Since April, states across the country have been kicking people off Medicaid, and no state has kicked off more people than Texas. We’re at 1.7 million. And counting.
Some of this is right-sizing. Medicaid is health insurance for low-income households, paid for by both federal and state governments. After several years of pandemic-era protections, people who have aged out or who now earn too much to qualify are no longer covered by the program, and it’s up to the states to sort all that out. Texas is a big state, so it seems logical that our numbers would be high.
But Texas isn’t just removing families for good reasons. More than 858,000 children lost coverage for missing signatures, late paperwork or other procedural reasons — issues that have nothing to do with whether they should qualify or not, kicking out kids whose families might have to decide between an inhaler and dinner, between medication and bills.
While filling out the application and gathering the documents that it requires, people hit all sorts of snags. Mail gets delayed or sent to an old address. Sometimes the forms are hard to find in the language the person speaks. Sometimes the state’s computer system kicks users off because they’re taking too long.
Yes, the state has made some effort to improve matters. It’s loosened some requirements, and Texas Health and Human Services dispatched loads of robocalls, emails text messages and such to help people learn about the process.
But why should the process be so hard in the first place? Especially when it could be much, much simpler.
Every state employs some version of a process called “data-driven” renewal, generally recognized as an accurate and efficient way to keep eligible people in the program minus all the hassle. Also known as auto-renewal or ex parte renewal, it uses reliable data sources, such as the Texas Workforce Commission and Social Security, to assess quickly whether an individual still qualifies. It entirely spares people from filling out a renewal application and gathering all those documents themselves. Plus, they dodge all the possible mishaps.
For the first time, thanks to federal reporting requirements, we now know how Texas stacks up compared to other states when it comes to data-driven renewal. And it’s bad. Dead last bad. So bad that this month Texas, along with a handful of other states, received a scolding letter from the federal government, urging it, in part, to do a better job.
Just 2.7% of people in Texas considered for renewal were approved via the data-driven process, according to an analysis by KFF, a nonpartisan health policy research group. That’s compared to a national average of roughly 31%.
“If we could just get up to the average, we’d have so many eligible kids who aren’t churning in and out of the program,” said Stacey Pogue, a senior policy analyst at Every Texan.
The unnecessary bureaucracy seems deliberate, given Texas’ general stinginess with Medicaid. The state has failed to expand Medicaid, beyond only recently extending it for new mothers, and has woefully poor coverage of children to begin with.
We don’t doubt that workers at the state’s health and human services commission are diligent and would rather see eligible people covered than not. What we question is why our leaders don’t set our agencies up to succeed. If Gov. Greg Abbott, Lt. Gov. Dan Patrick and Texas lawmakers value life as much as they claim, why isn’t the state at the top of the list for getting eligible children covered by Medicaid? They should spend the time before the next legislative session figuring it out.
“It boils down to, we make choices about how hard we want parents to work to keep their kids covered,” said Pogue. “And I think Texas often makes the choice to say it shouldn’t be easy.”
In what should be a win-win scenario, Texas is choosing to lose.
