Missouri Medicaid rolls grow in pandemic

By Kurt Erickson St. Louis Post-Dispatch

JEFFERSON CITY – The number of people on Medicaid in Missouri has jumped by nearly 100,000 people since the pandemic hit the United States.

Although some of the growth is likely due to the economic fallout of shutting down the economy to slow the spread of COVID-19, a federal relief package providing more money to states for Medicaid costs also is a factor.

In March, President Trump signed the Families First Coronavirus Response Act that allowed states to draw down extra cash for the public health insurance program for low-income people.

To be eligible, states were barred from altering eligibility rules and from raising premiums. They also aren't allowed to terminate coverage for those already enrolled in the program.

In Missouri, state officials suggest the lack of terminations, known as “churn,” may be playing a role in the growth of the rolls.

"Consistent with the federal Families First Coronavirus Response Act, the Department of Social Services will not terminate eligibility for any Medicaid participant unless the individual is deceased, requests a voluntary termination of eligibility, or the individual ceases to be a resident of the state through the end the federal emergency COVID-19 declaration," said Department of Social Services spokeswoman Rebecca Woelfel.

Through much of the second half of 2019, the monthly caseload hovered around the 850,000 mark. But, after the federal relief bill went into effect this spring, the number has risen, topping 957,000 at the end of July.

The increase comes after Gov. Mike Parson's administration came under fire last year over a drop in the number of children receiving Medicaid benefits.

Medicaid enrollment began climbing from around 840,000 in October 2014, according to data from the Department of Social Services. It peaked at nearly 997,000 in April 2017 and slowly declined until July 2018, when it began to fall more rapidly. In December, total enrollment stood at about 847,000.

The majority of those dropped from the rolls were children: 97,989 left the Medicaid program over that period. Most of the rest who lost coverage were custodial parents, 26,690 of them.

Enrollment is likely to continue growing as administration officials are preparing to implement a constitutional amendment approved by 53% of Missouri voters in the August primary that would expand Medicaid coverage to an estimated 230,000 additional low-income people.

The decision will mean adults between the ages of 19 and 65 whose income is at or below 138% of the federal poverty level will be covered. As of this year, that amounts to $17,608 for an individual and $36,156 for a household of four.

The federal government now covers about 65% of Medicaid costs, while the rest comes from the state. But populations covered under Medicaid expansion would have 90% covered by federal funding.

Parson and Republican officials have warned the strain of the pandemic on state coffers will force lawmakers to reduce spending on other areas of the state budget, including schools and universities, to accommodate the added costs.

But, an analysis by the Washington University-based Center for Health Economics and Policy found that expansion would add 231,000 adults and 40,500 children to the rolls, save $39 million a year and spur the creation of thousands of jobs.