CLARA BATES, Missouri Independent
Missouri’s rate of uninsured children has leveled off during the COVID-19 pandemic, reversing a years-long trend that has seen increasing numbers of children lose coverage, according to a report released Wednesday by the University. of Georgetown.
But researchers warn that the end of the federal public health emergency, which will likely occur next year and will require states to redetermine the eligibility of all Medicaid recipients, will put children at risk of losing inappropriately. health care coverage.
Missouri was previously identified as one of six states where children are most at risk of losing coverage once the public health emergency ends.
Wednesday’s report, by the Health Policy Institute Center for Children and Families in Georgetown, found that a majority of states from 2019 to 2021 saw declines or stability in their population of uninsured children, largely partly because of federal restrictions on states that prevent them from withdrawing Medicaid beneficiaries. from their Medicaid rolls during the public health emergency.
Missouri’s rate of uninsured children was 6.5% in 2019 and fell to 5.9% in 2021, according to U.S. Census data. The Georgetown University report analyzed federal data from 2019 and 2021 because 2020 data was not available.
Missouri had a higher prevalence of uninsured children than the national average in both years. About 86,000 children in Missouri were uninsured in 2021.
In the three years leading up to the pandemic, rates of uninsured children increased nationwide for the “first time in recent memory,” a Georgetown news release noted. This was also the case in Missouri: according to federal data, Missouri’s rate of children without insurance coverage rose from 4.8% in 2016 to 6.5% in 2019.
The Missouri Department of Human Services was criticized in 2019 for a significant drop in Medicaid enrollment after adopting a new renewal process and information system.
Missouri’s budget draft that year found that families were often kicked out of Medicaid despite being eligible for coverage due to difficulties with the renewal process, including not receiving the proper paperwork. or had submitted the documents only to be lost or not processed.
There were also long waits for Medicaid call centers at the time.
Supporters fear that once the public health emergency is over, Missouri could revert to a situation where the renewal process strips eligible Medicaid recipients of coverage due to administrative hurdles.
In a study earlier this year, researchers in Georgetown estimated that 6.7 million children across the country were at risk of losing coverage when the public health emergency ended. The federal government has predicted that nearly three-quarters of children who are removed from Medicaid rolls after the public health emergency ends will remain eligible but be dropped due to procedural issues.
“We often hear that procedural unenrolments occur when enrollees ‘fail’ to renew,” noted a Center for Children and Families article in August, “But it’s often a ‘system failure.’ ”
When children are uninsured, they are more likely to suffer from worsening chronic conditions, miss health checkups, and their families can receive high medical bills and even incur medical debt, Joan Alker, director of the Georgetown Center for Children and Families and the lead author of Wednesday’s study, said Wednesday during a press call.
Children in Missouri are particularly at risk, Georgetown’s previous report noted, because the state has no policy to provide continuous 12-month Medicaid coverage for children and also administers the Children’s Health Insurance Program ( CHIP) in a way that could lead to coverage gaps, including charging families premiums for CHIP.
Alker said by email that Missouri has a “history of lost paperwork for children,” referring to bureaucratic hurdles that create coverage gaps for eligible children. She credited the continued coverage provision during the public health emergency with helping to alleviate that.
The report’s finding that rates of uninsured children have declined slightly nationwide during the pandemic is “good news for America’s children,” Alker said during Wednesday’s press call. , but it “may be short-lived”.
Nationally, “millions of eligible children will likely fall through the cracks and become uninsured in inattentive or ill-intentioned states when federal continued coverage protection expires,” Alker continued.
The federal government has yet to announce the end of PHE, but will give 60 days notice, and once it ends, states will have up to 14 months to determine the eligibility of all Medicaid enrollees. .
The Missouri Department of Social Services told the MO HealthNet Oversight Committee that it expects to take a year to complete all renewals.
The Missouri Department of Social Services did not immediately respond to a request for comment.
In July, the state passed several federal flexibilities designed to reduce its backlog of Medicaid applications before it must renew all Medicaid participant records once the public health emergency ends.
These flexibilities will be in place until the end of the public health emergency resolution period and may mitigate barriers to verification. One measure, which focuses on requests received through the federal marketplace, allows the state to accept federal information rather than having to double-check it.
Missouri social services officials also said the agency is working to ensure it has up-to-date address information for attendees so it can reach them when the public health emergency ends. and that the renewals begin again.
At an August MO HealthNet meeting, Family Support Division Director Kim Evans said the state is working with managed care providers to update patient information in their system. eligibility if they had moved. They’re also making blasts on social media reminding attendees to update their contact information and working to move to an electronic notification system, Evans said.
Most adults in families enrolled in Medicaid nationwide are unaware that their services will soon be renewed, an Urban Institute study found last month, posing challenges for states to reliably communicate the coming change.
Unlike 35 other states, Missouri has yet to publicly provide its plan for the unfolding of the public health emergency or a summary of the plan, according to the Georgetown unfolding tracker.
Missouri is working to replace outdated technology, Robert Knodell, director of the Department of Human Services, explained during a press briefing in August.
There have been longstanding technical issues within the Missouri Department of Social Services that have left many manual processes — relying on paper forms — and overloaded with participants.
A 2020 report from the Missouri Department of Social Services and the nonprofit Civilla on difficulties enrolling in benefits programs concluded that to participants, “the system feels like a secret and no one knows. has the answer”. For staff, the report concludes, they feel “like an assembly line rather than connected to the people they serve”, and work feels “siloed”.
Children in states that “have not kept pace with modernizing their eligibility system” are at greater risk of losing coverage inappropriately, Alker said Wednesday.
Deborah Greenhouse, a South Carolina pediatrician and member of the American Academy of Pediatrics’ Federal Governmental Affairs Committee, said at Wednesday’s press conference that continued increases in pediatric respiratory disease and the mental health crisis of children make continuous coverage of children particularly necessary.
“Any interruption in coverage,” Greenhouse said, “would add another layer of crisis to an already dire situation.”
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