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Missouri cites problems with feds' Medicaid referrals

Wednesday, February 5, 2014 | 3:25 p.m. CST

JEFFERSON CITY — Missouri has received the names of more than 25,000 people determined to be potentially eligible for Medicaid through the federal government's online insurance marketplace.

But none of those people has been added to Missouri's Medicaid program yet.

Missouri officials say that's because the data from the federal government is not in a format that can be easily used and is fraught with errors and duplication, the St. Louis Post-Dispatch reported Wednesday.

"We're in the process of sorting it out," Brian Kinkade, acting director of the Missouri Department of Social Services, said.

The federal government's online insurance marketplace, which launched in October, was intended to be a one-stop shop for consumers where they can enroll in a subsidized private insurance plan or, if they meet income guidelines, have their application automatically sent to their state for Medicaid coverage.

The federal Centers for Medicaid and Medicare Services said the marketplace has found 25,487 Missouri residents eligible for Medicaid.

But Kinkade said Missouri received the data in "a flat file, basically like a spreadsheet."

"It's not in a format that can be automatically used," he said. "We're finding that the data's not of the best quality. There's a lot of duplications, a lot of missing information, a lot of poor-quality information."

The federal website doesn't screen applicants to see whether they are already receiving Medicaid, Emily Rowe, a unit manager in the state's Family Support Division, said.

"What we're finding is, the children are already covered," she said. But "the parents are still over the income (limit)."

Parents can earn no more than 19 percent of the federal poverty level to qualify for Medicaid in Missouri. That means a single mother with two children has an annual income limit of $3,711. Childless adults aren't covered unless they are elderly or disabled.

But Missouri's threshold for children is one of the most generous in the nation — three times the poverty level, or $70,650 for a family of four. Families in the upper income tier must pay premiums. Even so, additional children were expected to be added to Medicaid once their parents checked out the marketplace.

But that does not appear to have happened.

In the last three months of 2013, the state's Medicaid caseload dropped by about 14,000 people, including 7,829 children.

Medicaid enrollment generally tracks the economy, particularly the state's unemployment rate, Tim McBride, a health economist at Washington University in St. Louis, said. Thus, Medicaid enrollment rose during the Great Recession and has been falling again as the unemployment rate has declined. McBride is chairman of the Mo HealthNet Oversight Committee, a group composed of legislators and health care professionals.


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