Missouri officials are preparing to upgrade the state's system for verifying whether people are eligible for MO HealthNet, the state's Medicaid program, ahead of new federal work requirements set to take effect at the end of the year.
The Missouri Department of Social Services, which administers the program to approximately 1.3 million people statewide, will need to step up its verification efforts at the end of this year. That's when new federal rules will require many on the program to prove they work, volunteer or participate in other "community engagement" activities to maintain their benefits.
To continue receiving Medicaid benefits, "individuals must participate in and report 80 hours per month of qualifying activities, such as work, education, or approved volunteer service," agency spokeswoman Baylee Watts said in an email. "Compliance must be demonstrated the month prior to application."
The provisions are part of the sweeping federal spending bill passed last year. The new rules, commonly referred to as work requirements, apply to those who became eligible when the state expanded Medicaid benefits to cover low-income adults. According to recent data, there are around 360,000 people in that expansion group.
Recipients will also need to verify their eligibility twice a year instead of once a year. Those in the adult expansion group must meet compliance for at least one month within each six-month eligibility period.
To report their hours, MO HealthNet patients will apply for renewal through an online "citizen engagement portal." In the meantime, people can see if the new requirements apply to them using an online questionnaire.
The new reporting requirements will not apply to people with disabilities or families with children, Watts said.
"The community engagement reporting requirements apply only to adults in the Adult Expansion Group," she said. "Children who independently meet the eligibility guidelines for MO HealthNet or CHIP will not lose coverage solely because their parent/guardian does."
The state has budgeted more than $50 million to put the changes in place, hiring dozens of contract staff to help with the increased bureaucratic load. They include 33 people who will help with work-requirement questions and outreach and 88 to manage the increased volume in eligibility paperwork.
Most of that money comes from federal sources and grants, Watts said.
DSS is also upgrading technology with the aim of making the verification process easier for people to use. In some cases, the system the state uses will be able to comb through records to verify eligibility without contacting recipients.
Potential lost coverage
Federal officials have touted the changes as a way to cut down on wasteful spending and fraud in the Medicaid system.
But many, including St. Louis County Health Director Kanika Cunningham, say the additional paperwork may lead to tens of thousands of people falling off the Medicaid rolls and place strain on clinics, emergency rooms and other safety-net providers.
"WIll someone be able to make sure they respond in a timely manner to renew in six months?" she asked. "There's a lot of fear around: 'Well, what does this mean? How many hours? How do I report this? What counts? What doesn't count?'"
Cunningham estimates that 30,000 to 40,000 people in St. Louis County – about one-fourth of the county's total Medicaid recipients – may lose their benefits due to the reporting changes.
Cunningham said about 80% of the patients who visit the three county-run health clinics are on Medicaid. St. Louis County is the only county in Missouri that operates its own federally designated health clinics.
More uninsured patients could pose a financial threat for the clinics, she said. Cunningham and St. Louis County Executive Sam Page have been sparring with the county council, which argues the clinics cost too much to run.
"In the next three to four years, no telling how the healthcare landscape will look across the country, let alone Missouri and St. Louis County," she said.
Health officials say those who receive MO HealthNet benefits should be on the lookout for any communication from the state about changes. Keeping addresses and telephone numbers updated will help people know what they will need to do to verify their employment or other engagement requirements.
Recipients should also keep pay stubs, employer statements, time sheets, self-employment, school and volunteer records in case they need to provide physical proof of their compliance with the new requirements.
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