Texas continues to see Medicaid application delays

AUSTIN — Texas' backlog of Medicaid health insurance applications is raising concerns that eligible Texans continue to go without health care even if they qualify.

During the pandemic, Medicaid would automatically re-enroll recipients, allowing individuals to keep their Medicaid coverage even if their situations changed. That benefit ended in March following the sunset of the federal public health emergency.

Since then, the Texas Health and Human Services Commission has been working to evaluate eligibility and remove those who no longer qualify as well as enroll new applicants, but the process has been slow, said Diana Forester, director of health policy at Texans Care for Children.

A new report by the HHSC showed that the backlog is preventing families from receiving coverage in a timely manner. According to the September report, the state still had not processed 54,000 Medicaid applications submitted in or before March. The report does not indicate how many applications submitted after March are still waiting to be processed.

"Texas kids should not be stuck month after month waiting to find out if they can go see their doctor," Forester said. "When kids are eligible for health insurance and their families have jumped through every hoop the state puts in front of them, our state leaders need to make sure those applications are processed on time so kids can go to the doctor or get their medications."

The report, which is submitted to the federal government as part of the "unwinding" of pandemic-era Medicaid rules, also showed that pregnant women who were part of Medicaid for Pregnant Women — which allows qualifying women to receive free health coverage during their pregnancy — are, in many cases, not being transferred to Healthy Texas Women or HealthCare.Gov to receive coverage through other means following the end of their pregnancy-related Medicaid.

Additionally, of the 770,000 Medicaid enrollees due for renewal during August, 247,000 have not been processed yet, data shows.

"Now, the tidal wave of renewals Texas sent in the last three months is starting to hit, and backlogs for people newly applying continue to grow. Unfortunately, the harm of these delays falls on our neighbors who have to choose which bills they'll pay this month as their paperwork grows older and they wait to hear from the state whether they'll get the food and health care they need," said Karla Martinez, policy analyst at Every Texan.

According to 2021 census data, 5.2 million Texans of all ages were uninsured in 2021, representing 18% of the state's population. The state with the next highest uninsured rate was Oklahoma, with about 13.2%. The U.S. 2021 uninsured rate is 8.6%.

José Araiza, deputy chief press officer of the Health and Human Services Commission, said when HHSC determines that an individual is ineligible for Medicaid or CHIP, the Children's Health Insurance Program, it transfers that individual's account information to the federal health insurance marketplace to be assessed for eligibility for other health care coverage programs.

He said losing Medicaid or CHIP coverage is considered a qualifying event that allows an individual to enroll through the marketplace and is not limited to a specific enrollment period.

The delays are due to the "huge undertaking" of redetermining Medicaid eligibility for approximately 6 million Texans over 12 months, he said.

He said that as of this month, 74% of Medicaid applications were processed within the federal standard processing time and that Medicaid applications are taking an average of 30 days to complete.

"Due to redetermining the eligibility of 6 million Medicaid clients and the processing of an increase of SNAP (food stamp) applications, our lead time is higher than normal," Araiza said.