Almost 900,000 Texans have lost Medicaid since April and a backlog of applications has piled up, overwhelming the system and setting off a ripple effect that advocates worry is delaying families’ access to SNAP food benefits.
During the pandemic, federal regulations prohibited states from removing people from Medicaid, and more than 5 million Texans were able to access healthcare continuously. But these protections lifted in April and the state quickly began rechecking the eligibility of every individual in the program. In the months since the state launched this “unwinding,” hundreds of thousands have lost Medicaid coverage.
While some individuals have become ineligible because their incomes increased or they were children who aged out of the program, a majority — more than 600,000 — have been disenrolled in Texas because of procedural errors, according to KFF, a health policy research organization. This includes everything from sending in applications in the mail a day late to not including the correct documentation.
Without access to medical care, those who rely on the state’s health insurance — mainly children, but also women who recently gave birth and disabled adults — are left in anxious limbo where one health emergency could strap them with heavy debt.
“Every parent worries about their child getting hurt or seriously ill,” said Michelle Castillo, deputy director for nonprofit Children’s Defense Fund, at a news conference this week. “That fear is magnified when your child's Medicaid case is in limbo.”
The reverberations of state employees being overwhelmed has led to Texans also losing access to their SNAP, or the federal Supplemental Nutrition Assistance Program, after pandemic protections lifted in March. Around 3.5 million Texans depend on food benefits.
“People are experiencing long delays getting their applications approved and other people may be losing benefits if their renewals don't go through accurately,” said Celia Cole, CEO of the nonprofit Feeding Texas. “It just really increases demand at a time where food banks are already facing a kind of food supply crisis and already struggling to keep up.”
Before the pandemic, SNAP eligibility was checked twice a year. Currently, the waiting period for having an application reviewed is 100 days. The federal standard is 30 days.
“It’s the same humans and the same computer system that does the processing of these applications,” Stacey Pogue, a senior policy analyst at Every Texan, said. “It’s like squeezing a balloon on one part — then the problem goes to the other part. Even if they did have renewals and Medicaid running really well, it really puts extra pressure on an understaffed and broken system.”
According to an HHSC report from September, 54,000 Texas Medicaid applications submitted just in the month of March still hadn’t been processed as of August.
“As far as the computer system, it's never worked properly,” said Ilesa Daniels, a recently retired HHSC employee of 32 years and a member of the Texas State Employees Union, at a news conference. “Almost every day, there are issues with the program itself, which takes even more time and then it overburdens and overtaxes the workers, and then we have a shortfall of them.”
Texas has disenrolled the most people from Medicaid of any state, according to KFF.
Vulnerable groups including former foster children, mothers who aren’t two months postpartum and children who are citizens with undocumented parents have been denied as they attempt to participate in the renewal process, according to a whistleblower letter written by Texas Health and Human Services employees who did not name themselves, signing off only as “Concerned Texans and Dedicated Employees.”
These anonymous whistleblowers have written three letters to state officials, including Cecile Young, commissioner of the Texas Health and Human Services Commission and Gov. Greg Abbott. Abbott’s office did not respond to a request for comment.
In past months, at least 90,000 people were also accidentally booted from coverage because of a system glitch — but the Centers for Medicare and Medicaid Services, which goes by the acronym CMS, worked with the state to restore their care, HHSC spokeswoman Tiffany Young said. This month, 24,000 children were erroneously removed because of a different system glitch.
“Through HHSC’s quality assurance process, the agency identified Medicaid recipients who had their coverage terminated in error, worked systematically to reinstate coverage for all impacted Medicaid recipients and informed CMS,” Young said. “HHSC meets weekly with CMS to ensure that the redetermination process operates as smoothly as possible and informs CMS of any issues as they arise.”
The state has made some changes to address the chaos; the most recent group of people to have their eligibility redetermined will have 60 days to return an application instead of 30.
“It is a helpful small step,” Prague said, “but it doesn't respond to the level of crisis and the level of errors and the level of dysfunction. It doesn't help with backlogs. It doesn't help with computer errors. It misses the mark. It's simply not expansive enough to respond to the urgency and the scale of harm.”
Texas’ Democratic Congressional delegation wrote a letter urging the Centers for Medicare and Medicaid Services to require the state to pause all denials based on procedural errors and require an audit of the state’s system to bring it into “compliance.”
U.S. Rep. Lloyd Doggett, D-Austin, who signed the letter, said late Tuesday that Abbott could do something to address the wrongful coverage denials but had remained “indifferent,” so federal authority is needed to step in.
“It's imperative that the Biden Administration use its authority to demand accountability and require a pause until a complete audit and corrective action can be completed,” Doggett said at a news conference.
Harris County Commissioner Adrian Garcia, who was also present at the same news conference, added that more than half of all kids in Harris County rely on Medicaid for their health care, and the county is “bearing the financial burden of providing care for the uninsured.”
“Our hospitals, doctors and health care providers are also struggling with increased uncompensated care, putting a strain on safety net health care services and the entire system,” he said. “This has created chaos and uncertainty for many families. It's either incompetence or cruelty. Neither option reflects well on Governor Abbott.”
Part of that safety net is federally qualified community health centers, which are required to provide care for all patients, including those without insurance. But these centers began financially suffering and some are being overwhelmed with requests for help, said Jana Eubank, executive director for the Texas Association of Community Health Centers.
“We have to have some paying patients, we can’t sustain that indefinitely. If our numbers get a lot worse, I really am concerned that some of our health centers might have to close their doors,” Eubank said. “With the looming federal shutdown, if CMS is unable to provide oversight, unfortunately, I think some of these things are going to just continue to happen.”
Another 1 million Texans received notices mailed out on Sept. 9 to begin their Medicaid renewal process. Although the state agency has indicated it believes most individuals in this group remain eligible for Medicaid, many are worried that errors will subject them to the same results.
Cathy Moore, executive director of ECHOS, which helps immigrants and refugees in the Houston area apply for services, said she is seeing more and more people who are frustrated and have to sometimes revisit her agency in need of help.
“It's becoming very clear that there are large numbers of people that are being denied that shouldn't be,” Moore said. “It’s also very clear the unwinding was done in such a way that it's not going to be successful for the state or for the people who are enrolled in services.”
The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
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