Five months after a judge ruled Missouri must begin enrolling people in its newly expanded Medicaid program, the state is off to a slow start, with only 20% of newly eligible people signed up.
Missouri voters in 2020 approved expanding the government-funded health insurance program to people who make up to about $18,000 a year.
But drawn-out court battles and the coronavirus pandemic have plagued expansion efforts since voters approved the ballot initiative, said Tim McBride, a health policy professor at Washington University.
“It was projected that many, many people would enroll in the first two or three months of the expansion, so it’s been a little surprising that it's been going so slow,” said McBride, former head of the state’s Medicaid oversight committee. “There's been some focus groups done among the people who are actually eligible, and they really don't know [they’re eligible]. So, you know, so I think the word’s not gotten out to them.”
Last year, Republicans in the Missouri legislature said there wasn’t money in the budget for the expansion, but a court intervened, and the state began enrolling people in October.
Staff shortages in state and local health departments and the necessary focus on the coronavirus pandemic have made it difficult for the government to inform newly eligible people, he said.
Missouri hasn’t focused on enrollment as much as other states, McBride said.
“It’s pretty clear when you compare to other states that we're not doing as much outreach,” he said. “We got started late. And so there's a lack of awareness going on, despite efforts by a lot of people to try to clean up that awareness.”
Before the expansion, enrollment in the health insurance program for low-income people was mostly limited to children, pregnant people and people with disabilities. People in those groups still make up the vast majority of those enrolled in the state's Medicaid program.
Since October, the state has enrolled about 53,000 adults, or one-fifth of the projected 274,000 people who are now able to receive coverage in the program.
Nonprofits and community health clinics are working to enroll and educate their patients about the expanded coverage, but the coronavirus pandemic has complicated efforts, said Lachelle Livingston, director of population health at CareSTL clinics.
CareSTL has been trying to get the word out about new eligibility, she said.
“Right now the pandemic is the biggest challenge,” she said. “Patients who might want to come and sign up, they might be afraid to come in. There’s still fear and hesitancy on patients’ part as well as on the staff end.”
Applying for health insurance is complicated for many people, she said. It’s useful to have an expert on hand to help fill out forms. That’s harder to do over the phone or email. Phone numbers and addresses change, and internet service can be spotty, Livingston said.
The health center was planning a “sign-up blitz” to get people enrolled, complete with giveaways, but clinic officials decided to cancel it as coronavirus case numbers began to skyrocket, Livingston said.
The state is likely still processing thousands of applications that came in during open enrollment on the healthcare.gov marketplace, said McBride, the Wash U professor. That means total enrollment could be higher than the state is reporting.
Livingston hopes to see the numbers increase.
“Medicaid expansion will greatly improve the health of our communities, especially those underserved low-income communities that have not been able to seek out services,” she said. “There are a lot of people who have asthma and other underlying conditions that are choosing to pay bills instead of going to the doctor because they can’t afford it.”
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