the 45-day maximum turnaround time allowed by federal regulations. Adding people to Medicaid is labor intensive, and requires training and skills for the job. The program covers a wide population – children, people with disabilities, the elderly, adults who are pregnant or have children, and some without children. Different rules indicate who is eligible.
Missouri doesn’t have staff just to hold on. Last fiscal year, 20% of its employees who handled Medicaid applications quit their jobs, said Heather Dolls, 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 Division – which oversees enrollment – dropped from 47 in March 2021 to 10 in February 2022.
Almost every industry is now struggling to find staff, but the shortage of staff at Medicaid agencies across the country comes at a challenging time. States will soon have to review the eligibility of the millions of people enrolled in the program nationwide – an extremely difficult endeavor that will begin if President Joe Biden’s administration allows the Covid-19 public health emergency declaration to expire. If Missouri’s long application backlogs are any indication, the nation’s people have access to large-scale disruptions to benefits – even for those who are still eligible for insurance.
“If you don’t have people who actually process cases and answer phone calls, it doesn’t matter what policy you have,” said Jennifer Wagner, director of Medicaid Qualifications and Enrollment at the Center for Budget and Policy Priorities, a left in Washington, D.C. Leaning think tank
Federal officials say they will give states 60 days’ notice before the end of the public health emergency, so it is unlikely to expire before the summer. Once this is done, enlistment will not be expelled immediately: states can take up to 14 months to complete renewals, although budget pressures can force many to move faster. A bump of federal Medicaid funding in the states provided by Congress through the Covid Relief Act in 2020, will expire shortly after the end of the state of emergency.
Finally, employees need to answer questions, process information to make sure someone’s Medicaid enrollment should be renewed, or see if the person qualifies for a different health coverage program – before all benefits are exhausted and they become uninsured.
State Medicaid officials say stuffing is one of the top challenges they face. At a January meeting of the Medicaid and Chip Payments and Access Commission, an outside panel of experts that advises Congress, Jeff Nelson said 15% to 20% of qualified staff at the Utah Department of Health are new. “We’ve got one-fifth of the workforce who probably don’t know what they’re doing,” said Nelson, who oversees eligibility for Utah’s Medicaid program.
The number of qualified staff vacancies at the Texas Health and Human Services Commission nearly quadrupled in almost two years – 1,031 vacancies at the end of February, compared to 260 on March 31, 2020, according to spokeswoman Kelly Weldon.
Medicaid renewals are less labor-intensive than the initial application, but it takes time for a qualified employee to know the ins and outs of the program, Wagner said.
“A few months before you became fully operational,” said Wagner, who previously oversaw the Illinois Department of Human Services offices that determine applicants’ eligibility for Medicaid, the Supplemental Nutrition Assistance program that provides food stamps, and other support programs.
Other social services may get stuck in the process because many employees handle applications for other programs. In addition to Medicaid, Kentucky Department for Community-Based Services staff handles SNAP and childcare assistance applications.
Consumer advocates who engage people with security-net programs are concerned that they will not be able to keep an overwhelmed workforce.
“It’s going to be a lot of work for everyone,” said Miranda Brown, an outreach coordinator at the Kentucky Equal Justice Center, a legal aid group that helps people apply for benefits.
Brown says he recently called a state office on behalf of a client late in the day. He waited for an hour just to be informed by a caseworker that the company could not process any more cases that day.
“I even have one [phone] The line that I cross faster than a consumer calling for themselves, “he said.” If it’s hard for me, it’s very difficult for those who are trying to call at their lunch break at work. “
South Carolina plans to hire “several hundred workers” earlier this spring to help manage renewals at the end of public health emergencies, said Nicole Mitchell Threat, deputy director of the Department of Health and Human Services’ Qualifications, Enrollment and Member Services. The turnover rate among qualified workers from July 2020 to June 2021 was about 25%, jumping from 15% in the previous 12 months.
In Missouri, Dallas said his department hopes the recently approved pay rise will help improve staff recruitment and staff morale and retention. The department is being sued for delaying enrollment for SNAP benefits, which it also oversees.
Kim Evans, director of the family support division at the Missouri Department of Social Services, told the State Medicaid Oversight Committee in February that her division was offering overtime and even pizza to speed up the processing of applications. But the department is enrolling fewer than 3,000 people each week, waiting thousands and delaying their care.
Stacey Whitford, 41, of M0, Kansas City, applied for Medicaid in December for herself and her 13-year-old son. Her son needed hearing aids which he said cost $ 2,500 each without insurance. She also lined up a support worker for the boy with autism through the mental health department, but said she was told that staff could start as soon as her son was enrolled in Medicaid.
“It’s like hanging a gold stamp 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 the status of their application, then on March 31, just four months after applying, they were finally approved.
“I’m so excited! We can run with scissors now,” he joked.
But Elliott, the mother of Salem’s four children, is still waiting. He stopped calling the state’s Medicaid helpline because of the high call volume and frustration with spending hours on hold and disconnection. Instead, he examines his application through enrollment specialists at the clinic where he applied.
He was sent home with Ibuprofen and Tamiflu from the ER and has yet to see a bill. If her Medicaid application is approved, her coverage will be backdated to the month she applied, probably covering her ER trip. But if his application is rejected, the cost will be added to his medical loan, which Elliott estimates is already several thousand dollars.
“I think it’s a joke,” Elliott said of Missouri’s expansion of Medicaid. “Like they’re throwing it 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 creates in-depth journalism about health issues. It is an editorially independent operating program KFF (Kaiser Family Foundation).