HHSC Whistleblowers Release New Letter as Doggett & Texas Democrats Urge Biden Administration to Audit Medicaid Program, Pause Coverage Terminations

WASHINGTON, Sept. 21 -- Rep. Lloyd Doggett, D-Texas, issued the following news release on Sept. 20, 2023:

U.S. Representative Lloyd Doggett (TX-37) and the entire Texas Democratic delegation have renewed their urgent request that the Biden Administration pause procedural terminations of Medicaid coverage until a comprehensive audit of the Texas Health and Human Services Commission's (HHSC) faulty system is conducted and brought into full compliance with federal law. Just after this request, a third whistleblower letter from HHSC staff was forwarded to Governor Abbott, who has remained silent about his Administration's failures throughout the Medicaid redetermination process. This letter expresses deep concern about significant procedural delays and erroneous coverage denials.

Since April, nearly one million Texans, including thousands of children, pregnant and postpartum women, and seniors, have lost access to a family physician and lifesaving medication. Many of these coverage losses are preventable and the result of unidentified HHSC errors. With an additional one million Texans currently undergoing eligibility redetermination, it is essential that the Centers for Medicare & Medicaid Services (CMS) intervene swiftly to prevent more erroneous denials of health care.

"Under Governor Abbott's direction, hundreds of thousands of Texans have lost vital health care coverage. And many first learn about their loss when a health care provider turns them away," said Rep. Doggett. "The Biden Administration has the authority and responsibility to enforce federal law and protect Texans from further catastrophic denials until this deficient state system is fully corrected. CMS must hold Abbott and HHSC accountable for jeopardizing the health of vulnerable Texans and prevent future erroneous denials of care for children, pregnant women, seniors, and those with disabilities."

"Until CMS acts," Doggett continued, "Texas will continue to lead the Nation in disenrollment rates under Abbott's indifferent leadership."

"Many of these coverage losses likely result from the failures in Texas's ex parte renewal process, which requires States to consult available data from other public benefits programs and automatically renew Medicaid coverage for those deemed eligible. Only 2.4% of all beneficiaries slated for redetermination received a coverage renewal through the ex parte process...Texas's shockingly low ex parte renewal rate, the second worst in the Nation and less than one-tenth the national average, demonstrates a clear failure to comply with federal law." the Members wrote.

Whistleblower reports from HHSC staff have detailed multiple concerns and violations in the State's Medicaid redetermination process, resulting in thousands erroneously denied coverage. Recently, an error in the ex parte renewal system resulted in 24,000 children losing coverage when they should have been enrolled in the Texas Children's Health Insurance Program (CHIP).

On August 22, Doggett and the Texas Democratic delegation first called on the Biden Administration to quickly intervene ahead of the September 9th notice to another cohort of beneficiaries--children, seniors, and individuals with disabilities.

The latest whistleblower report can be viewed here (https://doggett.house.gov/sites/evo-subsites/doggett.house.gov/files/evo-media-document/govenor-abbott-you-must-take-action-now.pdf) and past reports can be viewed here (https://doggett.house.gov/sites/evo-subsites/doggett.house.gov/files/evo-media-document/hhsc-employee-email-medicaid-redeterminations-7.25.23.pdf) and here (https://doggett.house.gov/sites/evo-subsites/doggett.house.gov/files/evo-media-document/more-issues-and-challenges.pdf).

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September 19, 2023

To: Chiquita Brooks-LaSure, Administrator, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244

Dear Administrator Brooks-LaSure:

In follow-up to our initial August 22nd request to which we have yet to receive a response, we write to express our strong, continued concern regarding the State of Texas's violation of federal Medicaid rules and obstruction of health care access for hundreds of thousands of Texas children, pregnant and postpartum women, cancer patients, seniors, and individuals with disabilities. Vulnerable and marginalized Texans are being denied access to a family physician, essential medications, maternity and postpartum care, mental health treatment, and more--endangering their lives and financial wellbeing. To protect beneficiaries, it is imperative that CMS intervene and require a pause on procedural terminations until Texas's faulty system undergoes a comprehensive audit and is brought into compliance.

With errors continuously discovered after beneficiaries have already lost their coverage, it is insufficient to conduct a narrowly focused audit or permit Texas to continue procedural terminations prior to the completion of an audit and all corrective actions. Such an audit should be conducted by federal personnel who are granted complete access to Texas's IT system and test all coverage groups and aspects of the renewal application. While CMS has worked with the State to restore coverage for most of the first 100,000 people identified who lost coverage in error, it took months to complete and the resulting disruptions were devastating for families cancelling necessary health care appointments throughout the summer. It is also unclear how many more consumers may have been erroneously terminated from the program. Just last week, the State acknowledged a new error was discovered in the ex parte renewal system that resulted in 24,000 children losing coverage instead of being placed into CHIP. These errors warrant swift federal intervention and a pause to ensure corrective action.

To date, nearly one million Texans have lost health coverage, more than twice the number of patients in any other state. About three-quarters (74%) of these denials of care were for procedural reasons, not due to a determination of actual ineligibility. Outrageously, Texas has terminated coverage for 69% of all beneficiaries who have undergone the redetermination process. This is the highest disenrollment rate in the Nation and only eleven other states have terminated coverage for more people than they have renewed.

Many of these coverage losses likely result from the failures in Texas's ex parte renewal process, which requires States to consult available data from other public benefits programs and automatically renew Medicaid coverage for those deemed eligible. Only 2.4% of all beneficiaries slated for redetermination received a coverage renewal through the ex parte process. Federal law requires that each State must "to the maximum extent practicable establish, verify, and update eligibility using...data matching...and determine...eligibility based on reliable, third party data." Texas's shockingly low ex parte renewal rate, the second worst in the Nation and less than one-tenth the national average, demonstrates a clear failure to comply with federal law.

In North Carolina, a state that has also not yet expanded Medicaid eligibility, 79% of all beneficiaries who have undergone redetermination were renewed through the ex parte process. Two other non-expansion states have also met or exceeded the national average. All non-expansion states have an ex parte renewal rate over 10% except for Texas, Kansas, and Wyoming. It is clear that Texas's highly restrictive eligibility criteria is not the sole basis for its very poor redetermination outcomes. It is imperative that CMS pause procedural terminations in Texas until the ex parte renewal system is audited and corrected to comply with federal law.

Despite our previous request to you that CMS act to protect the health of so many, approximately one million notices were mailed on September 9th for a third cohort of Texans to begin the redetermination process. The State believes these vulnerable beneficiaries remain eligible for Medicaid, but unless you intervene to ensure Texas's faulty system is corrected, they will likely face the same devastating health care denials that nearly one million other Texans have already received since April.

To prevent more disastrous coverage losses and protect the health and due process rights of our many economically disadvantaged neighbors, we urgently request your intervention and an immediate pause of procedural terminations in Texas. A thirty-day extension for beneficiaries to complete paperwork does not fix the many IT issues continuously being discovered as more Texans are erroneously denied health care.

It is imperative CMS begin formal enforcement proceedings without delay to ensure procedural terminations are halted until Texas's system is thoroughly investigated and corrected to comply with federal law, including ensuring compliance with ex parte renewal requirements. A few phone calls are completely insufficient as coverage hangs in the balance for one million Texans, the vast majority of whom are children and disproportionately from communities of color. Please act now. We stand ready to work with you, the State of Texas, and any willing partner to promote health equity and protect health care access.

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Original text here: https://doggett.house.gov/media/press-releases/hhsc-whistleblowers-release-new-letter-doggett-texas-democrats-urge-biden