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At the start of the pandemic, when families lost their jobs and access to health care, the federal government relaxed Medicaid rules to allow more people to stay on the national health insurance program.

But now about 1.3 million Texans, mostly children, could begin to lose health insurance if a federal pandemic emergency is over, expected by the end of this year – raising concerns that Texas’s understaffed security system is not very ready. before that them.

The declaration of state of emergency did not allow states to exclude people from the Medicaid list because they were experiencing financial instability caused by COVID-19. The result? Over the past two years, the number of Texans using Medicaid has grown by about 20%.


Now health officials and researchers have estimated that 880,000 to 1.3 million Texans are probably not eligible for Medicaid, but are still on the list because of the rule. The state’s plan to speed up their removal faster than required by the federal government – and with limited resources – supporters are concerned that millions more may lose coverage due to administrative failures, even if they meet the requirements.

“We already have a huge problem without insurance in this state, and it could just be a perfect storm,” said Jana Yubank, executive director of the Texas Association of Public Health Centers, a network of local centers that provides care to 1.6 million Texans. , almost half of which are uninsured. “We are tearing at the seams. … The last thing we need is more uninsured people. ”


Once the so-called Pandemic Emergency (PHE) is over, the work begins to process applications from about 3.7 million recipients from Texas whose eligibility has not been considered since their registration, and find those who still have qualifications. to maintain their coverage.

National child protection experts say it is important that states return their Pandemic-era recommendations so that it is sympathetic, collaborative and not driven by political desires to exclude as many people as possible from Medicaid.

Texas has the highest level of uninsured people in the country and is one of 12 states that have abandoned the Medicaid expansion to include more people under the Affordable Care Act. Researchers say the Medicaid expansion could add up to 1.3 Texas.

If they can’t do it right, access to health care for the state’s most vulnerable – pregnant women, children, the elderly and adults with disabilities – is at stake, said Tricia Brooks, a research fellow at Georgetown University’s McCourt Center for Public Policy. for children and families.


“But it turns out it’s really the responsibility of the state,” Brooks said. “How does the state approach the removal of continuous protection, how long does this process take and the procedures in place. There the rubber meets the road. “

In March 2020, Congress passed the Coronavirus Response Act in the first place, which allowed states to temporarily increase federal funding for Medicaid by 6.2% provided that all are enrolled in Medicaid until the end of PHE.

The idea was to prevent the loss of people’s insurance at a time when a record number of people were losing their jobs, employers ’health insurance and housing, facing a huge threat to public health.

In other words, if someone was admitted to Medicaid, they could remain registered until the health emergency was officially declared.

As Texans lost their jobs – along with employer insurance or the ability to pay out of pocket – the number of Texas Medicaid program participants jumped from 3.8 million in February 2020, a number that has declined in recent years to about 5.1 million in December 2021 year. , reports the Texas Commission on Health and Human Services.


According to the Georgetown University Center for Children and Families, the number of entrants in Texas grew faster than the national average, with the number of entrants increasing by 20% compared to the national average of 16%.

The number of children on Medicaid here has grown by 26%, while the increase across the country has averaged 21%.

Earlier this year, President Joe Biden promised states that they would receive a warning 60 days before it would end.

The current expiration date is July 15. The deadline for notifying the state of preparations for its completion was Monday, and it passed without that notice. So while there has been no official announcement, the current presumption is that the health emergency will be extended at least until October.

If this happens, states will find out in August whether the PHE will expire in October, and benefits may end as early as November 1.

Promotion of PHE

Texas is one of eight states that plan to eliminate PHE requirements sooner than the federal government recommends – in six months instead of a year.


It is a move that will save the state the cost of Medicaid, but could cost Texans critical access to care if done too quickly or carelessly, health experts say.

“Too soon vacations (from PHE) will result in human and financial costs not only for millions of Texans, but also for the security of the state, already tense pandemic,” – said in a letter written by state health officials and signed by 10 Texas. health-related groups, including those representing state physicians, hospitals, health insurance plans, pediatricians, community health centers, and others.

According to the agency’s plans, released in March, the Texas Health and Welfare Service, which is tasked with handling the influx, expects “a lot of work” and a “potential burden on the qualifications system” when the PHE dismantling process begins.


The amount of work involved in the process, government officials say, is comparable to the launch of a large-scale Affordable Care Act that has overhauled health insurance and delivery systems nationally and nationally.

Subsequent administrative nightmares – hours of waiting on the phone to check passwords or get answers to questions, mail notifications sent to obsolete addresses – are likely to leave hundreds of thousands of those who are eligible for Medicaid, with a gap in health coverage so far they are trying to navigate an already complex system.

“Gaps in the coverage of children, new mothers and other vulnerable patients can lead to disruptions in access to medicines, therapies and other treatments,” reads a letter sent to government officials by health groups. “Delaying or skipping treatment often leads to worsening of the condition and greater use of expensive care.”

Critics of Medicaid say they believe the state will need the time it takes to effectively return rules to a pandemic without gaps in coverage, and that it is necessary to exclude unskilled people from the program as soon as possible to support services to those who still need them. .


David Balatt, a conservative health expert in Austin, said the Texas Health Service “has invited more resources to better help those affected by the transition” as a way to compensate for expected staffing problems.

“Allow people who are not eligible for Medicaid to continue receiving benefits, harming patients who truly deserve to participate in the program,” said Balat, who runs the Right to Health initiative at the Texas Right-Wing Public Policy Foundation. “Texas can and should make the transition as smooth as possible … But if someone is no longer eligible for Medicaid, they should not continue to take away critical resources from those for whom they are intended.”

Asked whether the state is prepared for the influx of applications and why officials are trying to do so in a shorter time, officials from the state HHS told a few details.

“As in many states, Texas is balancing several political, operational, and financial priorities in deploying Medicaid continuous coverage related to federal public health emergencies,” HHS spokeswoman Kelly Weldon said in an email. “The estimated timing of the discontinuation of Texas HHSC’s Medicaid continuous coverage is based on our forecasts of capacity and workload. It is important to note that the deadlines in our plan are approximate. “


The recipients of Medicaid in Texas are mostly children, pregnant women, and the elderly and people with disabilities who are in or close to poverty. Income limits are among the lowest in the country. Childless, able-bodied adults cannot claim under any circumstances in Texas.

Most of those who will lose Medicaid after graduating from PHE, say state health officials, are children who are old or whose income no longer allows them to qualify, people who were pregnant at the time of qualifying but are now ineligible. under this rule, or adult recipients who are no longer eligible for child support in their family.

Some of these women and children may be eligible to participate in other programs, such as the Child Health Insurance Program, Healthy Women in Texas, or market insurance plans.

It is expected that another 280,000 technicians will be able to move to another group eligible to participate in Medicaid.


Although the federal government gives states a year for transitional recipients, the Texas plan, released in March, shows it will be completed by February 1, 2023, processing up to 75% more applications per month than recommended by U.S. Medicare Centers and Medicaid.

To meet the new demand, the agency plans to temporarily relocate staff from other departments to help with casework, hold job fairs and increase recruitment for open vacancies by adding staff to help with data entry and interview planning, and automate some scheduling systems and others.

Officials also plan to hire temporary workers, introduce a flexible work schedule and reduce the time to adapt new employees by 50%.

The backlog could further complicate the already complex application process, which requires documentation, and could confuse or intimidate parents, making it difficult for them to apply at the right time, Yubank said.


Children, who make up the majority of Medicaid recipients in Texas, are the largest group that need to be re-registered by their parents and likely to retrain – but they are particularly vulnerable to coverage gaps, Eubenk said.

“This is a population that really worries us – children who continue to have rights, but because of infrastructure problems will not be re-enrolled and will have gaps,” she said. “There are so many things that can create this problem.”

Disclosure: The Texas Association of Public Health Centers and the Texas Public Policy Foundation were financial supporters of The Texas Tribune, a nonprofit, nonpartisan information organization funded in part by donations from members, foundations, and corporate sponsors. Financial supporters play no role in Tribune’s journalism. Find their full list here.


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