Feds ‘deeply alarmed’ as more Texas kids lose Medicaid than any other state

Xavier Becerra wrote a letter to Gov. Greg Abbott on Monday urging Abbott’s administration to make sure that children who are eligible for Medicaid health insurance are not mistakenly removed from the program. All states in the U.S. are in the process of what’s known as the Medicaid “unwinding,” in which they check every person who received Medicaid health insurance during the pandemic to see whether they still qualify for the program. In Texas, almost everyone who qualifies for Medicaid is a child, a pregnant or postpartum mom, or a person with a disability.

In a statement Monday, a press officer for Texas Health and Human Services said the state has been working closely with the federal government throughout the unwinding process, and noted that the process was a “massive undertaking.”

The press officer, Tiffany Young, said the state’s unwinding plan started with Texans least likely to be eligible for Medicaid, like children who had turned 19 during the pandemic.

“This thoughtful approach meant most disenrollments occurred within the first six months of the unwinding process,” Young said in a statement. “HHSC is committed to ensuring that those qualified for benefits receive them.”

A spokesperson for Abbott’s office did not immediately respond to a request for comment.

In Texas and other states, advocates have said the speed with which children have been removed from Medicaid could mean that kids who qualify are being removed unnecessarily. Of the 2.6 million Texans that the state has already reviewed for eligibility, 37% were denied Medicaid for procedural reasons, according to data the state released in November. Procedural reasons include failing to respond to the state’s letters asking for information or failing to provide the requested information on time, meaning that some of those denied might still be eligible.

“State choices matter, and Texas chooses to make it harder than it needs to be to keep kids covered,” said Stacey Pogue, a senior policy analyst with Every Texan.

Becerra wrote letters to Texas and eight other states that had unusually high numbers or rates of children losing Medicaid. In Texas, more than 909,000 children have been removed from the Medicaid program since April, according to the state’s most recent data. That’s more than any other state in the U.S. Becerra’s letter, which uses less recent data, noted that as of September, almost one out of every four U.S. children who has lost Medicaid insurance was a Texan.

It’s unclear how many of the children removed from Medicaid have gotten health insurance coverage elsewhere. Without health insurance, children could go without necessary care, experts said.

Young, the HHSC officer, said that the net decline in Medicaid’s caseload—which dropped by 15% as of September—was not unexpected given that the caseload increased by 50% during the pandemic.

In Tarrant County, the unwinding process affects almost 400,000 people who receive health insurance from public programs. More than 75% of county residents who had Medicaid health insurance as of April were under 21, according to state data.

Advocates for children’s health said Texas’s plan for checking eligibility was flawed for multiple reasons. In particular, they say Texas hasn’t done enough to use its existing sources of data, like income data from the Texas Workforce Commission or the Supplemental Nutrition Assistance Program, to verify whether someone still qualifies for health insurance. These systems, known as “ex parte” or automatic renewals, vary by state. In Texas, just 2.7% of renewals were done automatically, compared to a nationwide average of 30%. If the state were to use the data it already has, Pogue said, it could determine whether a child is eligible even if paperwork gets lost in the mail or their parents fill it out incorrectly.

Improving this process, Pogue said, would lessen the backlog of Medicaid and SNAP applications the state is currently working through.

Texas has already started the reviewing the majority — 79% — of the 6 million Medicaid cases it plans to review. Moving forward, Pogue said the state could take steps to make it easier for families to keep their Medicaid health insurance if they still qualified for it.

Becerra’s letter recommended several steps Texas could take to keep more children enrolled in health insurance coverage, including expanding Medicaid so that more people could qualify for it. Texas is one of 10 states that has decided not to expand Medicaid so that more adults could receive health insurance. Texas has the highest number and rate of uninsured residents in the nation.

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