State's Medicaid cuts result in low official objection rate

The Associated Press

JEFFERSON CITY, Mo. -- The public outcry over Missouri's Medicaid cuts seemed significant -- Capitol protests, critical editorials, frequent news conferences by advocates for the poor and disabled.

But officially, the Department of Social Services reports a mere whimper of objection.

Barely 1,000 Medicaid recipients have requested hearings to challenge their cuts, and just 424 have gone through with those hearings, according to department figures. That's fewer than 1 percent of the 142,000 people whose coverage was cut off or altered because of eligibility changes signed into law by Gov. Matt Blunt.

Why the disconnect between rhetoric and reality?

Edna Olinger, of Festus, said it just wasn't worth it to appeal.

"We knew it would not come out to our favor," said Olinger, 31, a quadriplegic who since a gun accident eight years ago has depended on Medicaid to pay for a personal assistant to take care of her at home.

Olinger had been paying about $450 a month to qualify for Medicaid. Under a law that took effect Sunday changing the income eligibility threshold for the disabled, Olinger has been told by the state that she now must spend $900 a month before Medicaid coverage can kick in.

"Pretty much, I wouldn't be on Medicaid anymore because there's no way I could reach that," she said.

While Olinger is temporarily relying on the help of a friend, Alice VanDyke is still wondering how she and her husband, Jeff -- both disabled -- will pay the $1,012 monthly needed for them to qualify for Medicaid as a result of Sunday's cuts.

The VanDykes had been covered under a now-eliminated program that allowed the disabled with incomes above the traditional Medicaid cutoff to still qualify for coverage so long as they worked at least a little each month.

They used Medicaid to pay for doctor's visits and nine medications treating various ailments, as well as for Jeff's personal care attendant and medical equipment.

Alice VanDyke, 54, of Columbia, said they didn't request a hearing on their cuts because it appeared pointless.

"What the hearing would be for was to basically make sure the amount that Medicaid figured was the correct amount," VanDyke said. "Our Medicaid person (at the state office) said there wasn't any reason to do it because she knew the figures were right."

Appeal hearings review whether circumstances are different from what state workers were aware of when determining whether a person was no longer eligible for Medicaid. The low hearing rate may indicate the department's information is fairly accurate, said agency spokeswoman Deborah Scott.

The hearing rate might also appear low because some Medicaid recipients may have corrected their eligibility status after a conversation with a case worker. But Scott said no figures were immediately available about the number of people sent notification letters who were later determined to remain eligible.

Craig Henning, an advocate for the disabled, has another theory about the low number of hearing requests and the even lower number of people who show up for them. He said some poor and disabled people simply don't have a way to get to the hearings.

Still others may have been too confused to understand what was happening to them, much less how to file an official objection, he said.

A federal lawsuit contends that Medicaid cut-off notices sent earlier this year to low-income parents were too complicated to understand, using language well above the reading level of average Medicaid recipients.

House Budget Committee Chairman Brad Lager, R-Maryville, said there has been more confusion among Medicaid recipients than he had expected when the Republican-led Legislature passed the cuts earlier this year.

"I don't think that's necessarily the department's fault; I think a lot of your advocacy groups are working very hard to scare their members," Lager said.

Lager remains convinced that those most in need of medical help still will get it -- either from the government, a community group or some other source.

"If we find out there is a segment or group who has fallen through the cracks, I think this General Assembly is going to be very open to going back and looking at that, and if we find problems we're going to fix that," Lager said.

To people such as Olinger or the VanDykes, the problem already exists. They may not have officially appealed their cuts, but they still are appealing for help.

"I do have faith, and that's the thing that's got me through it as far as I have without being in a totally depressed stage," Alice VanDyke said. "I know that God will see us through it, and I just hope that Governor Blunt will listen to what we say."

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EDITOR'S NOTE: Capitol Correspondent David A. Lieb covers Missouri government and politics for The Associated Press.