Missouri struggles to administer safety net programs. Congress is proposing more red tape

Yahoo

5 days ago

Courtney Leader, who spoke at a Capitol press conference on Monday, worries that her daughter's Medicaid coverage would be at risk under proposed federal cuts (Clara Bates/Missouri Independent).
When Courtney Leader gets the letter from the state each year telling her it's time to recertify her daughter's Medicaid eligibility, she scrambles to make sure the paperwork gets to the right place.
Leader, of Ash Grove, considers herself adept at navigating her 8-year-old daughter's complex medical needs and appointments, but even she has fallen through the cracks of Missouri's safety net thanks to the state's red tape.
Without Medicaid for her daughter, who has complex medical needs and developmental disabilities, Leader's family wouldn't be able to afford the thousands of dollars in monthly costs for her feeding tube and formula, specialty appointments and at-home nurses.
Yet despite Leader's diligence, her daughter was once kicked off Medicaid after the state lost her paperwork. Even when the paperwork makes it through, she says it takes days to confirm.
She has waited hours on the phone for help, just to be automatically disconnected, and has refreshed the online chat again and again trying to get answers — knowing any delay could cost her daughter coverage.
Now, as Congress proposes changes to Medicaid that promise to add even more bureaucratic hurdles for families like hers, Leader worries about what's in store for her daughter's health care coverage.
'I'm terrified that further red tape throughout the system will disrupt my daughter's care and put her health in jeopardy,' she said. '…Medicaid is a lifesaver, but I've seen the challenges of an overburdened system firsthand, and felt the panic when my paperwork was lost.'
'Perfect storm': Missouri advocates decry Medicaid application delays, coverage losses
Leader spoke on Monday alongside the heads of several advocacy organizations gathered at the Missouri Capitol to sound the alarm on the potential ramifications of Congress' planned changes to Medicaid.
The federal reconciliation bill aims to extend President Donald Trump's 2017 tax cuts, in part by cutting at least $600 billion nationally from Medicaid over a decade.
Proposed Medicaid changes include work requirements estimated to potentially kick over 100,000 people off in Missouri — many of whom would be still eligible but could lose coverage anyway due to procedural issues. Co-pays would be added for some patients, eligibility checks would increase to twice a year and thousands of adults would need to confirm their work status each month.
The Supplemental Nutrition Assistance Program, or SNAP, would also face enormous reductions under the proposed budget, potentially cutting thousands of recipients in the state.
Missouri would be in an especially vulnerable spot, advocates said, because the state Department of Social Services has struggled for years to administer safety net programs.
The Family Support Division, which oversees benefits administration for the state, is understaffed: The agency's request to fund 220 new staff this year was not granted by the legislature. And failures in the administration of Medicaid and food assistance programs have earned rebukes from the federal government and possible sanctions from a St. Louis judge.
Emily Kalmer, Missouri government relations director for the American Cancer Society Cancer Action Network, said the Department of Social Services' struggles to administer these programs could be exacerbated by the proposed federal changes to Medicaid and SNAP.
'With all the challenges they already have, and then this timeframe,' she said, referring the Family Support Division and the proposed implementation of work requirements at the end of 2026 '…we're just going to have a lot of things happening at the same time, and how the legislature decides they want to use their limited budget to deal with that — it's going to be kind of the perfect storm.'
One in five Missourians is on Medicaid, or over 1.2 million people. Missouri's Medicaid program covers 39% of all children in the state and pays for two-thirds of nursing home care.
A single low-income adult has to make under $20,814 annually to qualify for Medicaid.
At various points in recent years, the state has had the worst, or among the worst in the nation processing times for Medicaid applications, prompting federal scrutiny last year.
Missouri is also being sued over its administration of SNAP, with a judge concluding the state violated federal SNAP law and the Americans with Disabilities Act for the way it runs its call center eligibility interviews.
The average wait time for the general call line, which includes Medicaid queries, was just over one hour in March, It was 49 minutes for the line specific to SNAP interviews.
'Broken system': Call center backlogs impede Missouri families seeking food assistance
Thousands of callers are automatically disconnected before getting through to a person: Over 50,000 calls were automatically ended for the SNAP interview call line in March and nearly 16,000 for the general call line.
The work requirements being considered by Congress mandate 80 hours of work per month, or various exemptions, including for caregivers and those with disabilities.
Most adults on Medicaid are already working or would qualify for an exemption. But in the states that have tried work requirements, including Arkansas, thousands lost coverage even though they were eligible. It's estimated that over 100,000 Missourians could lose coverage due to work requirements.
Kalmer shared the story of one cancer patient who struggled to get on Medicaid because of the state's hurdles, but wouldn't have gotten on at all under the proposed federal changes.
The woman had been working when she fell and had spinal surgery, and then found out she had thyroid cancer. Her private insurance wasn't going to cover anything, so she applied for Medicaid and 'didn't hear anything,' so couldn't go to the doctor for care. She reached out to Kalmer who was finally able to get her coverage.
During the course of her treatment for cancer, the woman wasn't able to work, and didn't qualify for Social Security.
That means under the work requirements proposed by Congress, she wouldn't have qualified for Medicaid.
Kalmer said to qualify as disabled and exempt, you must be officially declared disabled by Social Security, a process that can take months or years.
'This entire time that she's been going through this cancer journey, she would not be necessarily qualified for the exemptions that are in the bill,' Kalmer said.
Congress also wants to require Medicaid recipients to pay copays of up to $35, which could discourage very low-income patients from seeking care.
'All of this is really just creating more and more roadblocks for the valuable health insurance that cancer patients need and rely on to get the treatment that they need,' Kalmer said.
Traci Gleason, vice president of external affairs for the progressive Missouri Budget Project, said the changes will create significant 'barriers to care' for Missourians.
'There is simply no way that they can make those kinds of cuts to Medicaid without slashing health care for Americans, slashing health care for Missourians,' she said. 'And I want to be clear that the consequences to Missourians, both on Medicaid and those who are not, really, can't be overstated.'
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