Missouri fails to fulfill Medicaid reporting law

JEFFERSON CITY, Mo. -- Missouri's social services agency has failed to publish a list of employers who have significant numbers of workers on Medicaid -- a violation of both a state law and a gubernatorial order.

The department acknowledged that its first report on Medicaid in the workplace falls short of the law's requirements. But a spokeswoman said that because of the way it gathered its data, the agency would have violated a federal regulation had it named specific employers.

In 2006, Gov. Matt Blunt ordered the Department of Social Services to produce a quarterly report, beginning in summer 2008, of each employer with 50 or more employees or their family members receiving benefits from the government-run Medicaid health care program.

A 2007 state law contained the same order.

But the department's first report includes only general numbers. It states that 589 companies employ at least 50 people each who either receive Medicaid benefits themselves or have a spouse or child who does so. The report says 9.4 percent of the work force for those companies were families on Medicaid.

But the report does not identify any of those companies by name, even though that was the first criterion listed in both the law and executive order.

The report is dated July 31 and was posted on the department's website without any publicity.

Asked about the report Tuesday, a Blunt spokeswoman said it falls short of the governor's expectations.

"Clearly they have a lot of work to do on the report," said Blunt spokeswoman Jessica Robinson. "We would expect subsequent versions would have additional and greater details."

State Sen. Tim Green amended the reporting requirement to a 2007 bill that renamed Missouri's version of Medicaid as "MO HealthNet" and placed a greater emphasis on preventive health care.

Green had intended to use the report to push for greater private health care requirements on employers who receive public tax incentives for their developments. By not naming any specific employers, the department "defeats the purpose" of the report, said Green, D-St. Louis.

To compile its report, the Department of Social Services relied on a database of employers and employees maintained by the state Department of Labor and Industrial Relations for unemployment benefits. Employers could not be named, because federal regulations do not allow public disclosure of confidential information from such databases, said Jan Carter, an assistant to the social services director.

Carter said the department will look for a different means of compiling its data that will allow specific businesses to be named in future reports.

"This is the first time we've had to put this report out, and this was the easiest way to do it," Carter said. "Once we found out it was confidential and couldn't be used, we knew we had to come up with something else. We want to be in compliance with the law."

Missouri is one of several states with laws requiring the publication of employers with workers on Medicaid.

Illinois issued a report in October 2006 that similarly failed to include the names of any employers with workers on Medicaid, likewise citing federal confidentiality requirements for labor department data. Unlike the Missouri law, the Illinois Medicaid reporting statute included an exception if it clashed with federal requirements. But Illinois has not published any subsequent annual reports.

Others states have listed specific businesses.

Massachusetts relied on employer-employee data from its revenue department to help identify 1,474 employers with at least 50 workers who received publicly subsidized health coverage. In May, it published a top 25 list of such employers. Wal-Mart led the way with 5,021 employees on public health care but the Commonwealth of Massachusetts was third with 3,320 such employees.

In January, Rhode Island published a list of 256 employers that had at least 50 employees who received public health benefits. Wal-Mart also topped that list, with 1,343 Rhode Island workers receiving public health benefits. Along with numerous other private businesses, the list included the U.S. Postal Service, the state of Rhode Island and various cities.