Korra Elliott has tried to keep away from seeing a physician whereas ready to get on Medicaid. She worries she will’t afford extra payments with none insurance coverage protection. However in early March — 5 months, she mentioned, after making use of and with nonetheless no resolution about her software — a suspected case of the flu despatched her blood stress hovering and landed her within the emergency room.

The 28-year-old mom of 4 from Salem, Missouri, is among the many tens of hundreds of uninsured Missourians caught ready because the state slogs by way of a flood of functions for the state-federal medical insurance program. Missouri expanded this system final yr after a prolonged legal and political battle, and it now covers adults who earn up to 138% of the federal poverty degree — about $18,800 yearly for a person.

Missouri had almost 72,000 pending Medicaid functions on the finish of February and was averaging 119 days to course of one, greater than twice the utmost turnaround time of 45 days allowed by federal guidelines. Including individuals to Medicaid is labor-intensive, and the roles require coaching and experience. This system covers many populations — kids, individuals with disabilities, seniors, adults who’re pregnant or have kids, and a few with out kids. Completely different guidelines dictate who qualifies.

Missouri merely doesn’t have the employees to sustain. Final fiscal yr, 20% of its staff who dealt with Medicaid functions left their jobs, mentioned Heather Dolce, a spokesperson for the Missouri Division of Social Companies. And the common quantity of job functions obtained for every opening within the division’s Household Help Division — which oversees enrollment — dropped from 47 in March 2021 to 10 in February 2022.

Nearly each trade is struggling to discover staff now, however staffing shortages in state Medicaid companies across the nation come at a difficult time. States will quickly want to evaluate the eligibility of tens of millions of people enrolled in the program nationwide — a herculean effort that can kick off as soon as President Joe Biden’s administration lets the covid-19 public well being emergency declaration expire. If Missouri’s prolonged software backlogs are any indication, the nation is on track for a mass-scale disruption in individuals’s advantages — even for those that nonetheless qualify for the insurance coverage.

“In case you don’t have individuals truly processing the instances and answering the telephone, it doesn’t matter what insurance policies you’ve in place,” mentioned Jennifer Wagner, director of Medicaid eligibility and enrollment for the Middle on Finances and Coverage Priorities, a left-leaning assume tank in Washington, D.C.

Federal officers have mentioned they may give states 60 days’ discover earlier than ending the general public well being emergency, so it’s unlikely to expire earlier than summer season. As soon as it does, enrollees received’t be kicked off instantly: States can take up to 14 months to full renewals, though finances pressures could push many to transfer sooner. A bump in federal Medicaid funds to states, supplied by Congress by way of covid reduction laws in 2020, will finish shortly after the emergency’s expiration.

In the end, staff are wanted to reply questions, course of info confirming somebody’s Medicaid enrollment ought to be renewed, or see whether or not the particular person qualifies for a totally different well being protection program — all earlier than the advantages lapse and so they grow to be uninsured.

State Medicaid officers have mentioned staffing is one of the highest challenges they face. In a January assembly of the Medicaid and CHIP Fee and Entry Fee, an outdoor panel of consultants that advises Congress, Jeff Nelson mentioned 15% to 20% of the Utah Division of Well being’s eligibility staff have been new. “We’ve obtained a fifth of the workforce that doubtlessly doesn’t know what they’re doing,” mentioned Nelson, who oversees eligibility for Utah’s Medicaid program.

Eligibility employee vacancies on the Texas Well being and Human Companies Fee quadrupled over roughly two years — 1,031 open positions as of late February in contrast with 260 as of March 31, 2020, in accordance to spokesperson Kelli Weldon.

Medicaid renewals are much less labor-intensive than preliminary functions, nevertheless it takes time earlier than an eligibility employee is aware of the ins and outs of this system, Wagner mentioned.

“It’s months earlier than you might be absolutely useful,” mentioned Wagner, who beforehand oversaw the Illinois Division of Human Companies’ workplaces that decide candidates’ eligibility for Medicaid, the Supplemental Vitamin Help Program that gives meals stamps, and different help applications.

Different social providers could also be gummed up within the course of as a result of many staff additionally deal with functions for different applications. As well as to Medicaid, staff for Kentucky’s Division for Group Based mostly Companies deal with SNAP and youngster care help functions.

Shopper advocates who join individuals to safety-net applications fear that an overwhelmed workforce received’t have the opportunity to sustain.

“It’s going to be a lot of work for everybody,” mentioned Miranda Brown, who helps individuals apply for advantages as outreach coordinator for the Kentucky Equal Justice Center, a authorized assist group.

Brown mentioned she just lately referred to as a state workplace on behalf of a consumer towards the tip of the day. She waited on maintain for an hour solely to be informed by a caseworker that the company couldn’t course of any extra instances that day.

“I even have a [phone] line that I get by way of sooner than a client calling for themselves,” she mentioned. “If it’s exhausting for me, it’s very exhausting for shoppers who’re attempting to name on their lunch break at work.”

South Carolina deliberate to rent “a couple hundred staff” starting this spring to assist handle renewals on the finish of the general public well being emergency, mentioned Nicole Mitchell Threatt, deputy director of eligibility, enrollment, and member providers on the Division of Well being and Human Companies. The turnover charge amongst eligibility staff was about 25% from July 2020 to June 2021, leaping from a 15% charge within the earlier 12 months.

In Missouri, Dolce mentioned her division hopes a just lately authorized pay enhance will assist recruit extra staff and enhance employees morale and retention. The division is being sued over delays in enrollments for SNAP advantages, which it additionally oversees.

Kim Evans, director of the Missouri Division of Social Companies’ Household Help Division, informed the state Medicaid oversight committee in February that her division was providing extra time and he or she was even providing to purchase pizza to pace up the processing of functions. However the division is enrolling fewer than 3,000 individuals per week, leaving tens of hundreds ready and delaying their care.

Within the suburbs of Kansas Metropolis, Missouri, Stacey Whitford, 41, utilized in December for Medicaid for herself and her 13-year-old son. Her son wants listening to aids that she mentioned price $2,500 apiece with out insurance coverage. She additionally lined up a help employee for the boy, who has autism, by way of the Division of Psychological Well being however mentioned she was informed the employee can start solely as soon as her son is enrolled in Medicaid.

“It’s similar to hanging a golden ticket proper in entrance of your face and saying, ‘Right here it’s, however you may’t contact it,’” she mentioned in early March.

Whitford spent hours on the telephone attempting to kind out the standing of their functions, then on March 31, simply shy of 4 months after making use of, they have been lastly authorized.

Stacey Whitford utilized for Medicaid for herself and her son in December. He wants the protection for listening to aids however the household had to wait months earlier than lastly being authorized on the final day of March. “It’s similar to hanging a golden ticket proper in entrance of your face and saying, ‘Right here it’s, however you may’t contact it,’” Whitford mentioned in early March as their wait neared 100 days.(Christopher Smith for KHN)

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

However Elliott, the mom of 4 in Salem, remains to be ready. She gave up calling the state’s Medicaid helpline after rising annoyed from spending hours on maintain and being disconnected as a result of of excessive name volumes. As an alternative, she checks on her software by way of the enrollment specialists on the clinic the place she utilized.

She was despatched house from the ER with ibuprofen and Tamiflu and has but to see a invoice. If her Medicaid software is authorized, her protection can be backdated to the month she utilized, seemingly overlaying her ER journey. But when her software is rejected, that price can be added to her medical debt, which Elliott estimates is already tens of hundreds of {dollars}.

“It makes me really feel prefer it’s a joke,” Elliott mentioned of Missouri’s enlargement of Medicaid. “Like they’re simply throwing it on the market to get all these individuals to apply for it, however they’re not going to actually assist anyone.”

Bram Sable-Smith: [email protected], @besables

Rachana Pradhan: [email protected], @rachanadixit