Medicaid enrollment in Missouri begins; applications appear vigorous

The expansion of Medicaid in Missouri began in 2021, and after resolution of a lawsuit at the Missouri Supreme Court in July, enrollment applications were accepted starting on October 2021.

As of January 21, 2022, enrollment in the adult expansion group (AEG) had reached 58,536 persons.  Reports indicate, though, that there have been a large number of applications with enrollment “pending”, reaching a reported 69,000 persons (as of January 7).  Altogether this suggests that perhaps more than 120,000 persons, who have already applied to the program to date, may eventually be enrolled in the AEG; if the majority of those applications are approved. 

It is worth noting that Governor Parson’s budget proposal for FY2022 estimated that 178,303 persons would be enrolled in the expansion three months after the expansion started (see Missouri Department of Social Services, Fiscal year 2022 budget request, page 48).

A Missouri Medicaid Enrollment Dashboard, launched by the Center for Health Economics and Policy at the Institute for Public Health is tracking Missouri Medicaid enrollment trends, with a focus on enrollment by type of recipient, by region, by county, applications to the program, and enrollment in managed care plans.

Documented on the Dashboard, the trends in applications to the program, suggest that the number of enrollment applications for Medicaid from September through December 2021, totaled 111,940 applications, about 157 percent higher than the number of people who applied to the program (total of 43,640) in the same four months in 2020. Historical patterns suggest that many people apply for Missouri Medicaid through the federally facilitated marketplace (FFM) during the “open enrollment period”, which ran from November 1, 2021, to January 15, 2022.  In fact, data reported on the dashboard indicates that 60.6% of the applications in December were through the FFM, while 27.4% were made online. Enrollment in the adult expansion group suggests that the number of people applying in the St. Louis region exceeds 20% of the projected enrollment in most counties (see table).

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Sources: (a) (b)

The large number of pending Missouri applications are likely explained by a number of factors. As noted, the state receives a large number of applications from the FFM during the open enrollment period and spend some time confirming the applicant is eligible for Medicaid. In addition, the state has staff shortages, which have been reported in the media, also exacerbated by state agency staff who are out due to the COVID-19 pandemic.

The new recipients of Medicaid are required to choose a Medicaid managed care plan upon enrollment.  If the recipient did not choose a managed care plan these adult expansion group enrollees are assigned to a managed care plan.  In Missouri, three managed care plans are contracted to manage Medicaid enrollees – Healthy Blue, Home State and UnitedHealthcare.

The Center for Health Economics and Policy has also produced policy briefs,  which discuss the potential impact that expansion is expected to have on the number of Missouri Medicaid enrollees, and the demographics and health status of newly eligible Medicaid beneficiaries.

The Center for Health Economics and Policy at the Institute for Public Health, Washington University in St. Louis advances evidence-based research to improve health and works with policy makers and public health leaders to drive more equitable health policy.