Texas cut Medicaid staffing during the pandemic. Millions are now at risk of being dropped from the program.

MM Curator summary

[MM Curator Summary]: Many in the state are concerned that staffing levels needed to process benefits programs applications are not sufficient to deal with the PHE wind down.


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More than 1 million Texans were added to Medicaid coverage during the pandemic, many of them children, thanks to emergency federal funding that deters states from dropping recipients during the health crisis.

But those gains could soon be erased, according to patient advocates, who worry that state health officials are not prepared for the influx of new and returning Medicaid applications that could pour in as early as this spring, when the Biden administration is scheduled to lift the emergency declaration.

The state health agency has already shown signs it may not be ready, falling behind last summer in processing food assistance sign-ups, which uses the same employees as Medicaid. That backlog followed a round of staffing cuts the agency was ordered to make in 2020 as part of an early pandemic response by Republican state leaders.

“We had said this will be an issue, and it’s now coming to a full head,” said Melissa McChesney, a health policy adviser at UnidosUS, a Latino advocacy group.


From January to October, the state’s timeliness rate for processing food assistance applications fell from over 90 percent to 66 percent, even though the total number of people signing up remained nearly the same. That means a third of all people seeking help were unable to get it within 30 days.


“It’s not that they weren’t eligible, it’s that the case was never even determined if they were eligible,” said Rachel Cooper, a senior policy analyst at the left-leaning think tank Every Texan.


Now add to the uncertainty millions of Medicaid recipients who will need to be quickly cleared to gain or continue their medical coverage.

The agency cut the equivalent of just over 700 eligibility jobs last fiscal year, much of it through a hiring freeze; as of the fall, it was down by what would amount to about a thousand positions from the end of 2019 — a 15-percent cut for an agency that had roughly 7,000 eligibility workers in 2019.


A spokesperson said the Health and Human Services Commission is working with health plans and other contractors to prepare for the renewals and will automate the process as much as possible, cross-checking details on recipients with available wage and Social Security data. The agency is urging Medicaid recipients to update their contact information by going to YourTexasBenefits.com.


Missed deadlines, coverage gaps


Since the pandemic began, Medicaid enrollment in Texas has grown by more than 1.2 million people, to just over 5 million total recipients as of October. That includes nearly 1 million children and more than 200,000 low-income women who are pregnant or gave birth during the health emergency.


The growth has been a blessing for many families whose children have been frequently bumped from the program because of missed deadlines or other procedural errors, only to later reapply and be accepted back into Medicaid. That ricochet can leave eligible children without coverage for months at a time.


The state Legislature recently reduced the number of spot checks to twice annually, down from four times. Critics say the automated process can be rife with old data and misrepresent a family’s actual income. Once a family is flagged as no longer eligible for Medicaid, it has only less than two weeks to respond from when the state mails a request for documentation.


In 2019, 40 percent of children who were bumped from the program re-enrolled within six months, suggesting they had been wrongly dropped.


Texas is also one of a dozen states that has refused to expand Medicaid to adults who make too little to qualify for subsidized insurance through the Affordable Care Act. Republican leaders have publicly avoided the issue in recent years, but previously argued that Medicaid was inefficient and pointed to other problems like the high costs of certain medical care.

“Having reliable access to care is sometimes more than just having a clinic available to you,” said Andrea Caracostis, a doctor who heads a federally qualified health clinic in Houston. “It has to do with your ability to pay for it, and if they have assistive Medicaid, that’s one less thing they have to worry about.”

For new mothers who may end up losing Medicaid coverage, there are other programs they can move into that provide some access to basic services like health screenings and contraceptives, and potentially private insurance if they can afford it. But it will fall largely on local health providers to help them navigate what can be a confusing maze of applications.


The bigger concern, advocates say, is thousands of eligible children suddenly losing coverage because of an overwhelmed system. That’s what happened in Utah in mid-2020 when the state restarted renewals of its Children’s Health Insurance Program. More than 6,000 children, or 41 percent of all recipients in the program, lost their coverage and had to reapply, according to news reports.


Missouri saw a smaller but still significant drop in 2018 and 2019 when it restarted renewals with an overhauled eligibility system.


“I can only imagine it’s going to take a hit on us as well,” Caracostis said. “All the revenue we were counting on for X amount of Medicaid patients we may not have later on.”


Last week the Biden administration extended the health emergency for three more months amid the latest COVID wave. If it is the last extension, states could begin processing renewals as early as May 1.