An Indiana company hired to determine the eligibility of Missouri Medicaid patients for in-home care has instead "been a complete disaster from the beginning," statewide health care advocates charged on Tuesday.

Indianapolis-based SynCare LLC won a state contract in February to assess whether Missouri's 55,000 Medicaid recipients, many of whom are senior citizens or disabled, qualify for home-based medical services or even help with cooking, cleaning and other daily chores. The contract is worth more than $5 million a year.

Several groups that represent such patients instead want the state to cancel the company's contract, which took effect in mid-May. They say SynCare has been unable to fulfill its responsibilities and is keeping needy patients from receiving vital care with comically inept customer service.

"These are not isolated incidents," said Imre Komaromi, a legislative advocate with the Independent Living Resource Center in Jefferson City. "It's something that's happening systematically, statewide."

Komaromi spoke Tuesday morning at a Columbia press conference, joined by several patients who shared stories of being made to wait on the phone for hours, seeing drastic reductions in the number of hours of care they receive or simply being ignored entirely. Similar rallies were held in Cape Girardeau, Springfield and St. Louis.

SynCare is a certified minority enterprise that helps evaluate and coach Medicaid patients at high risk for hospitalization—those with multiple chronic diseases or high-risk pregnancies, for example.

Last June, SynCare withdrew a request for a property tax abatement from the Indianapolis Metropolitan Development Commission tied to the creation of 114 jobs, citing "changing market conditions." At the time, the firm had 31 employees.

Telephone and e-mail messages to the company's Indianapolis headquarters and its Missouri offices in Ballwin both Monday and Tuesday went unanswered.

A spokeswoman for the Missouri Department of Health and Senior Services, which oversees the SynCare contract through its Division of Senior and Disability Services, said the state is taking the complaints seriously.

"We are aware of the problems SynCare has encountered in these initial months of the contract, and will continue to demand they deliver the services required by the contract," agency representative Jacqueline Lapine said in a written statement.

Troubled by skyrocketing costs in its health insurance program for low-income residents, Missouri lawmakers approved the move to third-party Medicaid eligibility screenings in 2010.

The state had previously allowed client assessments by the same organizations that ultimately provided home-care services — and saw the number of people receiving home services increase by 15 percent, while annual costs grew by one-third.

A consultant estimated Missouri could save $3.4 million annually by using an outside group to determine eligibility, which involves verifying patients' income and health conditions. But groups such as Services for Independent Living and the Missouri Alliance for Home Care say the quick-fix approach will cost the state more as patients receiving less help wind up in nursing homes rather than on their own.

Marcellus Walker, 48, said he's waited two months for SynCare to respond to his request for state services— far longer than the contractual requirement that contact be made within three days, and home visits within 15 days. He described a precarious daily balance caused by schizophrenia, multiple sclerosis and high blood pressure.

"Without (home services), we're kind of lost," Walker said. "It seems like they're just as lost as we are."

Soon after its selection as the state contractor, SynCare announced it would hire an additional 157 workers in Missouri, plus 10 in Indiana. Earlier this month, the company fired 29 employees at its Ballwin office, the St. Louis Post Dispatch reported.

Patients and advocates at the Columbia protest called the SynCare staffers unprepared, overwhelmed and poorly trained. Seventy-two-year-old Russel Hughes of Ashland described spending six hours on the phone one day trying to resolve his concerns — "And they still haven't called me back," he said.

"They don't even fully understand what it is they're doing," Komaromi added. "When you even get somebody (on the phone), they are unable to answer questions, or have no authority."