When Rebecca Uccello got a call that her daughter鈥檚 Medicaid coverage was in jeopardy, she said it 鈥渟ent me into a tailspin.鈥�
Her 13-year-old daughter, Izabella, has been on Medicaid since age two because of severe developmental disabilities, including a birth defect which prevents her spinal cord from properly developing and a neurological condition which causes fluid build-up in the brain.
Uccello, of Springfield, said she received renewal paperwork to verify Izabella鈥檚 eligibility on July 7 by mail. She signed, scanned and uploaded it to the state鈥檚 website the next day.
Roughly a month later, her daughter鈥檚 caseworker delivered the news that the Department of Social Services never received her paperwork and Izabella was in danger of losing coverage.
Uccello鈥檚 shock quickly gave way to panic and anger, she said.
鈥淚t鈥檚 terrifying as a parent to even think that medical coverage could be lost over paperwork,鈥� Uccello said.
For three years, federal pandemic-era protections paused states鈥� annual Medicaid renewal processes, barring states from removing participants in almost all cases.
Those protections expired earlier this year.
As Missouri and all states begin reassessing the eligibility of every Medicaid participant on their rolls, one major is that many are losing coverage due to paperwork issues rather than a lack of eligibility.
And that concern appears to be well-founded: Uccello says this is the third time in the last decade she has needed to scramble to protect her daughter鈥檚 Medicaid coverage due to paperwork issues.
鈥淲hat is there to prove that she needs Medicaid renewed? She鈥檚 permanently disabled,鈥� Uccello said. 鈥淚 understand they鈥檙e trying to make sure that all their ducks are in a row, and that there鈥檚 no fraud鈥ut on the flip side, knowing that there鈥檚 nothing that鈥檚 going to make her ineligible except for death, it鈥檚 frustrating.鈥�
Missouri鈥檚 process of evaluating all 1.5 million Medicaid recipients on its rolls began with renewals due in June and will take a year. Of those who lost coverage , three-quarters lost it for what are called procedural reasons rather than being determined ineligible.
According to the health policy nonprofit , that places Missouri around average nationally for its rate of procedural disenrollments.
The social services department has said it is working to , as well as performing outreach to educate participants about the process 鈥� and has it is working to avoid disruptions in coverage for eligible participants.
When Uccello realized her daughter鈥檚 health care coverage was in danger, she reached out to her state representative, a tactic that she said worked when Izabella was four and paperwork issues nearly cost her coverage.
A spokesperson for Missouri鈥檚 Department of Social Services said in an email to The Independent that 鈥�this is the first we have heard of that issue鈥� regarding paperwork submitted online potentially being lost.
Izabella鈥檚 caseworker resubmitted the paperwork on her behalf, and this time it was a success. Izabella鈥檚 Medicaid coverage was reinstated.
It was a relief, Uccello said, but only until the renewal comes around again next year.
鈥淲hat do you do?鈥� she said. 鈥淗ow else can you submit paperwork and make sure that they get it?鈥� It鈥檚 terrible that parents who have medically fragile and medically complex children also have to deal with the heartlessness of this system.鈥�
74% of losses were procedural in first two months
Procedural disenrollments refer to a variety of paperwork-related issues that prevent the state from determining a participant鈥檚 eligibility 鈥� including that the state never received the completed paperwork or the participant never received the form.
For instance, a participant may not receive the paperwork if they lack a stable address or changed addresses, or may not return it if they received but didn鈥檛 understand the forms.
Around 40,000 of the roughly 54,000 Missourians who lost coverage in the first two months lost it for procedural reasons.
Kim Evans, Director of Family Support Division, which oversees the eligibility side of Medicaid, said at last week鈥檚 quarterly meeting of the MO HealthNet oversight committee that she could not yet single out specific factors contributing to the procedural denials.
鈥淩ight now, we really haven鈥檛 had a chance to really dig in to see where everything is landing. We鈥檙e starting to look at that now,鈥� she said.
Enrollees have 90 days after termination to submit the required paperwork for reconsideration and can be reinstated 鈥� rather than needing to fill out an entirely new application for Medicaid.
Because Uccello resubmitted the paperwork within the 90 day grace period, Izabella鈥檚 coverage loss was brief, she said, likely lasting from Aug. 3 to Aug. 7. (And because she was found eligible within 90 days, Medicaid would cover that lapse.)
In the first two months of renewals, just over half of the individuals reviewed, or 116,418 people, were determined still eligible. 54,160 Missourians lost coverage. 52,142 are still pending.
Evans said it鈥檚 generally too early to extrapolate trends in the data 鈥� in part because the 90-day window of reconsideration is still open for all those who have been disenrolled, so they could still cycle back on.
鈥淲e still feel like we still need another month of data in the books before we can really dig into the deep analysis and start to say okay, this is why this is what an average looks like for us,鈥� Evans said.
Children make up half of those who lost coverage聽
Even if parents lose coverage, children are often still eligible due to higher income limits for kids. But they sometimes fall through the cracks.
Half of all Missourians who lost coverage in June and July were children, or 27,085 children.
Missouri鈥檚 share of children being disenrolled is third-highest among the 14 states that report age breakouts, according to 鈥� after Kansas and Idaho.
Sixty-eight percent of the kids who lost coverage in the first two months lost it for procedural reasons 鈥� making up 18,355 of the 27,085 kids who were dropped from the rolls.
Sen. Tracy McCreery, D-Olivette, voiced concern at last week鈥檚 MO HealthNet oversight meeting about children losing coverage.
鈥淚 am concerned that there are kids being kicked off that quite possibly are still eligible, and it鈥檚 because they鈥檙e dependent on adults getting the paperwork or getting all the forms turned in,鈥� McCreery said.
Evans responded that it 鈥渋s a process that we really watch very closely鈥� and that the state has held off on terminating some participants, keeping them as pending renewals, 鈥渂ecause we wanted to go in and check those cases to ensure that we have done that correctly.鈥�
Evans said the department is working on publishing any changes in the outcomes of pending cases in future months.
This story was originally published by the Missouri Independent, part of States Newsroom.
