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Missouri Medicaid program enrolls 4,300 under expansion, working on efficiency

by Ryan Pivoney | October 8, 2021 at 5:40 a.m. | Updated October 8, 2021 at 1:40 p.m.

Approximately 25 percent of individuals who have applied for Medicaid under Missouri's recent expansion have been enrolled.

In less than a week since the Missouri Department of Social Services began processing applications, more than 4,300 Missourians have gained access to health care coverage for which they were previously ineligible.

Roughly 275,000 Missouri residents are eligible for Medicaid benefits and services under the expansion; MO HealthNet, the state's Medicaid program, has had 17,000 applications since it began accepting applications Aug. 10.

The department began processing the applications Oct. 1.

The Missouri Department of Social Services has begun enrolling Missourians under an expanded Medicaid program and is working through several updates within the system.

At a state Senate committee hearing Thursday, MO HealthNet Office of Transformation staff briefed lawmakers on how the department is handling Medicaid expansion so far and discussed ongoing efforts to improve efficiency within the state's Medicaid program.

MO HealthNet was recently expanded to include an additional 275,000 people after a lengthy political and legal fight stemming from the General Assembly's failure to provide funding for expansion costs in last session's budget bills.

The Missouri Supreme Court ruled in favor of expansion and MO HealthNet began processing applications at the beginning of the month, with coverage retroactive to July 1 of this year.

As of Tuesday, 4,300 Missourians have been enrolled, Kirk Mathews, Office of Transformation chief, said.

"There are still pending applications in the queue that are being evaluated for their eligibility determination," Mathews said.

Because the department doesn't know how quickly people within the expansion population will submit applications or what the total number will be, Mathews said he doesn't know what the next few months will look like in regards to processing applications.

He said eligibility is determined within the DSS Family Support Division, which has 45 days to determine if an application is eligible for Medicaid.

"I think they're turning it around faster than that," Mathews said. "They did have some pending applications that had been submitted after July 1, but until Oct. 1 had been denied, those were all kept in a queue and are being re-evaluated for their eligibility determination now."

Missourians between the ages of 19-65 who individually earn less than $17,774 each year, or $37,570 for a family of four, qualify for Medicaid benefits and services under the expansion.

In addition to the expansion, MO HealthNet is undergoing several updates to make its processes more efficient.

The Office of Transformation has been working through 54 projects impacting the MO HealthNet program - 31 have been completed and 23 are in progress.

The projects address issues within MO HealthNet areas like eligibility and enrollment, hospitals, managed care, pharmacy, program integrity, program policy and provider reimbursements.

An automatic pharmacy rebate system, for example, is one of the projects that has been completed so far.

Most projects are based on recommendations from a 2020 report that identified concerns about MO HealthNet's financial sustainability and provides pathways for improving quality of care and reducing future spending.

Of the 23 projects in progress, 17 are on schedule and six are behind for various reasons, such as limited resources or pending court actions.

Print Headline: Missouri Medicaid program enrolls 4,300 under expansion, working on efficiency


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