Missouri Is Number One — in Cutting Health Care for Poor Children

Reduced Medicaid and CHIP enrollment is hitting Missouri's most vulnerable kids hard.
Reduced Medicaid and CHIP enrollment is hitting Missouri's most vulnerable kids hard. COURTESY FLICKR/TaxRebate.org.uk

Great news, Missouri, we're finally number one!

Yes, Missouri ranks at the very top of the 50 states in the decline of health care coverage for poor children between March 2017 and March 2019. Combining Medicaid and the Children's Health Insurance Program (CHIP), Missouri's enrollment decline of 12.8 percent is numero uno in America. That drop would be more than five and a half times the national-average enrollment decline of 2.3 percent in the era of Trump.

The findings, published July 17 by the national Center on Budget and Policy Priorities (CBPP), haven't gotten local coverage that I can find. But they dovetail with the widely discussed recent news that the number of children falling off of Medicaid rolls is at 95,000, a fifteen-percent, one-year decline, also tops in the nation.

CHIP is a federal-state partnership (like Medicaid) for children ineligible for Medicaid but who still live in low-to-moderate-income working families. Politically, CHIP isn't quite reviled as Medicaid among those offended by the Affordable Care Act — aka Obamacare — so when one combines the two programs and measures enrollment decline over a two-year period, it's quite a statement to have, by far, the largest coverage drop in the United States.

The bottom line is simple: Missouri is cutting health care for its neediest children at a dramatically faster rate than any other state. And the malfeasance isn't even limited to the customarily vilified Medicaid program.

Lest you think it's all a function of Missouri's rollicking-good economy, consider that, according to CBPP, the drop in the state's unemployment rate during the two-year period was well below the decrease nationally. Also, just-released federal job statistics for June show Missouri lost 2,237 jobs in the past year.

One explanation for the coverage decline might have been that the state had done a better job during the past two years of rooting out welfare cheats, thus reducing the numbers. But had that been going on, why did Gov. Mike Parson declare at a news conference last December he was creating a new Medicaid and Fraud Abuse Task Force designed to catch welfare cheats who, he claimed, had stolen $170 million from the state? Why was there no mention by the governor of having trimmed welfare rolls?

The only mention of numbers came when Parson and former House Speaker Todd Richardson — head of MO HealthNet, which oversees the state Medicaid program — were asked if they'd consider joining 36 other states in expanding Medicaid coverage, a step that would bring billions of federal dollars into the state. That would be no.

Ah, those were the good old days, when a man could talk proudly about Medicaid being all about fraud and financial peril, when cutting poor people off of their health care was a sign of fiscal responsibility. In January, Parson touted a $50 million cut in state health spending because of reduced Medicaid rolls that he had failed to mention a month earlier in unveiling the task force. His budget director attributed the good fortune to presumed improvement in the economy. (Spoiler alert: That wasn't it).

But a funny thing happened on the way to zero spending on Medicaid: People started noticing that poor children were losing their health coverage. That's not a good look, even for Obamacare opponents.

The first public coverage of slashing children from the Medicaid rolls came in early February, when Sen. Scott Sifton, D-Affton, demanded that Richardson explain why 57,000 children — among 71,000 people overall — had lost Medicaid coverage in the previous year. "The state should provide answers to ensure that no one — no child — was cut from Medicaid simply because of red tape," he said, prophetically.

At that time, it was learned publicly that in 2018 the state had begun automating its verification system for Medicaid eligibility. Using technology from the previous century, the state had sent letters to recipients and those who didn't respond — either because they'd moved and didn't get them, didn't understand the letters or otherwise failed to prove their eligibility — were booted. And, of course, there were understaffed call centers with average waits of 45 minutes or more that frequently dropped calls and were largely derelict.

Timothy McBride, a Washington University health economist who chaired the MO HealthNet oversight committee publicly questioned that the enrollment drop was related to an improved economy: "The process," he said, "is breaking down because we don't understand the situations of low-income people." (It was announced last week that McBride had been dumped from his oversight post by Parson in May.)

In the ensuing months, the only changes that occurred were in the numbers, which skyrocketed. So last week, House Minority Leader Crystal Quade, D-Springfield, released a letter she had recently sent to Republican House Speaker Elijah Haahr, father of four, wondering about all those kids dropping off the rolls.

But now the number was 95,000 children. I guess that's the threshold for admitting the problem. In a revealing sentence, Haahr noted that "more than a month ago" he had asked a subcommittee chairman to investigate the enrollment drop that had been revealed publicly five months earlier.

Haahr assured Quade he "personally requested" Richardson explain the numbers to two key Republican House colleagues and himself. And if that weren't bold enough, he promised that "if MO HealthNet's response fails to adequately answer our concerns or new ones arise, I will give my full support to Rep. [David] Wood and Rep. [Jon] Patterson to hold hearings on this issue."

Wow! Hearings! This man sounds like a member of the Squad or something.

With no apparent sense of irony, Haahr noted in his letter that Wood and Patterson "have extensive knowledge of MO HealthNet and the utmost care for the most vulnerable Missourians, especially our children, that extends beyond partisan lines" (emphasis mine).

That's certainly nice to hear from one of the top leaders of the Republican Party, the one that "along partisan lines" (read, hatred of Obamacare) has turned away as much as $10 billion federal dollars — dating back to 2014 — that would have provided health coverage for somewhere between 230,000 and 350,000 "vulnerable Missourians," the large majority of whom remain without coverage. Not to mention saving lives.

Missouri is one of fourteen states that continues to refuse to expand Medicaid, a cost of at least $1.5 billion annually to the state. But as awful — and frankly, stupid — as that might be, it pales in importance to the immorality of allowing children to go without their medications or treatment of their illnesses or preventive health care or vaccinations or maybe even the examination they need to get into school in the coming weeks.

It cannot be overstated that in many of those 95,000 cases, the parents don't know they've lost coverage. They'll find out the hard way, when they try to get medical care for their uncovered children.

This is abhorrent, but not an aberration. It's the perfect storm of incompetence meeting inhumanity. Missouri's state government is chronically underfunded, so it's hardly a shock that its technology is scandalously outdated and its health care employees unable to perform their basic duties.

But most important, let's not forget the more recently imbedded culture of ignoring and denigrating the poor. In that regard, apparently, Missouri is second to none.

Ray Hartmann founded the Riverfront Times in 1977. Contact him at [email protected] or catch him on St. Louis In the Know With Ray Hartmann and Jay Kanzler from 9 to 11 p.m. Monday thru Friday on KTRS (550 AM).

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