Written by Timothy McBride, PhD, Bernard Becker Professor, Brown School; co-director, Center for Advancing Health Services, Policy & Economics Research, Institute for Public Health
**This report is based on July 2024 state of Missouri administrative data.
The process of unwinding (from the Public Health Emergency) has concluded in Missouri and data from that unwinding have been released by the state of Missouri. In addition, the state faced a surge in the number of applications to Medicaid during the recent open enrollment process (and perhaps because of churning back on to the program after coverage was lost), leading to the Center for Medicare and Medicaid Services to send the state a letter of concern about significant delays in processing applications, a large number of pending applications, and underperformance of call centers. This article summarizes the latest findings on enrollment, the Medicaid expansion, applications, and the unwinding based on state of Missouri Family Support Division data (as posted on their website) as analyzed by WashU’s Center for Advancing Health Services, Policy & Economics Research.
Number of MAGI Applications. In July 2024, the number of MAGI (Modifed Adjusted Gross Income) applications reached 23,549, a small increase over the level in June (22,366 in June; see graph below). Although the number of MAGI applications was much higher during the Obamacare open enrollment period (see graph), as it was in previous years, the average number of applications received during the unwinding period (19,891 per month) has been significantly higher than the number received before the unwinding began (average, 16,600) (excluding open enrollment months). It is difficult to determine why there has been an increase in number of applications in recent months, but it is possible that some people who lost Medicaid previously are applying for Medicaid coverage again (churning) or are switching to another category of Medicaid once they lose Medicaid during the unwinding (e.g. switching into the Adult Expansion Group).
Pending applications. The number of pending MAGI applications increased slightly to 17,922 in July 2024 from 16,931 in June 2024, though this is significantly below the pending number of almost 53,000 pending applications in January 2024 (see graph). The significant increase in pending applications led to significant delays in processions applications for Missourians seeking Medicaid, rising from a reported average of 10 days in April 2023 to a reported average of 57 days in February 2024, though the average of pending days dropped to 33 days in July 2024 (see graph). Note that the delays in processing applications were very significant in early 2022, before Missouri enacted a mitigation plan, then the average number of days to process applications dropped significantly. As noted above the number of days to process applications rose again significantly lately, leading to another letter from CMS.
Total net enrollment. Net enrollment in Missouri’s Medicaid program dropped to 1.27 million in July 2024, down -16% from the peak enrollment hit right as the unwinding began in June 2023 (1.5 million).
Who is losing coverage? Looking at the drop in enrollment of -248,340 since the unwinding began, over half (55%) of the enrollees losing coverage are children (-137,125) (see graphs below). This is in part because children are a large share of the enrollees in Medicaid. But on the other hand, the eligibility level of children for Medicaid is quite high (up to 300% of the federal poverty level), so it remains perplexing why so many children are losing coverage.
Update on Medicaid expansion. As noted, the expansion of Medicaid began in Missouri in July 2021, with the first people enrolled in October 2021. As shown the graph, the current enrollment in the Adult Expansion Group (AEG) is 329,306 in July 2024. AEG enrollment fell in the first seven months of the unwinding, then has risen slightly in some months, dropped in other months, perhaps suggesting there is some churning into the AEG, offsetting those losing coverage during the unwinding.
