Media Spotlight on TX Lege’s Stalled Children’s Health Coverage Bill



Over the last month there has been a flood of media coverage about Texas knocking children off of their Medicaid health insurance over red tape and the stalled Children’s Health Coverage Bill in the Texas Legislature.

The Texas Tribune’s recent article included this explanation of the basics:

Most states check whether children still qualify for Medicaid once a year, when it's time for them to reenroll. In Texas, the HHSC uses an automated system to detect income changes in households with children on Medicaid several times a year. That's led to thousands of kids being abruptly kicked off the program — and data shows that many of those removals were in error.

House Bill 342 aims to give all of the state's children on Medicaid continuous coverage for a year, with no income checks in the interim. Democratic State Rep. Philip Cortez of San Antonio filed the bill in November. Since then, dozens of others have publicly signed on to the bill, including Republicans Sarah Davis of West University Place and J.D. Sheffield of Gatesville as joint authors. In the Texas Senate, state Sen. Judith Zaffirini of Laredo has introduced a similar bill. [Emphasis added.]

The San Antonio Express-News article that first reported on the problem and the proposed solution highlighted one of the many families affected by the state’s current approach:

Rocio Castillo, a mother of four who lives in San Antonio, said her children have lost Medicaid coverage due to paperwork issues. She is constantly sending documentation to the state, she said, even though nothing is changing with her family income.

That article also ran in the Houston Chronicle.

The Spectrum News story on the bill includes an interview a representative of a health clinic who has seen kids miss out on health care under the current approach:

She says it's not uncommon for parents to be suddenly notified that their child has been kicked off Medicaid. 

"Some parents will decide that if they're not eligible, if they don't have that Medicaid card, that they really can't bring their child in for care," said Rogoff.  

So, these families leave the clinic without getting the care they need for their children.

The issue has also drawn national attention, including this article in Politico. The article noted,

Of the 6,471 children's families the state contacted each month in 2017 and 2018, on average, only 372 were found to have incomes too high for Medicaid. Another 4,162 children were kicked off for a procedural reason, such as failure to respond to the letter.

Texas newspapers have called on the Legislature to pass the Children’s Health Coverage Bill to solve this problem.

For example, the Austin American-Statesman editorial urged the Legislature to support the bill, noting:

Studies have shown that having access to Medicaid can, over the long term, lead to improved reading scores, decreased high school dropout rates and a greater likelihood of completing college — all paving the way for higher earning potential. Why? Children who are able to get the medical care they need miss less school and are less likely to fall behind academically.

Importantly, Medicaid also covers screenings for developmental delays that can be improved through speech or physical therapy. Left undetected and untreated, such issues can prevent kids from keeping up with their peers in the classroom.

And the Beaumont Enterprise editorial board expressed its support for the bill, pointing out that:

Texas already leads the nation in uninsured children, with about 835,000 having no coverage. Bureaucratic games like this only make that problem worse.

Major Texas newspapers have also published a number of op-eds from children’s health care experts urging state leaders to take action.

In a Dallas Morning-News op-ed, Dr. Valerie Borum Smith, a pediatrician in Tyler, explained:

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. [Emphasis added.]

The San Antonio Express-News ran an op-ed by Patrick Bresette from Children’s Defense Fund - Texas. The op-ed shared the organization’s experience working directly with families tripped up the state’s policy:

Two months ago, a single mother named Katherine came to the Children’s Defense Fund distraught. Her seven-year-old son had recently come down with a bad infection and a high fever. Like any good mother, Katherine took him to the doctor. But when she got there, she was shocked to learn that her son had been dropped from the Medicaid program without any warning. Suddenly, she was living every parent’s worst nightmare: her child was sick, and there was nothing she could do about it…..

These income checks are a bureaucratic nightmare for families. More than once, parents have come to us for help because they were asked to provide proof of employment for companies they’d never even heard of.

Others received their letters days after the deadline for responding had passed. Families with hourly jobs whose incomes fluctuate month-to-month and those in rural communities, who work in seasonal industries like agriculture, can be especially hard hit.

In their Fort Worth Star-Telegram op-ed supporting the bill, a local school board member and a staff member of Children At Risk wrote:

We all want our students to have access to high-performing schools, with caring and involved teachers and administrators to provide them with the skills needed to grow and learn. But even the best education settings possible are meaningless if we do not have healthy children in the classrooms ready to learn.

And a number of leading Texas foundations focused on supporting children’s health published an op-ed in the Austin American-Statesman, outlining the ways that bill before the Legislature would improve efficiency:

One possible solution that 24 other states already implement is continuous coverage in Children’s Medicaid. Continuous coverage ensures children are enrolled for a full year at a time. Not only does it make life easier and healthier for families, but it saves administrative costs at the state level and improves efficiencies for doctors, health care centers and health plans. Leaders must understand that requesting paperwork from thousands of families every month requires the labor of considerable state personnel. Texas already employs continuous coverage for CHIP and it is the norm for those of us with commercial coverage. Families would still have the responsibility of proving eligibility and renewing coverage annually.

State lawmakers are on the verge of running out of time to move the Children’s Health Coverage Bill through the legislative process. Texans are clearly watching to see if they will support children’s health or squander this opportunity.