Thousands of Texas kids just lost their Medicaid health insurance. What does that really mean? [Fort Worth Star-Telegram]

Thousands of Texas children have lost their Medicaid health insurance since April, a sign to multiple health policy experts that some children will go without both insurance and health care in the coming months.

The state released its first report July 14 detailing the number of Texans it has determined are no longer eligible for Medicaid and CHIP health insurance programs. More than 500,000 Texans were deemed to be ineligible, according to the state's data.

"We know that it's mostly children" in that group of 500,000 people, said Diana Forester, director of health policy for the nonprofit Texans Care for Children.

The Medicaid unwinding process, as it is known, is a massive undertaking for all U.S. states. During the COVID-19 pandemic, the federal government gave states additional funding for their Medicaid programs, with the requirement that everyone enrolled in Medicaid could stay in the program, even if they no longer qualified.

At the end of May, when the nationwide public health emergency ended, states began the unwinding process. In Texas, that means the state's Health and Human Services Commission must check whether the 5.9 million people enrolled in Medicaid are still qualified to be a part of the program, all while the agency struggled with workload shortages and an outage of the 2-1-1 hotline, a primary way for Texans to respond during the Medicaid renewal process.

The state reviewed more than 785,000 people in May, according to the data released. Of those, almost 405,000 people lost their health insurance because of procedural reasons, like not replying to mail, phone calls, or texts from the state asking for information.

The high rate of procedural denials indicates to Forester that Texas is "struggling along with all of the other states with this monumental task."

Other health policy experts said the numbers raised red flags. Joan Alker, executive director at the nationwide nonprofit Center for Children and Families, said Texas' numbers were the worst she's seen of any state that has reported data so far.

"More than 400,000 people didn't make it through the process," Alker said. "The state could have paused, given people more time, tried harder. But they were very quick to cut off half a million people."

she added.: "It suggests to me that Texas is not following federal law on how they're supposed to be checking people's eligibility."

Advocates for children like Alker and Forester outlined two major fears for young children during this process. First, that kids who still qualified for Medicaid would lose their benefits because the state wasn't able to reach their family. For families that move or change phone numbers frequently, the state might have a hard time reaching them. If the state can't contact the family, the child would lose Medicaid for procedural reasons. And second, kids who no longer qualify for Medicaid, like if they're family income has changed, might not get directed to other programs that they do still qualify for, and so might go without health insurance coverage altogether.

Laura Dague, an expert on Medicaid at Texas A&M University, cautioned that the state's first report should be interpreted with several caveats.

First, she pointed out that Texas' plan for checking availability started with the children and adults it thought would be least likely to still be eligible.

"That means that in these first few months, we might see a high proportion losing Medicaid," she said.

Dague, an associate professor in the Bush School of Government and Public Service, also said the high number of procedural denials is hard to understand without more information from the state. Someone could be kicked off of Medicaid because their renewal packet didn't get to them, she said. But there could also be scenarios in which someone simply decided not to send their packet back in, because they knew they weren't going to be eligible and didn't want to go through the process.

"There's really no way to know from these data what fraction were 'we couldn't get a hold of these folks' versus, it was the right person and they chose not to respond," she said.

By the end of the unwinding process, Dague's research estimates that up to 750,000 Texans will lose their Medicaid health insurance. Texas has more uninsured residents, and a higher rate of uninsurance, than any other state in the nation. In Tarrant County, Dague estimated that between 50,000 and 65,000 residents, most of them children, could lose their Medicaid or CHIP health insurance.

Although Medicaid is commonly understood as a health insurance program for people with low incomes, the program looks different in every state. In Texas, few adults are eligible for the program. The Texas Medicaid program mostly insures children, pregnant people, and people with disabilities. Texas is one of just 10 states that has decided not to expand Medicaid to a wider group of adults.

Do you or a family member have health insurance through Medicaid or CHIP? We want to hear from you. Contact cmccarthy@star-telegram or call or text 817-203-4391 .