Kids caught in health care crisis; Abbott, lawmakers must act
For the past two years Texas has been prohibited from removing children from Medicaid as a part of the COVID-19 public health emergency. But with recertification and renewals starting back up earlier this spring, Texas children especially are losing access to needed health care at an alarming rate.
The good news is the governor and legislature can fix this if they have the will to act.
Texas already leads the nation in the number and rate of uninsured children. Just under 1 million Texas kids do not have health insurance. Similarly, Texas holds the distinction of being one of two states with a double-digit rate of uninsured children at 11.8 percent. The national average is 5.4 percent.
Before the public health emergency ended and the Medicaid and CHIP renewals began, over 400,000 Texas children were already eligible for those programs but not yet enrolled in either. Now, with serious concerns around how renewals are occurring so far and the markedly high level of procedural denials for children, the gap between eligibility and enrollment will only grow.
To date, 500,000 Texans have lost access to Medicaid. Over 80 percent of denials of continued coverage have been for procedural reasons – that is, not based on a determination of ineligibility, but on issues with paperwork. Worse for Texas, the vast majority of those now without access to health care are children – making an already untenable crisis even worse.
The high rate of uninsured children coupled with the fact that to date around 338,000 of the 404,904 procedural denials have been for children’s Medicaid means this crisis will only continue to be exacerbated. According to the Center for Medicare & Medicaid Services, enrolled children under age three, immigrant families, and children with disabilities may be particularly vulnerable.
Failure to act now will have dire consequences for Texas children, their health, and many related outcomes. Additionally, as children lose coverage we will see a decrease in preventative visits and primary care access and an increase in chronic health conditions and emergency room utilization, along with a corresponding increase in uncompensated care costs and both near-term and long-term costs of health care for families and the state.
First, Texas can utilize flexibilities and updated guidance from CMS to reduce procedural denials and facilitate the re-enrollment of eligible Texans denied for procedural reasons. Every option must be explored.
Second, Texas must better use thirdparty data to help verify eligibility and implement Express Lane Eligibility. This was a bipartisan proposal passed overwhelmingly and quickly by the House that was not even referred to committee in the Senate until the final days of the legislative session.
Third, all states will be required by federal law to provide one year of continuous coverage to children beginning on January 1, 2024. Instead of waiting, Texas should enact this policy now.
Fourth, Texas must modernize the Health and Human Services Commission and make technical upgrades and improvements to YourTexasBenefits.com, the 2-1-1 system, and similar resources for health coverage and services. Immediate changes should be made to allow electronic submission of renewal documents during the 90-day reconsideration period and plainly state an individual’s renewal dates and deadlines to reduce confusion.
Last, Texas can finally adopt Medicaid expansion, as 40 states and Washington, D.C., have already done. This will draw down over $100 billion in federal funds, increase health care access for 1.4 million Texans, and lower insurance costs for everyone.
There are still millions of Texans on Medicaid who will go through the recertification process over the next year. By making specific improvements and policy decisions, Texas can minimize disruptions to health care access for those who are still eligible, while laying the groundwork for a healthier Texas. We must act.