Medicaid is a health care safety net. It shouldn’t be yanked out from under those who need it most, yet that’s what is happening in Texas, which already has the highest rate of uninsured in the nation.
More than a half-million Texans —mostly children, young adults and new mothers—have lost their Medicaid coverage since April 1, when a COVID-19 public health emergency allowing for extended Medicaid eligibility came to an end. Of that staggering number, 450,000 have been dropped for procedural reasons such as missed notifications from the state, incorrect documentation, failure to renew on time and difficulty navigating the state’s cumbersome technology platforms.
It’s unclear exactly how many of those were ineligible, but an anonymous letter written in late July by employees of the Texas Health and Human Services Commission, which manages the state Medicaid program, claimed about 80,000 eligible Texans had lost coverage erroneously, according to the Quorum Report and the Texas Tribune.
Last week, the federal Centers for Medicare & Medicaid Services sent the state a letter sounding alarms about its high rate of disenrollments. The letter also warned that people of color are especially at risk of losing coverage because they are less likely to have broadband or internet access, or transportation or jobs that permit Medicaid office visits to help them navigate there-enrollment bureaucracy. The federal agency suggested bolstering call center staffing to reduce problems in the re-enrollment process.
Making matters worse, Texas has been slow to automatically renew eligible Medicaid recipients using existing records such as state payroll and welfare data. Virginia has managed to re-enroll 66% of its eligible Medicaid clients this way. Texas has done so in less than 1% of its cases.
Medicaid disenrollment problems were foreseeable
The debacle exacerbates a public health crisis largely of the state’s own making, considering the federal government gave states more than a year to prepare for reducing its Medicaid rolls.
When children, new mothers and vulnerable patients lose health insurance, they often miss out on the medications, therapies, and other medical care they need. Delayed or skipped treatments can make conditions worse and lead to higher health care costs for taxpayers who foot the bill for the uninsured. Massive Medicaid coverage losses on the scale happening now also put heavy stress on the state health care system. Hospitals, physicians, community health centers and other providers still trying to recover from the COVID-19 crisis now deal with more patients who can’t pay for the care they need without Medicaid.
The Editorial Board urges HHSC to pause its disenrollment process immediately to ensure that as many Texas as possible who qualify to stay on Medicaid get a chance to renew before they are dropped. If the state won’t hit pause, then the federal government should demand it, as it has already done in at least six other states struggling to manage the transition. HHSC should also update its website, YourTexasBenefits.com, to clearly state when a Medicaid enrollee’s benefits are set to expire.
Texas’ high percentage of procedural denials raises red flags, said Diana Forester, director of health policy of the children’s health advocacy group Texans Care for Children.
“It means that the process is not working properly, whether the state is sending renewal information to the wrong mailing addresses or parents are running into bureaucratic delays with the state when they try to renew their children’s health insurance,” Forester said in a statement.
Legislature shortchanged funding to manage Medicaid dilemma
The 88th Texas Legislature that concluded in May provided just $111 million of the $143 million that HHSC asked for to help support additional staffing and outreach, technology upgrades, and other support to handle the transition, according to Texans Cares for Children. And though HHSC has boosted pay to help add and retain staff, that clearly hasn’t solved the problem.
Under federal rules, Texas has until April 2024 to ensure those who are eligible for Medicaid coverage continue to get it. Some of those being dropped are, indeed, ineligible. But until the state gets a better handle on who qualifies for Medicaid and who doesn’t, it should slow down the purging of the rolls and improve re-enrollment processes to avert an even greater uninsured crisis in Texas. Our state’s most vulnerable children, young adults and new mothers are depending on it.
Austin American-Statesman
