The average wait time for a person calling the Missouri state Medicaid helpline in May was almost 50 minutes, according to a letter the federal Centers for Medicare and Medicaid Services sent to state officials.
Federal officials are watching how states are removing people from Medicaid since a ban on removing them during the coronavirus pandemic public health emergency ended. This week, they detailed how states are doing in letters to administrators across the country.
“What CMS is saying with these letters is, ‘We're seeing a problem, here's a red flag that needs to be fixed,’” said Joan Alker, executive director of the Georgetown Center for Children and Families, who studies Medicaid enrollments.
In a letter Wednesday to Missouri Department of Social Services Director Todd Richardson, the agency assessed how well the state is complying with rules for disenrolling people from the state health insurance programs for poor and disabled people.
The Missouri Department of Social Services Family Support Division, which administers the state’s Medicaid program Mo HealthNet, is systematically reviewing Medicaid recipients in monthly batches to see if they still qualify for the program.
The CMS letters outlined three metrics: call center wait times, people disenrolled for procedural reasons and how long it took to process applications. Federal officials found Missouri’s average call center wait time was 48 minutes, and 44% of callers hung up before being helped.
If a person can’t get questions answered or submit information through telephone calls, they could risk losing coverage, said Sheldon Weisgrau, vice president of policy and advocacy at the Missouri Foundation for Health.
“A lot of folks need help in knowing how to interpret the kind of information they need to submit to Medicaid or to have it explained to them by a person rather than reading it in a letter,” Weisgrau said. “A lot of people call the call center for information, and if your Medicaid eligibility hinges on your ability to understand what you need to submit and you can't get through to a person who can explain, that’s a real problem.”
Long wait times and abandonment rates could also be an indicator of how well the state is reaching its most vulnerable residents, CMS officials wrote in the letter to Richardson. Poor people and people of color are less likely to have internet access and are more likely to use call centers to meet with enrollment staff.
“CMS has concerns that your average call center wait time and abandonment rate are impeding equitable access to assistance,” the letter read.
State officials say CMS is looking at all calls and not just Medicaid-related ones, which is skewing the data. They say updated reporting will reflect shorter wait times in the future.
A spokeswoman for the Missouri Department of Social Services said that the state has updated its call center technology and is dedicating more people to answering calls during busy times, and that wait times should become shorter in the coming months.
For other states, CMS also examined the number of Medicaid beneficiaries disenrolled because of procedural obstacles, including people who didn’t answer mailed forms or send the state needed information about their income.
Missouri was not yet reporting those numbers in May, the period CMS reviewed. However, provisional data released last month showed around 72% of the 32,000 people disenrolled in June were kicked off because of procedural reasons.
State officials at the time said the social services department was still processing many of those applications.
If state’s metrics don’t improve, it’s possible CMS could force states to pause their disenrollments, Alker said. The federal government could also pull funding for different programs or work with states to create a strategy to improve their processes.
The latter option has worked in the past. Early last year, CMS stepped in and worked with the state as Missouri struggled to process Medicaid applications after the state expanded the program to more low-income residents.
In the CMS letter, it showed that only 1% of Missouri’s May applications took longer than 45 days to process.
“I think it’s important that CMS has publicly posted these letters in real time,” Alker said. “That suggests to me that they're getting much more serious about enforcement. I think states would do well to pay attention.”
