The Dallas Morning News

Red tape imperils children’s health

Thousands of Texas kids lose Medicaid due to inefficien­t monthly income monitoring


There are more uninsured children in Texas than any other state. In 2017, more than 1 in 5 uninsured children in the U.S. lived in Texas. And the situation is getting worse.

Recent data from the Texas Health and Human Services Commission revealed that the uninsured rate for Texas children increased for kids of all background­s, income levels, race and ethnicitie­s.

We must do better. Children enrolled in Medicaid receive six months of continuous coverage followed by six months of monthly income monitoring to ensure they remain eligible. Texas relies on an automated system for these monthly checks, but a recent audit revealed this system was incorrect at least 30% of the time. If the system indicates a family’s income threshold may have increased above Medicaid coverage levels, the state sends a letter requesting verificati­on of income. Ten days later, a child is automatica­lly disenrolle­d if the state has not received a response.

This result is thousands of children each month losing Medicaid coverage due to paperwork errors and red tape. Families are confused by multiple requests for the same informatio­n; they receive letters past the due dates; they move and may not receive letters at all. Many of my patients are unaware that their Medicaid lapsed until they are sick and come to the clinic seeking care.

The monthly income checks also unfairly affect seasonal workers whose incomes vary from month to month. Recent data from the Texas Health and

Human Services Commission reveals that these administra­tion issues are the cause of 92% of cases of children losing coverage when the monthly income verificati­on catches inadequate informatio­n. This means on average 4,100 children lose coverage each month due to red tape.

What does losing Medicaid coverage mean for a child? For my patients with asthma, it means losing their preventive medication­s that reduce emergency room visits and hospitaliz­ations. For my adolescent patients struggling with depression, it means losing consistent counseling that improves their mental health and reduces risks of crisis and suicide. For my 4yearold patients preparing for prek, it means a delay in the vaccines they need to enroll in school.

Texas legislator­s have the opportunit­y to repair the system. Twelvemont­h continuous coverage for children in Medicaid is the single most effective way our state can reduce our uninsured rate and fix the redtape issues keeping children from consistent care. It’s a simple solution to a complex and burdensome problem. Texas should enact House Bill 342 and Senate Bill 637 to provide 12 months of continuous eligibilit­y for children in the Medicaid program.

We know that Medicaid is an effective empowermen­t program. Children enrolled in Medicaid are more likely to graduate from high school and attend college. They earn higher wages and pay more taxes as adults than their uninsured peers. A policy that is knowingly dropping thousands of eligible kids off coverage cannot and should not be left in place.

Dr. Valerie Borum Smith is a pediatrici­an at St. Paul Children’s Clinic in Tyler and a fellow of the American Academy of Pediatrics. She wrote this column for The Dallas Morning News.

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