Missouri has just over a month to bring its Medicaid program back into compliance with federal regulations, and state officials said Friday they were optimistic about meeting that deadline despite the average wait time. for Medicaid claims which still hovers around double what is allowed.
The processing time for a Medicaid application, which was on average 100 days in early August, is now “about 90 days, 85 days,” Kim Evans, director of the state’s Family Support Division, said Friday. A mitigation plan approved last month by the Centers for Medicare and Medicaid Services (CMS) requires Missouri to reduce that wait time to 45 days by September 30.
“We’re on track right now to do that,” Evans said.
Before Medicaid eligibility was extended to include low-income adults last year, the average processing time was eight days. As wait times remain high, the backlog of pending applications fell to 23,804 on Friday morning, below 35,393 at the end of July.
The federal government formally asked the state to produce a mitigation plan in May, after identifying “multiple issues with Missouri’s prompt processing of claims,” according to a letter obtained by The Independent.
CMS began working with Missouri officials in early 2022 to identify strategies the state could adopt to address the backlog. But in May, the federal government was unhappy with Missouri’s progress.
In July, CMS released a summary of Missouri’s shortcomings and endorsed the state’s proposed strategies to help bring it back into compliance with federal standards. The state Medicaid program, called MO HealthNet and administered by the Department of Human Services, has engaged in these strategies.
Rare and national experts, as well as longtime observers of Missouri’s Medicaid program, said CMS’s decision to intervene was unusual and shows how serious enforcement delays have become.
During a briefing with reporters on Friday, Evans downplayed the significance of the federal intervention.
“It’s something normal,” Evans said. “It’s not unique to Missouri and it’s not something we had to do because Missouri was so behind that we couldn’t save it.”
If the state fails to comply with the plan set out by CMS, the federal government could implement even stricter compliance measures. Eventually, Missouri could face financial penalties.
“We have crises”
The state’s stance on Medicaid waiting lists was just one topic of an extensive press conference held Friday by leaders of the Missouri Department of Social Services, or DSS.
Agency leaders discussed a series of challenges that have plagued the department for years, most of which have been intensified by the pandemic.
The most discussed challenge, which contributes to Medicaid wait times and ongoing issues across the agency, was understaffing.
Darrell Missey started in January as director of the children’s division — investigates child abuse and neglect and administers the foster care system. He said when he took the job: “I walked in and found out we had some crises going on..”
Despite a 5.5% wage increase for state employees, there are currently between 900 and 1,000 vacancies in the DSS, according to data shared Friday. There are 6,630 full-time positions budgeted for, but only 5,760 full-time employees.
Staffing shortages impact almost every aspect of the ministry, including level of care available for children and young people placed in the juvenile justice system.
“We’re being creative in moving resources around to cover the workload,” said Karen Meyer, the department’s director of human resources, who also pointed to the ongoing mass hiring events.
In the Family Support Division, Evans said, they’re flexible enough to “move staff from one program to another when we’re behind schedule” because “the same people who process Medicaid applications are double-trained. to take care of SNAP benefits as well.”
SNAP, the Supplemental Nutrition Assistance Program, is the program that provides federal food assistance. Missouri is currently facing a federal trial long wait times for interviews required to receive SNAP benefits.
Hiring new employees takes time, and “sometimes people get into it and decide it’s not the job for them,” Evans said. “It’s very complicated.”
The turnover rate across the department currently stands at around 35%, meaning more than a third of all employees leave the department in a year, said Meyer, the director of resources. human.
In the Children’s Division, there could be up to 200 vacancies, said Patrick Luebbering, chief financial officer of DSS. There was 237 vacancies in the division in April.
The effect for workers is an increase “in workload and how often they have to be on call,” Missey said.
The Youth Services Division, which deals with the treatment and rehabilitation of young people who are committed to state juvenile courts, faces more young people in its custody but fewer staff to supervise them, said Scott Odum, director of the agency.
According to Robert Knodell, acting director of the DSS, a big part of the challenge is the state’s low pay rate. The starting salary was $34,666 for DSS employees after the salary increase in April.
“We still have a long way to go to make our compensation more competitive and continue to address that,” Knodell said.
The other crisis Missey said he faced when he started his new job, in addition to personnel issues, was that the state had “too many foster children. “with nearly 14,000 children and only about 5,000 foster homes.
“There’s always a scramble about where they need to go,” he said.
Missey advocated a prevention-centric approach that would reduce the need for more children to go into state care and replace a “reactive” system “driven by fear of what might happen later,” which who grows more foster children.
In the shorter term, “we need to work to stabilize the force” to prevent people from quitting and make the number of cases tolerable, he said, and we “need to have a preventive force from the start that will help to reduce the number of children cared for. ”