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Since April, the number of Texans who lost their Medicaid coverage is close to 900,000. This has caused a significant backlog of applications, which has overwhelmed the system. Consequently, advocates are concerned that this backlog is delaying families’ access to SNAP food benefits, creating a ripple effect.
During the pandemic, federal regulations prohibited states from removing people from Medicaid, and more than 5 million Texans were able to access healthcare continuously. But these protections lifted in April and the state quickly began rechecking the eligibility of every individual in the program. In the months since the state launched this “unwinding,” hundreds of thousands have lost Medicaid coverage.
While some individuals have become ineligible because their incomes increased or they were children who aged out of the program, a majority — more than 600,000 — have been disenrolled in Texas because of procedural errors, according to KFF, a health policy research organization. This includes everything from sending in applications in the mail a day late to not including the correct documentation.
Without access to medical care, those who rely on the state’s health insurance — mainly children, but also women who recently gave birth and disabled adults — are left in anxious limbo where one health emergency could strap them with heavy debt.
During a recent news conference, Michelle Castillo, deputy director for the nonprofit Children’s Defense Fund, expressed that all parents have concerns about their child’s well-being and the possibility of them getting injured or becoming seriously ill. However, the anxiety intensifies when a child’s Medicaid case remains unresolved.
The reverberations of state employees being overwhelmed has led to Texans also losing access to their SNAP, or the federal Supplemental Nutrition Assistance Program, after pandemic protections lifted in March. Around 3.5 million Texans depend on food benefits.
Celia Cole, CEO of the nonprofit Feeding Texas, stated that individuals are facing significant delays in receiving approval for their applications, potentially resulting in others losing their benefits if their renewals are not accurately processed. This situation exacerbates the demand on food banks, which are already grappling with a food supply crisis and struggling to cope with the existing challenges.
SNAP eligibility used to be assessed twice a year prior to the pandemic. However, at present, the application review process takes 100 days, which exceeds the federal standard of 30 days.
“The processing of these applications is carried out by the same humans and computer system,” stated Stacey Pogue, a senior policy analyst at Every Texan. “It’s comparable to squeezing a balloon in one area, as the problem simply shifts to another area. Even if renewals and Medicaid were functioning efficiently, it would still exacerbate the strain on an already understaffed and dysfunctional system.”
According to an HHSC report from September, 54,000 Texas Medicaid applications submitted just in the month of March still hadn’t been processed as of August.
Ilesa Daniels, a retired HHSC employee of 32 years and a member of the Texas State Employees Union, expressed her dissatisfaction with the computer system at a news conference. She stated, “Throughout my time, the computer system never functioned properly. Almost every day, we encountered issues with the program itself. This not only consumed more time, but also overwhelmed and overworked the employees, resulting in a shortage of staff.”
Texas has disenrolled the most people from Medicaid of any state, according to KFF.
According to an anonymous whistleblower letter signed off as “Concerned Texans and Dedicated Employees,” individuals from vulnerable groups such as former foster children, mothers who are less than two months postpartum, and children with undocumented parents have faced denials when attempting to participate in the renewal process within Texas Health and Human Services.
These anonymous whistleblowers have written three letters to state officials, including Cecile Young, commissioner of the Texas Health and Human Services Commission and Gov. Greg Abbott. Abbott’s office did not respond to a request for comment.
According to HHSC spokeswoman Tiffany Young, in previous months, around 90,000 individuals were unintentionally removed from coverage due to a system glitch. Nonetheless, the Centers for Medicare and Medicaid Services (CMS) collaborated with the state to reinstate their healthcare. This month, a separate system glitch led to the erroneous removal of 24,000 children.
Young stated that, as a result of HHSC’s quality assurance process, they were able to identify Medicaid recipients whose coverage had been mistakenly terminated. They took systematic steps to reinstate coverage for all affected recipients and promptly informed CMS. Additionally, HHSC holds weekly meetings with CMS to ensure a seamless redetermination process and promptly updates them on any arising issues.
In order to tackle the chaos, the state has implemented certain modifications. Now, individuals who are part of the latest group to have their eligibility reassessed will be granted a 60-day period to submit their application, instead of the previous 30-day limit.
Prague expressed that while the small step is helpful, it falls short in addressing the severity of the crisis, errors, and dysfunction. It does not alleviate backlogs or computer errors, and ultimately fails to meet the necessary criteria. In summary, it lacks the necessary scope and urgency to effectively address and mitigate the harm caused.
Texas’ Democratic Congressional delegation wrote a letter urging the Centers for Medicare and Medicaid Services to require the state to pause all denials based on procedural errors and require an audit of the state’s system to bring it into “compliance.”
U.S. Rep. Lloyd Doggett, D-Austin, who signed the letter, said late Tuesday that Abbott could do something to address the wrongful coverage denials but had remained “indifferent,” so federal authority is needed to step in.
During a news conference, Doggett emphasized the urgent need for the Biden Administration to exercise its authority by insisting on accountability and implementing a temporary halt until a thorough audit and necessary corrective measures are carried out.
Additionally, Harris County Commissioner Adrian Garcia, who was in attendance at the aforementioned news conference, emphasized that over 50% of children in Harris County depend on Medicaid as their primary source of healthcare. He further highlighted the county’s responsibility in shouldering the financial strain of offering medical assistance to those without insurance.
“He stated that our hospitals, doctors, and health care providers are facing difficulties due to the rising burden of uncompensated care. This strain is impacting safety net health care services and the overall system,” he remarked. “Numerous families are experiencing chaos and uncertainty as a result. It is a matter of either incompetence or cruelty, and neither choice paints Governor Abbott in a positive light.”
According to Jana Eubank, executive director for the Texas Association of Community Health Centers, federally qualified community health centers, which are obligated to offer healthcare services to all patients regardless of insurance coverage, are an essential component of our safety net. However, these centers have started facing financial difficulties and are becoming increasingly burdened with the high volume of assistance requests.
Eubank expressed concern about the sustainability of our healthcare centers if we don’t have paying patients for an extended period of time. They may have to close their doors if our numbers continue to decline. Additionally, with the possibility of a federal shutdown and a potential lack of oversight from CMS, these issues could persist.
On September 9, an additional one million Texans were sent notices to initiate their Medicaid renewal process. While the state agency has expressed confidence that most individuals in this category still qualify for Medicaid, there is widespread concern that potential errors could lead to similar outcomes.
More and more individuals, seeking assistance, are returning to ECHOS, an organization aiding immigrants and refugees in Houston, as stated by Cathy Moore, the executive director of the organization. She notes a growing population of frustrated individuals requiring repeated support.
Moore stated that it is increasingly evident that numerous individuals are being unjustly denied, and this should not be the case. Moreover, it is evident that the process of unwinding was executed in a manner that will not yield success for the state or for the individuals relying on the services.
To check if you qualify and apply for Medicaid or or still have access to care, you can either call 211 or check the Your Texas Benefits website. You can also check SNAP benefits at the Your Texas Benefits website.
Neelam Bohra is a 2023-24 New York Times disability reporting fellow, based at The Texas Tribune through a partnership with The New York Times and the National Center on Disability and Journalism, which is based at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.
Disclosure: Every Texan, Feeding Texas, Texas Association of Community Health Centers and New York Times have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
