Over 333,000 Missourians Lost Medicaid Due to Paperwork Issues
Nearly 92% of the 333,000 Missourians who lost Medicaid coverage were dropped due to paperwork problems, not because they were actually ineligible for benefits.
JEFFERSON CITY, MISSOURI — More than 333,000 Missourians lost their Medicaid coverage between January 2025 and February 2026, with nearly 92% of those terminations resulting from paperwork problems rather than actual ineligibility, according to new federal data.
The U.S. Centers for Medicare & Medicaid Services reported that 333,265 Missouri residents lost coverage during the 14-month period. Of those cases, 91.9% were classified as procedural terminations, meaning the Missouri Department of Social Services could not verify continued eligibility due to missing forms, incomplete information or other administrative issues.
Healthcare advocates express growing concern as Missouri prepares to implement federal Medicaid work requirements and twice-yearly eligibility reviews starting January 1, 2027. The new mandates were included in legislation known as the One Big Beautiful Bill that was signed last year.
New Federal Rules Could Worsen Problems
A recent federal rule change may compound existing paperwork challenges in Missouri’s Medicaid system. The Centers for Medicare & Medicaid Services last week narrowed exemptions from work requirements for people classified as “medically frail,” a category advocates had hoped would protect individuals with serious illnesses that prevent them from working.
Under the new guidelines, other exemptions can be met simply by meeting certain criteria, such as recent incarceration or receiving substance abuse treatment. However, the medically frail exemption now requires states to determine both that someone has a qualifying condition and that it “significantly impairs the individual’s ability to comply” with work requirements.
Cancer Patients Face Additional Barriers
Emily Kalmer, a lobbyist for the American Cancer Society Cancer Action Network, said she worries cancer patients will lose coverage under the stricter requirements. The additional documentation needed for medical exemptions could create more processing delays and procedural terminations statewide.
Legal advocates report that clients’ cases are sometimes automatically terminated even when they submitted their Medicaid renewal paperwork on time. The procedural terminations occur when the state cannot process applications or renewals within required timeframes, regardless of whether recipients remain eligible for coverage.
The work requirements will apply specifically to adults covered through Missouri’s Medicaid expansion program. Advocates had already raised concerns that eligible Missourians might lose coverage due to paperwork they never received, could not understand, or that state systems failed to process properly.
Missouri’s high rate of procedural terminations mirrors national trends as states work through post-pandemic eligibility reviews. The federal government had paused routine Medicaid eligibility checks during the COVID-19 public health emergency, leading to a backlog of cases requiring review once normal operations resumed.
