Luebbering noted that the state’s food stamp program, known as SNAP, also saw a significant decrease in enrollment last year. He said the decline in both programs indicated there was an environmental effect on enrollment.

“If we saw a 70,000 drop in (Medicaid) and I saw nothing in SNAP, we would be having a different conversation,” he said. “The problem is, we saw a 50,000 caseload drop in SNAP that has nothing to do with the new (Medicaid alert) system.”

McBride said he struggled to accept the financial explanation, noting that other states did not have as significant an enrollment drop despite their healthy economies. He pointed to Tennessee as the only state with a bigger drop-off — topping Missouri’s reduction with a 9 percent decline.

Luebbering added that the Missouri department had not sent out annual renewal letters to all Medicaid recipients since about 2015. Part of the drop-off could be credited to the state’s need to catch up for those few years. Other states already had automated systems in place.

McBride pushed back, asking Luebbering how sure he was that all 70,000 Missourians who were no longer enrolled didn’t need Medicaid anymore.