New TX Data Shows Huge Delay for Medicaid Applications
For Immediate Release
September 14, 2023
Contact: Peter Clark, [email protected]
Advocates Warn that Texas Kids Are Missing Out on Health Care
Austin - Data released this week by the Texas Health and Human Services Commission show the state has a large backlog of Medicaid health insurance applications that it has not processed, raising concerns that Texas children are missing out on health care even though they are eligible for Medicaid and their families have submitted applications. The new data also raise concerns that when the state is removing moms from Medicaid for Pregnant Women as pandemic-era Medicaid rules end, in many cases it is failing to transfer them to Healthy Texas Women or HealthCare.Gov.
“Texas kids should not be stuck month after month waiting to find out if they can go see their doctor,” said Diana Forester, Director of Health Policy at Texans Care for Children. “When kids are eligible for health insurance and their families have jumped through every hoop the state puts in front of them, our state leaders need to make sure those applications are processed on time so kids can go to the doctor or get their medications.”
The data are included in the September report that HHSC submitted to the federal government as part of the “unwinding” of pandemic-era Medicaid rules that allowed enrollees to remain covered without renewing their coverage. The report contains data on the latest group to go through the unwinding renewal process, composed of Texans enrolled in Medicaid for Pregnant Women, as well as data on regular annual renewals for Texans who enrolled in Medicaid a year ago. Data previously released in August for Medicaid renewals from April through July revealed that the state did not determine the eligibility status of most of the children it removed from Medicaid during that time period.
The September report shows that the state still has not processed 54,000 Medicaid applications submitted in or before March. The report does not indicate how many additional applications submitted since March are still waiting to be processed. A separate report from HHSC shows that 24 percent of Medicaid applications processed by the state in August were delayed beyond the standard for timely completion. The data on renewals, as opposed to applications, also underscore the current delay. Of the 770,000 Medicaid enrollees due for renewal during August, 247,000 have not been processed yet. Additional background on the state’s ongoing delays is available here. The delays suggest that children and other Texans who are eligible for Medicaid — including those who the state erroneously removed from Medicaid — are stuck waiting for many months for health insurance, which can lead to troubling delays in medical care.
“We’ve seen warning signs the eligibility system is strained in waves over the last year” said Karla Martinez, Policy Analyst at Every Texan. “Now, the tidal wave of renewals Texas sent in the last three months is starting to hit, and backlogs for people newly applying continue to grow. Unfortunately, the harm of these delays falls on our neighbors who have to choose which bills they’ll pay this month as their paperwork grows older and they wait to hear from the state whether they’ll get the food and health care they need.”
The September report shows that a total of 770,000 Texans were subject to the Medicaid renewal process in August. That group is mostly composed of moms who enrolled in Medicaid for Pregnant Women during the pandemic but also includes regular renewals for approximately 225,000 Texans who enrolled in Medicaid a year ago. In addition to the 247,000 renewals that are still pending, 195,000 Texans were confirmed eligible and remained enrolled; 125,000 were confirmed ineligible, removed from Medicaid, and transferred to CHIP or the HealthCare.Gov Marketplace; and 203,000 were removed from coverage due to “procedural denials.”
The data on procedural denials raise concerns that when the state removes moms from Medicaid for Pregnant Women, in many cases it is not transferring them to other health programs — such as Healthy Texas Women or subsidized insurance on HealthCare.Gov — even if they are eligible. When procedural denials occur, the state does not transfer enrollees to other health programs. Procedural denials can happen when the state sends renewal information to the wrong mailing addresses, Texans run into bureaucratic delays with the state when they try to renew their insurance, or Texans choose not to return their renewal forms.
To address the delays and other challenges, advocates called on agency and state leaders to take a number of steps, including:
Provide updates on the scope of paperwork backlogs and whether backlogs are causing delayed entry to prenatal care for pregnant women or eligible families to run out of SNAP nutrition benefits;
Quickly ensure Texans can complete renewals and upload documents via the state’s website and mobile app in the 90 days following the loss of Medicaid to reduce the number of people who must re-apply;
Take immediate steps to boost Texas’ nearly-worst-in-the-nation rate of data-driven (“ex-parte”) renewals; and
Over the longer term, invest in fixing and maintaining its eligibility computer system. Lack of maintenance and system errors too often force eligibility workers to use time-consuming manual workarounds.
“Every parent worries about their child getting hurt or seriously ill, and that’s especially true when your child’s Medicaid case is in limbo,” said Graciela Camarena, Child Health Outreach Program Director at Children’s Defense Fund-Texas, whose team assists families in the Rio Grande Valley. “When children get kicked off for procedural reasons, they are not referred to other affordable health care options, like CHIP or HealthCare.Gov. Worst of all, families may not even know their Medicaid has ended until they show up at the doctor’s office. We’re seeing so many families who aren’t receiving their notices to renew. When they do receive a notice, it’s to let them know a decision has already been made, and their coverage is ending in 1 or 2 weeks—which simply isn’t enough time for them to figure out how to keep their child’s health insurance.”
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