Texas becomes ‘ground zero’ for kids losing their Medicaid health insurance

Texas kids are quickly losing their Medicaid health insurance in 2023, an alarming sign to advocates for children’s health in the state.

A report released Wednesday highlighted major progress in the state’s insurance rate for children last year. Last year, the number of uninsured Texas kids dropped by 14% compared to before the pandemic, according to the report, published by the Center for Children and Families at Georgetown University.

But last year’s progress was short lived. At least 728,000 kids in Texas have been removed from Medicaid as of Oct. 8 as part of the Medicaid unwinding process, more than in any other state in the U.S. Many of those children have likely not gotten health insurance elsewhere, experts said.

“Where a child lives makes a huge difference,” said Joan Alker, the center’s executive director and co-founder. “The unwinding process is once again laying bare how much of a priority child health is to governors and state legislators. Nowhere is this more true than in Texas.”

The unwinding process is a massive undertaking for Medicaid programs across the U.S. During the COVID-19 pandemic, the federal government gave states additional funding for their Medicaid programs, with the requirement that everyone enrolled in Medicaid could stay in the program, even if they were no longer eligible. But that requirement expired this year, prompting the state’s Health and Human Services Commission to start checking whether the 6 million people enrolled in Medicaid are still qualified to be a part of the program.

Tiffany Young, a spokesperson for the state’s health and human services commission, noted that Texas began checking eligibility for the children and adults it believed were least likely to still qualify for the program. Young said the state has delaying eligibility checks for children, as other states, like Kentucky, have decided to do.

“States are federally required to conduct a renewal for all Medicaid recipients over a 12-month period from when the state began their unwind of continuous Medicaid coverage,” Young said in an email. “Texas Medicaid and CHIP enrollment increased almost 50% during the Public Health Emergency, and HHSC will need the full 12 months to redetermine eligibility for more than 6 million people.”

To verify whether a child is still eligible for Medicaid, the state can either use information it already has on the child’s income or review paperwork submitted by the child’s parents.

Stacey Pogue, a senior policy analyst with the Texas nonprofit Every Texan, said families enrolled in Medicaid have reported challenges responding to the state’s paperwork. Focus groups have reported not receiving the paperwork at their home address, being confused by the paperwork, or not being able to read and complete it in their native language, Pogue said. Families can call the state’s 2-1-1 hotline for help filling out their forms, but Pogue said the hotline is only open during business hours and that the hotline has not been functional for parts of the last year because of glitches in the system.

Texas is one of 10 states that has not expanded Medicaid to make more low-income adults eligible for the program, meaning most of those who have Medicaid in Texas — and most of those losing coverage — are children, young adults, or new moms who recently gave birth.

“Our state has real policy levers that can remove barriers and benefit kids,” Pogue said. The state has become “ground zero for children losing health coverage during the unwinding,” she said.

Texas has more uninsured children than any other state in the nation, and it also has the highest rate of uninsured children. The Dallas-Fort Worth metro area in particular has a high rate of uninsured children, according to the report: Last year, about 11.3% of DFW kids were uninsured, compared to the state’s average of 10.9%. Both of these numbers are increasing this year during the Medicaid unwinding process.