Blog Center for Advancing Health Services, Policy & Economics Research

Public health emergency “unwinding” for MO Medicaid: Update for March, 2024

Written by Timothy McBride, co-director, Center for Advancing Health Services, Policy & Economics Research

On April 25, the state of Missouri released the tenth month of data on the unwinding of the Medicaid public health emergency (PHE) in a public dashboard. This post reviews some of the major conclusions from an analysis of the cumulative data, computed by this author from the state’s dashboard.

Nationwide Medicaid enrollment rose to a record high during the pandemic, and in Missouri the enrollment also rose to over 1.5 million at its peak before the unwinding (reinstatement of Missouri Medicaid recipients), a record.

The state releases data on the unwinding each month. But for this analysis Center for Advancing Health Services Policy and Economics Research at Washington University in St. Louis has looked at the cumulative totals over the entire ten months of the unwinding of Missouri to draw conclusions.

The State of Missouri has now reviewed 1.15 million cases from June 2023 to March 2024. Over 722,000 have retained coverage (63%), but over 277,000 have lost coverage (24%), including 127,767 children. Almost 152,000 cases remain pending (13%).

The numbers for Missouri can be compared to other states using, for example, the Kaiser Family Foundation’s unwinding website, which is being continuously updated. Nationwide over 21 million Medicaid enrollees have been disenrolled and over 44 million have had their coverage renewed, as of April 19, 2024.

Some major points about Missouri’s unwinding:

  • From June 2023 to March 2024, slighly more than one million (1,151,240) Medicaid cases have been reviewed in Missouri. The state’s plan is to review the total set of enrollees over a 12-month period.
  • Over the ten months, 63% (722,184) of recipients have been determined still eligible for Medicaid, while 24% (277,367) have lost coverage (been declared ineligible or lost coverage through a procedural determination). Another 151,689 (13%) are pending review.
  • Of those losing coverage over the ten months, 74% lost coverage for a “procedural determination” according to the state, which can be due to a range of reasons, while 26% lost coverage because they were reviewed and determined no longer eligible for the program. High “procedural determinations” is a metric being used widely to measure how states are doing (see Kaiser’s analysis) with their Medicaid redeterminations.
  • Of the total persons losing coverage so far over ten months, 46% (127,767) were children, 36% (99,629) were expansion adults, with the rest in other categories (see chart).
  • At the end of ten months, over 151,000 cases remained pending (an increase over the the 143,000 pending at the end of January 2024). Of the pending cases, 57% of the pending applications were children and 28% were expansion adults, 11% were custodial parents with the rest being in other categories (see Chart).
  • From an analysis of the data posted, it appears that the state made progress on resolving pending cases in March, or that the data posted reflects that progress. Perhaps about 20,000 cases over the ten months seem to have been resolved with most of those cases leading to recipients retaining coverage. As a result, the cumulative percent of recipients retaining coverage increased slightly to 63% in March, as compared to the cumulative total through February of 60%.

The process of recertifying enrollment in Medicaid, which generally had been done on an annual basis before the COVID pandemic, was paused during the Public Health Emergency (PHE) by federal law in early 2020. This meant that those enrolled in Medicaid during that period were not disenrolled. Federal law passed at the end of 2022 called for an end to the PHE, and a renewal of the recertification process, commonly called the “unwinding” of the pandemic as it is affecting Medicaid. The state also reported these data by law to the Centers for Medicare and Medicaid Services (CMS).