Late last year, Congress approved a bill that will have major implications for Missouri in 2023. After nearly three years of being barred from removing ineligible Medicaid enrollees from the program, Missouri will be allowed to resume eligibility checks starting April 1st.
Though this change may not seem like a big deal, the prohibition on checking whether participants are eligible to continue receiving services has been the primary driver of unsustainable Medicaid growth in Missouri since 2020. When the pandemic began, and the federal government started doling out relief funds, Missouri’s enrollment was well below 900,000. But as a result of the federal government conditioning relief funding for Medicaid on states no longer removing enrollees that were found to be ineligible, Missouri’s rolls have since grown by more than 575,000. Today, there are more than 1.4 million Missourians enrolled in the program; more than 720,000 are children.
Initially, the prohibition on disenrollment was supposed to continue until the federal public health emergency for COVID-19 expired. It was not necessarily surprising that once enrollment checks were stopped that program enrollment would skyrocket. Welfare programs typically experience a lot of what is called “enrollment churn,” as participant circumstances move people in and out of eligibility. What was surprising to many (myself included) was the continued extensions of the federal public health emergency.
Missouri’s emergency declaration for COVID-19 response ended more than a year ago. While it’s certainly true that COVID-19 remains present in our society, it’s also true that emergencies aren’t meant to last forever. Policymakers seem to understand this, as there was bipartisan congressional support for allowing states to resume eligibility checks, regardless of the status of the federal public health emergency.
The coming year will likely be a consequential one for Missouri’s government, as billions in federal covid relief funds that have been propping up the state’s budget begin to dry up. There is perhaps no issue with bigger financial implications than reinstating eligibility checks for Missouri’s Medicaid program. As long as the state’s Medicaid agency is equipped to quickly and accurately process the long-awaited enrollment checks without issue, the program should begin to right-size quickly. And if the agency isn’t prepared, Missouri’s elected officials should be prepared to step in and provide the necessary support, because there are far too many state tax dollars on the line.
