Red tape hurts families using Medicaid and CHIP

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Missouri children rely on Medicaid and CHIP for health insurance. Medicaid and CHIP coverage is beneficial to children’s health and has positive economic impacts. Healthy kids are more likely to graduate from high school and find the kind of jobs that contribute to the economy. Recently, Missouri has seen a significant drop in child enrollment in Medicaid and CHIP. 56,716 children lost coverage from January to December 2018.

A five year old with special health needs recently lost coverage due to problems during her annual review. Her family never received annual review forms in the mail. Her grandmother was unable to fill her prescriptions and the child was unable to attend her therapy appointments due to the loss of coverage. The child was still eligible for Medicaid.  Legal Services of Eastern Missouri contacted the Family Support Division and supplied the missing form and coverage was restored.

Missouri’s children are hurt by the Medicaid system’s red tape, computer system problems, and staffing issues. The significant decline started after annual reviews resumed in the State’s new Medicaid computer system. The annual review process is lengthy and difficult for families to navigate, causing many eligible children to lose coverage. Federal law says the state should only require a family to complete a paper review form when the state is unable to get the information through electronic databases. Following federal law, many other states have been able to electronically verify information for more than half of their families and avoid the need for long complicated paper forms.

Missouri has required more than eighty percent of families to return a paper form. Children are losing coverage when the form is sent to an old address, the Family Support Division loses the form, the form is sent in English to a parent with limited English proficiency, or the parent is otherwise unable to understand the eight page form. Also, because it is using two different computer systems, the Agency no longer extends Medicaid when a family’s Food Stamps are renewed nor does it check the address in the Food Stamp file before sending the renewal form.  The system is currently programmed to auto-close benefits (i.e., end coverage without manual intervention by Agency staff, rather than maintain benefits until all avenues are pursued).  When families have questions, the Agency’s call center routinely drops half of its calls and the families that get through average more than 20 minutes on hold.

Missouri legal aid offices are able to successfully assist these families in regaining coverage for their children who are almost always still eligible for health insurance. This success, however does not resolve problems for the thousands of families without such assistance.  Families losing health insurance coverage can reach out to legal aid and other organizations that are able to provide assistance.



Lucas Caldwell-McMillan

[email protected]
Legal Services of Eastern Missouri

Joel Ferber

[email protected]
Legal Services of Eastern Missouri

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