Texas Medicaid Coverage Loss: Unraveling Impact on Children

Last updated Sep 19, 2023

TL/DR –

The Texas Medicaid program faces challenges due to insufficient funding and administrative hurdles, hindering eligible individuals from enrolling or renewing their coverage. The article suggests that Governor Abbott should address these issues urgently by directing the Health and Human Services Commission to resolve coding errors and reduce procedural denials.

Texans Suffer Due to Lack of Investment in Key Programs

The Texas Legislature’s inability to fully fund the HHSC’s request for temporary additional eligibility workers has impacted Texas families. The state didn’t even ask for IT system improvement funds, despite known issues that require workers to use time-consuming manual processes. The state’s agencies aren’t often encouraged to ask for vital funding. In fact, the Governor, Lieutenant Governor, and Speaker of the House often say that they cannot include inflation or other major cost drivers in budget requests.

While Texas’ Medicaid program appears to provide healthcare access to low-income kids, elderly, pregnant women, and the disabled, behind-the-scenes bureaucracy and system errors make it difficult for eligible people to enroll or renew Medicaid. National statistics suggest that 75% of kids who lose Medicaid during unwinding will still be eligible, disproportionately affecting kids of color. These bureaucratic barriers magnify racial and health inequalities. A loss of Medicaid can mean kids miss out on sports physicals, mental health visits, or asthma treatments, and can even lead to a loss of in-home nursing assistance for medically complex kids.

Urgent Action Needed from Texas Governor and HHSC Executive Commissioner

All of Texas benefits when kids across the state can access healthcare when they need it. Medicaid covers over half of all Texas children and serves as a crucial support for low-income seniors, pregnant women, and disabled Texans. However, many, especially children, are being removed from Medicaid rapidly, often without checking eligibility.

Governor Abbott can take urgent steps by pausing procedural denials while:

Ensuring HHSC has the resources and direction to fix coding issues causing wrongful coverage termination, potentially in violation of federal law.
Directing HHSC to reduce its high procedural denial rate and improve its poor ex parte renewal rate.

Failing to act quickly could disrupt federal funding. Allegedly, system coding errors have already led to the loss of federal funds, and the federal Medicaid agency can defer certain federal fund payments until unwinding issues are resolved. If Texas fails to improve its Medicaid services, the CMS should intervene to ensure Medicaid renewals comply with federal law, reduce procedural denials, and promptly process Medicaid paperwork.

Texas has many policy options encouraged by CMS to improve Medicaid renewal outcomes, which don’t require changes to state law. Texas needs leadership to take urgent action. It’s Governor Abbott’s responsibility to ensure no more eligible individuals lose Medicaid coverage.