Over 2 million Texans have lost their health care coverage since the state began reviewing Medicaid eligibility in April 2023. This includes around 1.3 million children—more people than the entire population of Austin.
During the height of the COVID-19 pandemic, nearly 6 million Texans had consistent access to health care through Medicaid, as federal regulations prohibited states from stripping coverage. Texas began checking eligibility and removing people from Medicaid last April.
The state- and federally funded program provides health insurance for certain low-income Texans, including children, pregnant and postpartum women, people with disabilities, and seniors.
What you need to know
Nearly 74% of the children removed from Texas Medicaid rolls through March 11 were cut for procedural reasons—meaning the state did not have enough information to confirm the child’s eligibility—the Texas Health and Human Services Commission reported. Many of these children are likely still eligible for coverage, said Joan Alker, the executive director of the Georgetown University Center for Children and Families.
“This means that the renewal process has broken down in some way,” Alker told reporters May 2. “Perhaps the renewal letter got lost in the mail or a family has trouble completing the paperwork, the state's computer system is not determining eligibility, ... or the notices the state sends are too complicated to understand, especially for families for whom English may not be the parent’s first language.”
Texans are notified at least 10 days before their Medicaid coverage ends, according to an HHSC spokesperson.
Texas has removed more children from Medicaid than any other state during the Medicaid “unwinding” process, according to a new Georgetown University report. Nationwide, 4.16 million children lost Medicaid coverage from April-December 2023.
“Children and very poor parents, mostly women and new mothers, are at the heart of who's losing Medicaid,” Alker said.By the numbers
The state reported limited use of the “ex parte” renewal process, when an automated system determines Medicaid recipients’ eligibility using tax information and IRS data. Around 10% of all Medicaid renewals and 12% of children’s renewals were done automatically, the HHSC reported.
All other renewals were completed manually. The HHSC has added over 2,100 staff to help with the renewal process in the past year and is training 600 existing employees, according to information shared with Medicaid stakeholders April 8.
"We have also leveraged technology and contractor support as well as strengthened staff training to respond to the increased workload," HHSC spokesperson Tiffany Young said in an emailed statement. "We are actively working on additional opportunities to further streamline and automate our eligibility processes."As of March 29, the state was processing Medicaid applications in about 88 days, resulting in a backlog of 208,129 applications, state numbers showed. Applications for the Supplemental Nutrition Assistance Program were processed in about 42 days with 89,694 applications awaiting processing.
“The state's low rate of data-driven renewals over the past year and the long delays that Texas families are running into when they apply for Medicaid are symptoms of an outdated enrollment system that the Legislature needs to modernize,” said Diana Forester, director of health policy for the nonprofit Texans Care for Children, in a statement. “It's 2024, but applications and renewal forms that Texans fill out online still must be re-entered into the system manually by eligibility staff.”
What they’re saying
Texas already had the country’s highest rate of people without health insurance—16.6% of Texans—before Medicaid unwinding began, according to 2022 data from the U.S. Census Bureau.
“Because states run Medicaid and [the Children's Health Insurance Program], the nation's governors, and to some degree, their legislators, but primarily the governors, are ultimately responsible for how millions of children are faring during this process,” Alker said.
Dr. Kimberly Avila Edwards, an Austin pediatrician, said the impacts of Medicaid unwinding are “painfully visible” to pediatricians every day.
“Families are foregoing vital care for their children and teens for fear of financial devastation. Parents are checking in for their child's appointments, only to learn that child is no longer covered,” said Edwards, who is also a professor at Dell Medical School at The University of Texas.
Patients who experience gaps in health coverage are more likely to experience delayed medical care, unmet medical and mental health needs, and unfilled prescriptions, Edwards said.
“This in turn exacerbates medical issues and can force families into situations where they must decide whether to pay for out-of-pocket emergency care at the expense of groceries and other necessities,” Edwards said. “Medicaid is not a luxury—it's a vital program for tens of millions of children, their families and their communities. It provides lifesaving access to care for our nation's most vulnerable kids, especially those with special needs.”
One more thing
Texans without health insurance can visit federally qualified health centers, or FQHCs, which offer medical care regardless of insurance coverage or a patient’s ability to pay. There are 73 FQHCs located across 126 Texas counties, according to the Texas Association of Community Health Centers. These centers may offer medical, dental and behavioral health care; pharmacy services; and other support for patients.
According to the HHSC, Texans who do not qualify for Medicaid may be eligible for other state programs, including:
- The Primary Health Care Program, which provides primary care services at clinics across the state
- Healthy Texas Women, which offers free women’s health and family planning services
- Local mental and behavioral health authorities, which charge for services based on a patient's ability to pay
- The Texas HIV Medication Program, which helps low-income Texans access medications to treat HIV and related complications
To appeal a decision about their Medicaid coverage, Texans can visit a local eligibility office; call 211 and select option 2; or mail a letter to the Texas Health and Human Services Commission, P.O. Box 149027, Austin, TX 78714-9027.
To apply for Medicaid and other benefits, submit renewals, respond to requests from the HHSC and more, Texans can visit www.yourtexasbenefits.com.
"Texas has from April 1, 2023 to May 31, 2024 to initiate and complete redeterminations for all 6 million people enrolled in Medicaid and CHIP as of March 31, 2023," Young said. "We will continue to process applications as quickly as possible to serve all eligible Texans."
