How the Texas Legislature Can Improve Access to Health Coverage
Conversations about improving access to health coverage are starting to pick up at the Texas Legislature, with a hearing scheduled for next Tuesday on “recommendations that help individuals obtain health care coverage” as well as other topics. This blog post offers a brief summary of some of the health coverage challenges and opportunities that state leaders must address.
Here’s a look at the landscape:
Comprehensive health insurance, whether through Medicaid or other sources, improves access to health care. Uninsured individuals typically must wait longer to seek medical care, leading to worse health outcomes and higher costs for families and taxpayers. Kids with Medicaid “are more likely to have a usual source of care, well-child check-up and a specialist visit compared to uninsured children.”
Texas has the worst uninsured rate in the United States, including the nation’s highest rate for women of childbearing age with low incomes and for children. Among children under age six, the worst rates are in the Lubbock area, West Texas, and the Dallas Metroplex, although the rates are very high throughout the state.
Approximately half of the uninsured kids in Texas are eligible for Medicaid or CHIP, suggesting that the Legislature could make significant progress by addressing the barriers and long delays that families run into when they attempt to sign up their eligible kids for health coverage.
Here are Some of the ways the Legislature can help Texans obtain comprehensive health insurance:
Pass Medicaid expansion. It’s the biggest step the Legislature could take to reduce the state’s uninsured rate. It would expand eligibility for Medicaid health insurance to include adults with incomes below the poverty line — meaning folks who are currently in the coverage “gap” — and adults slightly above the line. It would also indirectly reduce the uninsured rate for kids through the “welcome mat” effect, in which parents enroll their currently eligible kids once they connect with Medicaid.
Pass “Express Lane” enrollment for kids who are already eligible for Medicaid or CHIP. The proposal would allow the Health and Human Services Commission to use already-verified information, such as a child’s enrollment in SNAP, as an indicator for Medicaid and CHIP eligibility. During the 2023 legislative session, this bipartisan bill by Representative Bucy, Harless, Jetton, Oliverson, and Bonnen overwhelmingly passed the Texas House but did not pass the Senate.
Invest in upgrading the technology in the state’s Medicaid enrollment system. One reason so many eligible Texans are unenrolled and uninsured is because the state’s enrollment system over relies on manual processes and paperwork and underuses data and technology. For example, applications and renewal forms that Texans fill out online must be re-entered into the system manually by eligibility staff, creating unnecessary delays that could be reduced if HHSC used technology that did not require staff to manually input information.
Improve language access and Medicaid outreach that addresses concerns of mixed-immigration status families. One in four Texas kids lives in a mixed-status household. (Note that undocumented immigrants are NOT eligible for Medicaid.) To ensure meaningful language access to Medicaid/CHIP, the state should make applications, notices, and outreach materials available in multiple languages, not just English and sometimes Spanish.
Address disruptions in Medicaid coverage for newborn babies. If a mother is enrolled in Medicaid insurance when she delivers her baby, under federal law her newborn is eligible and must be automatically enrolled in Medicaid at birth and through the first full year of life. However, over 60,000 Texas babies per year experience coverage interruption during the first year of their life, indicating that the automatic process is not working.