When the coronavirus pandemic emerged in March 2020, the U.S. government issued a requirement that states could no longer kick people off Medicaid during the public health emergency. The purpose was to prevent people on Medicaid—a government-run health care policy—from being left without insurance on short notice.

That requirement is still in place two years later, but health care advocates in Texas and Houston said they are worried about what could happen when it ends and millions of people have their safety nets put into jeopardy.

In September, the Urban Institute, a Washington, D.C.-based think tank, estimated as many as 1.3 million Texans could be deemed ineligible for Medicaid once the public health emergency ends. Roughly 3.7 million of the 5.3 million Texans enrolled in Medicaid will have their eligibility redetermined once the emergency ends, according to the Texas Health and Human Services Commission. Roughly 73.2% of Texas Medicaid enrollees are children, according to the latest HHSC data.

“Our main concern is you are looking at huge numbers having to reapply, and that’s going to take a lot of time to go through,” said Brian Sasser, chief communications officer with the Houston-based Episcopal Health Foundation, which works with health care nonprofits across Texas.

The pandemic also highlighted a debate that has been ongoing since 2010: whether the state should expand Medicaid to cover more people. ••State Rep. Cecil Bell, R-Magnolia, said he does not plan on focusing on Medicaid in the upcoming legislative session, as legislators have previously taken steps to provide alternative solutions for Texans, such as increased funding for local health care, expanded private sector insurance options and additional affordable prescription options.

“The feds have not maintained funding levels in the states, which previously expanded Medicare, creating economic challenges for those states and their citizens,” Bell said.

State of Medicaid

The public health emergency was still in place as of June with an expiration date of July 15. However, the government also requires a 60-day notice before Congress can allow the emergency to expire. That notice was not given May 15, meaning the emergency is likely to be extended into October, according to the Center on Budget and Policy Priorities, a group that analyzes federal and state budget policies.

In Montgomery County, the number of people enrolled in Medicaid hovered around 58,000 prior to the pandemic in 2019. Since then, the county rolls grew to 83,859 as of the most recent confirmed data from October. In Harris County, enrollment grew from about 680,000 in 2019 to 808,567 in October.

When the public health emergency ends, a portion of Medicaid enrollees will have their coverage automatically renewed if they are deemed eligible. There will also be an unwinding period of up to 12 months during which states are to work with individuals who were not automatically re-enrolled to help them keep their coverage if they are still eligible.

For states to succeed, they will have to focus on streamlining the application renewal process and communicating effectively with enrollees, said Farah Erzouki, senior policy analyst with the CBPP.

“These steps will be key to make sure people can be reached, that they know what changes are coming and they know what they need to do to keep their coverage,” Erzouki said during a May 18 press briefing.

Kayli Thompson contributed to this report.