The U.S. Department of Health and Human Services declared a public health emergency in response to the COVID-19 virus in January 2020, and in March that year, federal legislation was passed to maintain Medicaid coverage for people regardless of eligibility. During that period, the number of people in Texas on Medicaid grew from 3.9 million to approximately 6 million.
A majority of the people taken off Medicaid, more than 988,000, were removed due to procedural issues. Procedural denials often occur when Texas’ Health and Human Services Commission, which manages Medicaid for the state, doesn’t have enough information to determine eligibility for coverage. Those who were denied for procedural reasons can submit requested information to the state to have their coverage recertified.
Meanwhile, another 557,000 Texans were determined to be ineligible for Medicaid and didn’t have their benefits renewed.
Stacey Pogue, senior policy analyst for the advocacy group Every Texan, told KERA that many people are having trouble keeping their Medicaid coverage because they’ve never had to renew it before. “We have a lot of parents who are trying to jump over every barrier in the system, and sometimes it’s just too hard with too many pitfalls for some parents to make it through,” Pogue told the station.
The state uses a variety of ways to determine Medicaid eligibility. It can send letters to people in the mail or cross-reference federal databases. Some people’s coverage can be auto-renewed by using other state data, such as SNAP, Social Security, state wages and DMV records. While automobile registration renewal is one of the strongest tools states have to keep eligible people enrolled in Medicaid, according to the Centers for Medicare & Medicaid Services, only about 10% of those who retained their benefits in Texas did so through that channel.
Pogue put out a joint statement about the “unwinding” with Cover Texas Now!, a coalition of consumer and faith-based organizations whose goal is to have the state implement a sustainable health care system and provide quality affordable health coverage to Texans.“Texas leaders keep falling behind when it comes to making sure eligible kids are able to sign up without delay for the health care they need.” – Stacey Pogue, Every Texan
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“Just like before the pandemic, Texans with Medicaid health insurance have either proven they qualify or submitted paperwork that’s stuck in the state’s backlog,” Pogue’s statement said. “Texas leaders keep falling behind when it comes to making sure eligible kids are able to sign up without delay for the health care they need.”
According to Cover Texas Now!, data from the state’s Health and Human Services Commission shows that Texans, including children who may have been mistakenly removed from Medicaid, are stuck waiting months for the state to process their Medicaid applications. Some 39% of Medicaid applications processed by the state last month were delayed beyond the federal 45-day standard for timely completion.
As of last month, about 150,000 families had been waiting more than 45 days for their application to be processed. Additionally, the state has yet to process more than 48,000 Medicaid applications submitted during or before March of this year.
That’s why the coalition is pushing for state leaders to take action. According to Cover Texas Now!, the governor, Legislature and Health and Human Services Commission should take steps to immediately reduce the Medicaid application backlog. They should also work to ensure families can get in touch with eligibility staff. This can be done by adding night and weekend hours at local offices, through calling 211 and by improving the 211 call system.
In the longer term, the state should increase the use of auto-renewals for Medicaid and remove unintended barriers that families face when they try to apply for Medicaid or renew their coverage, the group said. Specifically, advocates believe the state should invest in upgrading its technology within the Texas Medicaid eligibility system, the 211 call system and the YourTexasBenefits website and app. Investment in community partners that are helping Texans enroll in Medicaid and providing more money toward maintaining stable, experienced state eligibility workers are steps that Cover Texas Now! believes are needed sooner than later.
Sen. Nathan Johnson, a Dallas Democrat, has filed several bills to expand Medicaid in Texas, including one that would have established an express lane to eligibility.
Johnson told the Observer the most direct way to expand Medicaid is through a “state plan amendment.” This would be a simple, statutory directive requiring the Health and Human Services Commission to expand Medicaid in accordance with the Affordable Care Act. This would cover Texans with income up to 138% of the Federal Poverty Line.
However, recognizing the challenges of the state’s current political environment, Johnson filed legislation that could expand Medicaid in three other ways: The state could let voters decided through a constitutional amendment; it could direct the Health and Human Services Commission to maximize Medicaid dollars, which can be done only through expansion; and lastly, Johnson said, he filed his Live Well Texas Plan, which would expand health insurance coverage, promote personal responsibility and reduce healthcare costs by investing in preventative care.
However, the senator added, expanding Medicaid alone won’t solve the state’s uninsured issues or the issues with the unwinding process. Expanded eligibility should come with clear processes, the workforce to accommodate that expansion and funding to ensure there aren’t any delays in applications and access to benefits. He also filed legislation to streamline the application process by using already verified income information to create eligibility for an "express lane." This process is currently being used only for people renewing their coverage, not new applicants.
“I think the state hasn’t committed enough resources in terms of people or systems to [the Health and Human Services Commission] and we should," Johnson said. If the state provided more resources to the commission, Johnson noted, "They would be better able to deal with crises like this."
