Korra Elliott tried to avoid doctor visits while waiting to get Medicaid. She worries that without any insurance, she won’t be able to pay more bills. But in early March — she said a decision on her application had still not been made after five months — a suspected flu case sent her blood pressure soaring and sent her to the emergency room.

The 28-year-old mother of four from Salem, Missouri, is one of tens of thousands of Missourians who are uninsured as the state struggles to apply for a flood of state federal health insurance plans.Missouri has had a long legal and political strugglesit now covers adults earning up to 138% of the federal poverty level — about $18,800 a year for individuals.

Missouri had nearly 72,000 pending Medicaid applications at the end of February, and it took an average of 119 days to process an application, more than double the maximum 45-day turnaround time allowed by federal rules. Adding people to Medicaid is labor-intensive, and these jobs require training and expertise. The program covers many groups of people – children, people with disabilities, the elderly, adults who are pregnant or have children, and some who don’t have children. Different rules determine who is eligible.

Missouri simply has no workers to keep up. Heather Dolce, a spokeswoman for the Missouri Department of Social Services, said 20 percent of employees who processed Medicaid applications left in the last fiscal year. The average number of job applications received for each open position in the family support unit, which oversees admissions, fell from 47 in March 2021 to 10 in February 2022.

Almost every industry is struggling to find workers right now, but staffing shortages at state Medicaid agencies across the country come at a challenging time.States will soon need to review tens of millions of people Enroll in the program nationwide — This arduous effort will begin once President Joe Biden’s administration allows the COVID-19 public health emergency declaration to expire. If Missouri’s lengthy filing backlog is any indication, the state is wreaking havoc on people’s benefits on a massive scale — even for those who still qualify for coverage.

“It doesn’t matter what policy you have if you don’t have someone to actually handle the case and answer the phone,” said Jennifer Wagnerdirector of Medicaid eligibility and admissions at the Center for Budget and Policy Priorities, a left-leaning think tank in Washington, D.C.

Federal officials have said they will give states 60 days’ notice before ending the public health emergency, so it’s unlikely to expire before the summer. Once they do, registrants won’t start right away: states can take up to 14 months to complete their renewals, although budgetary pressures may prompt many to move faster. The increase in Medicaid funding that Congress passed to states through COVID relief legislation in 2020 will end shortly after the emergency expires.

Ultimately, staff need to answer questions, process information that confirms someone’s Medicaid plan should be updated, or see if that person is eligible for a different health insurance plan — all before benefits lapse and they become uninsured .

State Medicaid officials say staffing is one of their biggest challenges. At the January meeting of the Medicaid and CHIP Payments and Access Committees, an outside panel of experts that advises Congress, Jeff Nelson said 15 to 20 percent of Utah’s health department’s qualified staff is new here. “One in five of our workforce probably doesn’t know what they’re doing,” said Nielsen, who oversees Medicaid eligibility in Utah.

Job openings for qualified employees at the Texas Health and Human Services Commission have quadrupled in about two years — with 1,031 openings as of late February, according to spokesperson Kelli Weldon. This compares to 260 as of March 31, 2020.

Medicaid renewals are less labor-intensive than initial applications, but it will take a while for qualified workers to understand the ins and outs of the program, Wagner said.

“You’re still months away from being fully functional,” said Wagner, who previously oversaw the Illinois Department of Human Services office that determines applicants’ eligibility for Medicaid, the Supplemental Nutrition Assistance Program that offers food stamps and Other assistance programs.

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Other social services can get bogged down in the process, as many staff also process applications for other programs. In addition to Medicaid, Kentucky Department of Community Services staff processes SNAP and child care assistance applications.

Consumer advocates who connect people to safety net programs worry that an overwhelmed workforce won’t be able to keep up.

“It’s a lot of work for everyone,” said Miranda Brown, who helps people apply for benefits as an outreach coordinator. Kentucky Equal Justice Centera legal aid group.

Brown said she recently called the state office near the end of the day on behalf of a client. She waited an hour, but a caseworker told her the agency couldn’t handle more cases that day.

“I even have a [phone] I get through the line faster than consumers call themselves,” she said. “If that’s hard for me, it’s also very hard for consumers trying to take advantage of their lunch break at work. “

South Carolina plans to hire “several hundred workers” starting this spring to help manage the public health emergency, said Nicole Mitchell, associate director of eligibility, admissions and membership services at the South Carolina Department of Health and Human Services. Renewal at the end of the event. . From July 2020 to June 2021, the turnover rate of qualified workers was about 25%, up from 15% in the previous 12 months.

In Missouri, Dolce said her department hopes the recently approved raise will help recruit more workers and improve employee morale and retention.The department is sue It also monitors delays in enrolling in SNAP benefits.

Kim Evans, director of the Family Support Division at the Missouri Department of Social Services, told the state Medicaid Oversight Board in February that her department was providing overtime and she even offered to buy pizza to expedite the processing of applications. But the department is enrolling fewer than 3,000 people a week, causing tens of thousands of people to wait and delay their care.

In suburban Kansas City, Missouri, Stacey Whitford, 41, applied for Medicaid in December for herself and her 13-year-old son. Her son needs hearing aids, which she says cost $2,500 each without insurance. She also placed a support worker for the autistic boy through the Department of Mental Health, but said she was told she would only be able to start work once her son was enrolled in Medicaid.

“It’s like hanging a golden ticket in front of you and saying, ‘It’s there, but you can’t touch it,'” she said in early March.

Whitford spent hours on the phone trying to sort through the status of their applications, and then on March 31, less than four months after they applied, they were finally approved.

“I’m so excited! We can run with scissors now,” she joked.

But Elliott, the Salem mother of four, is still waiting. She gave up calling the state’s Medicaid hotline after getting frustrated by her calls being put on hold for hours and being disconnected. Instead, she checks her application through an admissions specialist at the clinic she’s applying to.

She was sent home from the emergency room with ibuprofen and Duffy and has yet to see the bill. If her Medicaid application is approved, her coverage will go back to the month she applied, likely covering her emergency room trips. But if her application is denied, the cost will be added to her medical debt, which Elliott estimates is already in the tens of thousands of dollars.

“It made me think it was a joke,” Elliott said of Missouri’s expansion of Medicaid. “It’s like they’re just throwing it out there for all these people to apply for it, but they’re not really helping anyone.”

Kaiser Health News is a national health policy news service. It is an independent editorial project of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.