This article was co-published with The Texas Tribune, a nonprofit and nonpartisan newsroom that provides news coverage relevant to Texans. Their newsletter, The Brief Weekly, offers comprehensive updates on key Texas issues.
Reporting Highlights
- Texas Prioritized Speed: When federal pandemic-era protections ended last year, Texas swiftly removed more people from Medicaid than any other state.
- Persistent Warnings: Officials acknowledged some errors during the Medicaid unwinding, but an analysis revealed these mistakes were both preventable and predicted in persistent warnings.
- Eligible People Removed: Nearly 1.4 million people lost coverage not due to ineligibility but because of issues like not returning forms or completing them incorrectly.
For three years during the COVID-19 pandemic, the federal government provided Texas and other states with billions of dollars under the condition that they not displace people from Medicaid to avoid exacerbating the public health crisis. This agreement ended last year, leading Texas to rapidly remove more people from the program than any other state.
Officials admitted to errors after more than two million people, mostly children, lost Medicaid coverage. Some individuals who believe they were wrongly disenrolled are striving to regain access to the state and federally funded health care program, contributing to a backlog of over 200,000 applicants. A review by ProPublica and The Texas Tribune of various public and private records indicated these errors were preventable and foreshadowed by warnings from the federal government, whistleblowers, and advocates.
Texas chose an aggressive approach that contradicted federal guidelines, resulting in significant repercussions for state residents. Despite federal advice to proceed slowly and automatically renew eligible residents using existing data, Texas initiated reviews of about 4.6 million cases in the first six months, requiring residents to resubmit documents proving their eligibility. This led to nearly 1.4 million people losing coverage for administrative reasons rather than ineligibility.
The impact of this decision was particularly severe for Texas, where Medicaid coverage is limited to a smaller percentage of the population compared to almost any other state. Devastating consequences included children being forced to delay or forgo lifesaving operations and treatments due to lost coverage.
Efforts by state officials to address the issues included community outreach and hiring over 2,200 employees. However, Texas’ longstanding conservative stance towards Medicaid has largely excluded poor adults and restricted eligibility to primarily children, pregnant women, and disabled adults.
Federal officials had warned about moving too quickly with the unwinding and advised states not to review more than 11% of their caseloads monthly to avoid system overloads. However, Texas initiated reviews for about 17% of its caseload in the first month. Within the initial months, the state removed over 600,000 people, mostly for administrative reasons. Federal and state officials exchanged concerns and warnings throughout the process, but Texas continued its aggressive approach.
The effects on Texas residents were significant. Physicians reported that children with severe medical conditions unnecessarily lost critical care. Poor families faced additional financial burdens due to medical emergencies uncovered by insurance. Moreover, operational challenges led to long wait times for reinstatement of coverage and additional strain on healthcare facilities due to increased numbers of uninsured patients.
The federal government launched an investigation into these delays, emphasizing the need for states to ensure eligible residents could stay covered. Advocacy groups and healthcare providers welcomed the investigation, though there are concerns about the potential long-term impact and accountability.
Despite regaining coverage for some families, many Texans who lost Medicaid during the unwinding are still waiting for resolution. The state’s long processing times for applications exceed federal requirements, contributing to the ongoing crisis.
The Texas Health and Human Services Commission acknowledged operational challenges and committed to improving eligibility processes. However, the repercussions of their rapid unwinding approach continue to affect many residents who rely on Medicaid for their healthcare needs.
