Analysis: Missouri finally produces Medicaid report

Sunday, October 25, 2009 | 5:11 p.m. CDT

JEFFERSON CITY — After claiming for more than a year that it could not do so, the Missouri Department of Social Services has finally obeyed a state law and published a list of employers whose workers get government-funded Medicaid health care coverage.

Yet compliance with the Medicaid reporting law may only be an experiment. Although the list is supposed to be published quarterly, the department says there's no telling when it will produce the report again.

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As lawmakers in Washington, D.C., debate a national health care overhaul, Missouri's experience shows how slow and difficult it can be for bureaucracies to implement even incremental changes in the health care system.

Missouri was one of several states to mandate employer-Medicaid reports in recent years as a way to gauge the extent to which government was picking up the slack for businesses that either didn't offer their employees affordable health insurance or paid them so little that they qualified for Medicaid.

Missouri's Medicaid program is called MO HealthNet.

Then-Gov. Matt Blunt issued an executive order in November 2006 requiring the Department of Social Services to produce a quarterly report, beginning in summer 2008, of each employer with at least 50 employees or their family members enrolled in Medicaid. In 2007, the Missouri General Assembly put the requirement into law.

But no such report was produced the next year.

Instead, the department published a summary in summer 2008 stating that 589 businesses employed at least 50 people who either received Medicaid benefits themselves or had a spouse or child who did so. The report identified none of those businesses by name.

Officials at the Department of Social Services explained that they relied on a Labor Department database, and federal regulations barred the public release of its confidential information such as the names of employers. An agency spokeswoman said at the time that it would look for a different means of compiling the data so that businesses could be named in future reports.

Yet no report had been publicly released as of Oct. 14, when The Associated Press contacted the department to ask about it. Later that day, the department posted on its Web site a report dated July 31, which covered the employment period from January through March.

But the department again failed to follow the law's mandate to identify specific employers with workers enrolled in Medicaid, again citing the fact that it relied on the confidential Labor Department database. Instead, the report listed only a summary of work force sectors with Medicaid participants. (Retail trade led the way in raw numbers with 18,471 while the "administrative support, waste management and remediation" sector had the highest rate at 14.7 percent.)

To cite the Labor Department data as a justification for not complying with the Medicaid reporting law "sounds a little bit to me like, 'The dog ate my homework,'" said Greg LeRoy, executive director of Good Jobs First, a Washington-based nonprofit group that has been critical of government subsidies for corporations.

LeRoy noted that some states produced such reports by culling data from Medicaid applications that ask recipients to list their employers.

Missouri's Medicaid applicants also are asked where they work. That information is entered into a database by any of the department's 2,000 "eligibility specialists" spread across the state, said Scott Rowson, a spokesman for the Department of Social Services.

Asked if the department could use that data to produce a Medicaid-employer report, Rowson said last Tuesday: "I don't think there's any time frame or specific effort to do that."

He explained that the data was unclean, because there could be typos or variations in how state workers entered employer names.

Yet just three days later, the department released a report — relying on that data — that listed 172 specific businesses that employed at least 50 people enrolled in Medicaid health coverage for themselves or their families, covering the period of January through March.

On Friday, Rowson explained the stunning reversal by essentially saying he didn't know what was going on. He said other agency employees actually had been working on the full report for some time.

"It was certainly within our power. We're legally able to do it," Rowson said. "As it turns out, the process of scrubbing this data to make it usable and consistent takes awhile, and it's ready."

So here are the results. Wal-Mart Stores Inc., which had a work force of about 39,000 people in Missouri, topped the list with 4,595 employee families on Medicaid.

Second was Casey's General Stores Inc., which had 1,035 employee families on Medicaid out of a Missouri work force of more than 3,400.

Third was the state of Missouri, which had 1,017 employee families on Medicaid out of a work force of more than 59,000.

Will the Department of Social Services, as required by law, now produce a similar report each quarter?

"That completely remains to be seen," Rowson said. "I'm not sure how often they're going to be able to do this."

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