Missouri Considers Medicaid ‘Presumptive Eligibility’
After a year of campaigning by children's advocates to implement presumptive eligibility in Missouri's Medicaid program and its CHIP program, MC+ for Kids, the state Social Services Department in early September agreed to include the option as a line item in its budget draft due next year. Over the summer, officials from Metropolitan Congregations United, a St. Louis-based advocacy group, and the Social Services Department had discussed the feasibility and effectiveness of presumptive eligibility. Under presumptive eligibility, state-approved groups, called qualified entities, could enroll children who appear income-eligible in Medicaid or CHIP programs before confirming eligibility. Children enrolled through presumptive eligibility would receive health benefits immediately, and their parents would have 45 days to verify their income and complete the application to receive full coverage. Speaking to the Kaiser Daily Health Policy Report, Social Services Department Deputy Director Steve Renne said, "We do feel that presumptive eligibility can be another tool to expand the insured population" in the state. In Missouri, about 136,000 children are uninsured, according to the Kaiser Family Foundation's State Health Facts Online. During an Aug. 27 meeting with Dr. Katie Plax, chair of MCU's Health Care Task Force and a representative from Legal Services of Eastern Missouri, Social Services agreed preliminarily that hospitals, federally qualified health centers and local health departments would be considered qualified entities. If those entities prove successful in enrolling children presumptively, Plax told the Kaiser Daily Health Policy Report that she hopes to work with Social Services to expand the number of qualified entities. The department also agreed that children in families with annual incomes up to 225% of the federal poverty level, or $39,712 for a family of four, would be permitted to enroll in Medicaid or CHIP through presumptive eligibility, Plax said. Income limits for the state's health programs are 300% of poverty. However, Social Services officials must finalize the budget proposal before submitting it to the state Legislature in January, Renne said.
Plax said she now intends to ask Missouri Gov. Bob Holden (D) to support the presumptive eligibility line item by approving the Social Services budget, saying, "My hope is that the governor will be supportive." MCU, other community groups and advocates have sent about 2,500 letters in support of presumptive eligibility to Holden, who endorsed the idea as a gubernatorial candidate at a November forum hosted by MCU. One potential obstacle to getting presumptive eligibility approved is that Missouri, like many other states, is facing a budget "crisis." According to early estimates, administrative costs of implementing presumptive eligibility could total $1 million, Renne said. Recently, Holden announced $25.4 million in cuts to the Social Services Department, mostly in administrative areas. Medicaid reimbursements were not affected by the cuts. But Joe Squillace, a health policy analyst with Citizens for Missouri's Children, another advocacy group favoring presumptive eligibility, said the cuts indicate that the state government might be unlikely to approve initiatives such as presumptive eligibility unless they are "politically winnable." Although Plax said there could be a "struggle" over presumptive eligibility in the Legislature, she added, "We'll continue to build support for this." About 164 politicians, hospital leaders and community organizations in the state have endorsed presumptive eligibility, Plax said. Renne said he expects lawmakers to support the concept of presumptive eligibility when voting on the budget, but indicated that fiscal concerns could cause legislators to cut the line item (Amanda Wolfe, California Healthline, 9/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.