State should take extra steps to make sure that recipients receive eligibility reviews.
The pandemic is over, and the resumption of Medicaid eligibility reviews this spring has been anything but smooth.
Nearly 405,000 recipients in Texas were bounced from Medicaid rolls for procedural reasons, such as missing paperwork deadlines. Another 96,000 people lost benefits when they were deemed ineligible for Medicaid or the Children’s Health Insurance Program.
While it is easy to say that rules are rules and deadlines are deadlines, the Texas Health and Human Services Commission would be wise to make sure that recipients who otherwise would be eligible for Medicaid benefits aren’t tossed from the rolls without a proper eligibility review. The state should temporarily halt procedural denials and take extra steps to make sure that recipients get an actual eligibility review instead of relying on missed deadlines and other procedural mistakes to prune the rolls.
A brief reprieve would give recipients and the state time to correct a problem that would unnecessarily add to the ranks of the uninsured in Texas. The Medicaid process can be complicated and sometimes confusing, but red tape shouldn’t be a substitute for a meaningful eligibility review.
Based on the early eligibility reviews, 81% of Texans removed from Medicaid have lost benefits on procedural grounds, a denial rate that exceeds the national average by six percentage points. Health care advocates are rightly concerned that an unknown percentage of people who could be eligible for Medicaid coverage are without insurance. Texas already has the highest number of uninsured residents in the country and the most stringent eligibility rules. Texas also has declined to expand Medicaid coverage to more uninsured, low-income Texans under the Affordable Care Act.
Health care advocates say many of those denied are children who most likely would be eligible for Medicaid or another program if they received a full review. In addition to putting low-income families in an untenable position, removing recipients from the rolls without a review could make it more difficult for parents to see a doctor to get vaccinations and medical records that they need to enroll their children in school.
Without a doubt, some Texans will lose eligibility because they now exceed income requirements, their children have aged out of the program or for other change-of-life reasons. But their removal from Medicaid rolls for those reasons should be the result of an eligibility review. Otherwise, eligible low-income families, children and disabled adults will fall through the cracks, forgo medical treatment or end up in county hospital emergency rooms. And that is not good for these patients or taxpayers in this state.
The federal government wisely allowed Medicaid recipients to retain coverage during the pandemic to prevent low-income Americans from losing critical health care coverage in the middle of a national health emergency. Now Texas must make sure that procedural denials don’t strip eligible recipients of much needed benefits.
