Think about a great customer experience you had recently. For me, it was when I was shipped the wrong-sized winter boots. I called the company and explained the issue, and within two business days, a new pair of boots and a return shipping label were sent to my apartment. Easy. In our digital age, it’s no surprise that businesses have taken advantage of the available technology to create a great customer experience. 

There are certain aspects of our lives in which ease-of-use and good customer experience are more crucial than others. Obviously, healthcare is at the top of this list. When someone arrives at the hospital, they need to know that they’re already covered. Finding out that they are no longer on Medicaid in the time of an emergency can be devastating, especially for an individual or family with low income. Unfortunately, that’s what’s been happening in Missouri, and it’s due in part to bad customer service and wildly outdated computer systems.

On Tuesday, January 28th, the Missouri House of Representatives Subcommittee on Appropriations – Health, Mental Health, and Social Services held a hearing to help give the legislature and the public information about the current state of Missouri’s Medicaid program (also known as MO HealthNet). A particular area of focus was the significant decrease in enrollment numbers that the program has seen in the last year and a half. 

The subcommittee is chaired by Rep. David Wood, a Republican from Versailles, with Rep. Deb Lavender, a  Democrat, serving as the Ranking Minority Member. MO HealthNet and the Family Support Division (FSD), which handles the customer service side of the program, are run by the Department of Social Services (DSS). The DSS was represented by Jennifer Tidball, the department’s Acting Director, and Patrick Luebbering, the Chief Financial Officer of DSS and former Director of FSD. The two offered testimony and took questions from Chairman Wood and Rep. Lavender almost exclusively. Todd Richardson, former Speaker of the House for Missouri and current Director of MO HealthNet, also offered testimony. 

Although there are differing opinions about who and what was to blame for the decrease in enrollment in Medicaid, there was universal agreement, including from Richardson, that the current system that the department uses is broken and inefficient. As with many Missouri information systems, the one that handles eligibility for benefits is outdated. According to the DSS representatives, this is because the transition to the new systems after the Affordable Care Act passed in 2014 did not happen in a timely and efficient manner. In fact, it was so poorly managed that from 2014 to 2018, the department wasn’t even using the software to track eligibility.

“We were working spreadsheets and not working the system,” said Tidball.

The department claims that the significant drop-off in enrollees happened once the system began to automatically check enrollment eligibility on an annual basis. The issue that they’ve run into is three-fold.

First, individuals may have been kicked off of coverage because they are ineligible for their current program, but may be eligible for another program. 

Second, when a parent loses eligibility, the system automatically kicks their children off as well.

Finally, the notification process that lets someone know that they or their child has been removed is inefficient, outdated, and does not consider the realities of so many Missourians who live with low incomes. 

When someone is dropped from the Medicaid rolls, they are sent a letter via snail mail letting them know. This obviously isn’t a very efficient system for individuals with low incomes, who move frequently due to lack of access to affordable housing and may not have their mail forwarded. Rep. Lavender brought this up to the DSS representatives, asking “If [someone receiving benefits] moves and they haven’t got mail forwarding set up, how do you get a hold of them?”

“We don’t,” said Luebbering. He reported that they get a roughly five percent  response rate to the letters.

If someone is lucky enough to receive the letter, realize that they or their child are still eligible, and re-apply, they must go through the long and tedious application process again, which includes a 63-page paper application. This process is completely unsustainable.

These issues can all be solved by updating the systems the department uses to manage coverage and improving customer service. Currently, the system that tracks the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC ) eligibility cannot communicate with the system that tracks Medicaid eligibility, even though there is plenty of crossover. It is an old, clunky system, like many others that Missouri state government uses. 

One of the biggest takeaways we gained from this hearing is the realization that, if Missouri were to expand income eligibility for Medicaid in the state, the influx of federal dollars would help to fund updates to this system. Process improvements could also be made to ensure that such significant errors, which put Missourians health and well-being in jeopardy, don’t occur.

Richardson noted that a third-party vendor has done a top-down analysis of the state of MO HealthNet and should be releasing their report and recommendations near the end of January. Keep an eye on our blog, email, and social media for updates about that.

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