Getting Missourians Access to Healthcare

by Gregg Lombardi - Executive Director

I’m excited to report, albeit belatedly, about the work that Stacy Schaub and others have been doing on the Legal Aid Family Support Division Work Group in regard to problems the State of Missouri has been having in processing Medicaid applications. Other members of the Work Group include: Billie Orr, Alicia Johnson, Lisa Gentleman, Jeffiner Thompson, Emily DeStefano and Abbie Rothermich.

In the last year, the State has made major funding cuts and office reorganization in the Family Support Division (known as the FSD), which processes applications for public benefits, including Medicaid, Food Stamps, and Temporary Assistance. 

Medicaid provides health insurance for low-income Missourians who are permanently and totally disabled and, because of their disability, are not capable of gainful employment. It also pays for or subsidizes health insurance for children in low to moderate income families. For thousands of low-income Missourians, Medicaid is their only viable means of accessing long-term, pro-active medical care and the prescription medications they need to bring the pain and other aspects of their maladies under control.

The FSD funding cuts and reorganization have meant that for many Medicaid applicants there is no one to talk to from the State about questions they have on their applications and no one even to give them a receipt when they submit required documentation supporting their applications. We have had many situations in which we have actually faxed in information, like an income verification to the FSD for a client only to have the FSD send the client a letter several weeks later, saying that their application has been denied because they did not provide the FSD with the birth certificate.

The FSD also has gotten much slower in processing applications for Medicaid. So, now it can take several months to get a decision back from FSD, which is a long time to wait when you have a serious medical issue. 

Because of these obstacles and others, from September 2013 through March 2014, Medicaid enrollment in Missouri dropped 3.9% (approximately 33,800 people, one of the largest drops in Medicaid enrollment in the country. While this saves the State and the federal government money in the short-term, it greatly damages the health of the people who need Medicaid and leads to major costs for the hospitals that treat people who are wrongly denied Medicaid when they have catastrophic health crises as a result of not receiving the care they need.

Stacy Schaub, who is the Supervisor of Legal Aid’s Public Benefits Team in our central office, is part of a team of Legal Aid attorneys and other staff who are strategizing on how to respond to problems in the FSD’s processing of Medicaid applications and the processing of other public benefits. 

In early August, the Missouri HealthNet Oversight Committee held a meeting in Jefferson City on the status of Missouri’s Medicaid system. At the meeting, FSD leadership testified that, although there were problems that needed to be addressed, FSD had adequate funding and staffing to handle them. Stacy provided powerful testimony at the meeting bringing to light the numerous problems that the FSD is having.

I’m very proud of the work that Stacy and the other members of Legal Aid’s FSD Task Force have done on this issue. It’s a major step towards getting lots of Missourians in need the healthcare they need and that, under the law, they deserve.

Effie Day

Gregg Lombardi - Executive Director

Effie Day

39 years and 364 days ago, a young lawyer, fresh out of law school, started as a $4 per hour attorney for Legal Aid of Western Missouri.  She was smart, fiery and full of passion about the cause.



Tomorrow marks Effie Day’s 40^th year with Legal Aid.  In those years, Effie has litigated thousands of cases protecting the rights of low-income people to access healthcare through Missouri’s Medicaid program.  As prevailing counsel in numerous appellate cases, she has, for all practical purposes, written Missouri’s Medicaid law.  As a result of her successful appeals, Missourians now have the right to challenge the denial of Medicaid and to be informed why their claim was denied (Grant v. Toan).  The state can no longer use hearsay, out-of-court statements of non-examining physicians to support a denial of benefits (Bell v. Missouri State Division of Family Services) and Missourians with disabilities can qualify for Medicaid on the basis of multiple maladies (Crudup v. Missouri State Division of Family Services).



Although she has proven herself to be a talented appellate advocate, Effie’s passion is in helping individual clients obtain the benefits they deserve under the law.  She patiently and tirelessly assists her clients, often working well into the night and on weekends.  In the last twenty years alone, Ms. Day has provided representation for over 4,200 clients, winning well over 90% of the Medicaid appeals cases that she handles.

For the last seven years, Effie has also led Legal Aid’s Medicaid Appeals Project, at Truman Medical Center.  The staff at Truman refer patients to Legal Aid who have been denied Medicaid benefits and who the staff at Truman believe should receive those benefits.  Legal Aid staff then appeal these decisions.  The project has led to over 1,400 Truman patients, who are permanently and totally disabled, receiving Medicaid benefits after having had those benefits improperly denied.  The project has also generated well over $10 million in revenues for Truman for services, which the hospital would otherwise have had to write off.

Effie Day has brought justice to thousands of people throughout the state of Missouri.  Many of her clients had never had any one fight for their rights before Effie took their case.  By steadfastly protecting her clients’ most fundamental rights, Effie has given them faith that the justice system in Missouri can work for them.  She has taken away pain and given access to basic care to them and, in doing so, has made the state a better place to live for all of us. 

For Effie, tomorrow will be like any other day here.  She’ll come to work and devote herself completely to her clients’ cause.  If you get the chance, I hope that you will interrupt Effie’s work for a moment tomorrow and thank and congratulate her for the tremendous job that she continues to do for her clients.