A Decade Of Poor Service

Missouri March 2023 Benefit Report Issued

Thanks to indifference and incompetence, Missouri does much less for its struggling families now than it did a decade ago.

Food stamps and Temporary Assistance help fewer citizens.  MO HealthNet (Medicaid) has expanded – but soon will retrench below the number helped not long ago.  (More on that later.)

The bottom line is that conscious decisions by the Republican leadership in Missouri politics damns struggling families to more suffering than is necessary.

Let’s look at Temporary Assistance.  From March 2013 to this March the rolls declined by 7/8ths.  No, a better economy does not account for most of the drop.  The decrease comes from harsh rules imposed by the Missouri Legislature and the inability of the Department of Social Services to explain and run the program.  For example, back in 3/13 state workers approved 62% of applications.  This March just 33% of applications were accepted.  Why?

Oh yes, Missouri is less generous to TA families now too.  In March 2013 the average benefit of $229.77 worked out to $7.41 per day.  This March the per day amount was just $7.30.  (Good thing stuff is so much cheaper now than it was then!)

A decade ago Missouri had 936,963 people – about one person in six in the state – receiving food stamps.  Now 270,000 fewer people get help.  Yes, unemployment has decreased and wages – thanks to Missouri’s voter imposed minimum wage – have crept upward.  Yet, the number of underemployed people remains stubbornly high.  A larger portion of workers with dependents who are involuntarily part time ought to be getting food stamps than we now see on the rolls.  A related problem, as highlighted in the state press, is that many parts of Missouri are day car deserts.  Without reliable, affordable day care many moms can’t work as much as they need.  That reality too ought to push food stamp utilization higher.

Remember, back in 2013 families had to appear in person at a Family Support Division office and be interviewed for food stamps.  Now the state uses a Call Center based system which ought to make it easier…except that they have too few people to answer the ringing phones.

Fortunately, a growing part of the food stamp population has the time to wait for days for their calls to be answered.  This year 13% of Missouri food stamp recipients are over age 60.  Seniors on fixed incomes have been especially damaged by the post-pandemic inflation.  At the national level many experts predict that the portion of seniors pushed into poverty will soar over the next couple of years.

On to Medicaid.  During the Covid War states did not have to conduct annual case reviews of patients receiving Medicaid.  We’re now close enough to normality that the federal government mandated a return to the reviews.  This will be horrific in Missouri:  the state lacked the staff to keep-up on applications and regular reauthorizations before the pandemic and Missouri’s half-assed Medicaid Expansion.  Now they have a tremendous amount of work to do with even fewer workers.

As a result, instead of Income Maintenance workers working with a family, the state will depend on computer-generated letters and interactive on-line encounters to process eligibility.  The default, of course, will be to deny coverage.

This March 1.5 million Missourian (almost one in four) were covered by MO HealthNet. State bureaucrats have said they expect 200,000 to 300,000 citizens to lose coverage due to the reauthorization process.  I think they’re being too humble.  I have faith that Missouri’s broken “system” will erase one of four people from the rolls. 

By this March 333,944 Missourians were in the Adult Expansion category in MO HealthNet.  I expect that around 400,000 people will lose coverage, dropping the rolls below pre-expansion size.

“Wait, wait, wait,”   you say.  Won’t good people in the government protect these people?  Alas, this is Missouri. 

His Accidency, Mike Parson opposed Medicaid Expansion.  The lawyer and former legislator he put in charge of MO HealthNet voted many times against expanding Medicaid.  And, again this session, senior GOP leaders in the House and Senate repeated that the cost of Medicaid is unsustainable…then they voted for more tax cuts.

From the Monthly Management Reports for the Family Support Division and the MO HealthNet Division for March 2023 and March 2013 [ www.mo.dss/re ]

 

                                              March 2023                March 2013        

Temporary Assistance

  Kids                                  9,687                                       64,600

  Adults                              2,669                                        33,386

  Total                               12,356                                        97,986

  Payments                  $1,209,694                                $8,762,903

  Per Family                    $  226.45                                   $  229.77

  Per Day                         $   7.30                                     $  7.41

 

Food Stamps (SNAP)

  Participants                    666,365                                     936,963

  Benefits                   $125,673,841                            $120,089,649

  Per Person                   $  188.60                                   $  128.17

  Per Meal                        $  2.03                                      $  1.38

 

Medicaid (MO HealthNet)

  Enrolled                         1,502,793                                  878,444

  Covered                         1,510,707                                 918,943

  Cost                         $1,393,406,759                         $583,541,448

  Per Patient                    $  922.35                                   $  635.01

  Managed Care               1,214,290                                  436,373

  Premium                        $  374.07                                   $  195.28

 

Missouri Medicaid Without Managed Care:     

                                                                 296,417 : $939,171,691

(March 2023)                                                $ 3,168 per patient

 

Glenn Koenen