This article was co-published with The Texas Tribune, a nonprofit, nonpartisan local newsroom dedicated to informing and engaging with Texans. Readers can sign up for The Brief Weekly for essential coverage of Texas issues.
Reporting Highlights:
- Texas Prioritized Speed: When the federal government’s pandemic-era protections concluded last year, Texas acted rapidly, disenrolling more people from Medicaid than any other state.
- Persistent Warnings: Officials admitted to some errors during the Medicaid unwinding. Analysis indicates that many mistakes were preventable and had been previously highlighted in ongoing warnings.
- Eligible People Removed: Nearly 1.4 million individuals lost coverage due to procedural reasons such as not returning forms or incorrectly completing them, despite being eligible.
During the coronavirus pandemic, the federal government provided billions of dollars to Texas and other states under the condition that they would not remove people from Medicaid to avoid exacerbating the public health crisis. When this agreement ended, Texas swiftly disenrolled more people from Medicaid than any other state.
Officials acknowledged several errors after stripping Medicaid coverage from over two million people, predominantly children. Some individuals, who believe they were wrongly removed, are attempting to re-enroll, contributing to a backlog of over 200,000 applications. A review by ProPublica and The Texas Tribune of numerous public and private records revealed these mistakes were largely preventable and had been foreshadowed by warnings from federal authorities, whistleblowers, and advocates.
Texas’s rapid removal of people from Medicaid was contrary to federal guidelines and had significant consequences. The state, which already insures a smaller percentage of its population through Medicaid compared to almost any other state and is one of 10 that did not expand eligibility post-Affordable Care Act, experienced severe repercussions.
Key Perspectives:
Erin O’Malley, a senior policy analyst with Every Texan, remarked on the stark contrast in Texas’s approach compared to other states, highlighting the pressure on state systems.
During the pandemic, Medicaid enrollment increased significantly across the country. Texas saw its beneficiaries grow by over 50%. When continuous coverage mandates ended in April 2023, states faced the task of identifying ineligible recipients.
The federal Centers for Medicare and Medicaid Services (CMS) recommended a gradual approach, using existing government data to automatically renew eligible residents’ coverage. However, Texas opted for speed, reviewing about 4.6 million cases in the first six months and largely bypassing automatic renewals, which resulted in nearly 1.4 million disenrollments due to procedural issues.
Dr. Kimberly Avila Edwards, an Austin pediatrician, detailed the plight of children who lost Medicaid coverage, delaying critical medical treatments such as heart surgeries and care for significant health conditions.
Thomas Vasquez, a spokesperson for the Texas Health and Human Services Commission (HHSC), acknowledged that the agency learned many lessons and is working to improve its eligibility processes. He defended the rollout, noting community outreach and new hiring efforts.
Texas’s approach reflects the state’s historical conservative stance on Medicaid, as Governor Greg Abbott and state lawmakers have historically limited the program. An official comment from the governor’s office on the unwinding process was not provided.
Federal Response and Investigation:
The federal government advised states to review no more than 11% of their caseloads monthly. However, Texas initiated reviews for about 17% of its caseload in the first month. Federal officials expressed concerns over the rapid pace, but Texas officials downplayed these issues.
By the end of the first four months, Texas had removed over 600,000 people from Medicaid, primarily due to procedural failures. Secretary Xavier Becerra of the U.S. Health and Human Services called on Texas to increase automatic renewals using government data. The state subsequently admitted to erroneously disenrolling almost 100,000 individuals.
Ground Impact:
Families like Micaela Hoops’ faced significant challenges, losing Medicaid coverage due to procedural issues. Her children’s coverage was restored after more than 100 days, but the interim period involved substantial medical expenses and care delays.
Meanwhile, Texas’s median processing time for Medicaid applications now exceeds the federal limit, causing further strain on hospitals, clinics, and other safety net facilities. Some centers have had to lay off staff or curtail services.
The federal government launched an investigation into the long wait times for Medicaid applicants. Although this probe signifies an important step, it remains uncertain how effective it will be in the near term, especially for those who lost coverage during the unwinding.
CMS’s Stephanie Rossy emphasized that states’ choices impact eligible people’s ability to stay covered. Texas officials have noted ongoing improvements but have hesitated to discuss the investigation publicly.
Despite some Medicaid enrollees regaining coverage, many believe the state’s handling of the situation reflects a broader attitude towards low-income residents.