Quorum Report: Report: Texas saw progress on insurance coverage in height of pandemic, but is slipping again amid inaction from Abbott

“No state does a worse job at renewal than Texas”

A new report from the Georgetown University Center for Children and Families found the number of children insured under Medicaid in Texas and elsewhere increased during the COVID-19 public health emergency.

But with pandemic-era continuing coverage ending, those numbers are declining as part of the so-called “Medicaid unwinding” removing otherwise qualified people from the program, which is also the largest insurance program in the country for children.

According to the report, nationally 3.9 million children were uninsured in 2022 – tying 2017 for the second-lowest number in recent memory. The uninsured rate for children was 5.1 percent in 2022, compared to 5.7 percent. in 2019.

Texas made gains in that period, but still was dead last for coverage and has six of the top 10 worst metro areas nationwide for children’s coverage: Sherman, the Rio Grande Valley, Beaumont-Port Arthur, Midland, Abilene, and El Paso.

Before the pandemic, nearly one million Texas children did not have coverage. But thanks to 2020-era laws, more than 140,000 children gained coverage in Texas, the largest increase in the country, 854,000 remained without coverage in 2022. And with otherwise qualified people losing coverage (again) for paperwork errors and technical reasons, among other problems, the number is likely to rise.

“Texas’s [gains] illustrates how Medicaid coverage was crucial,” said Stacey Pogue, senior policy analyst at Every Texan. “Now we’re back to business as usual.”

The state, she said, makes it harder for those in need to apply.

“No state does a worse job at renewal than Texas,” she said.

Some of those problems seem to be a feature, not a bug.

Community groups find that people seeking to renew will be denied because the packet goes to the wrong address, are only in two languages (English and Spanish), or have inaccurate deadlines. That’s not to mention the website, which officials urge people use to renew, is frequently down. Call center waits tend to be up to an hour, and of course they are not open during evening hours when the working poor would be able to call.

But the issue is not staffing alone.

While the Health and Human Services Commission received an increase in funding and more staff to meet demands, including hiring more workers and implementing merit pay and salary adjustments, the training process is nevertheless intense and turnover is high.

The state auditor’s 2022 turnover report found that HHSC had the third highest turnover rate (26.3 percent) after the Juvenile Justice and Criminal Justice Department (combined 26.4 percent).

In April, HHSC announced it would resume the federal requirement that states conduct renewal determination for Medicaid recipients with an expected winddown finished by May 2024.

Dr. Valerie Smith, a pediatrician from Tyler and president-elect of the Texas Pediatric Society board, put a human face on losing coverage.

During a discussion on Wednesday morning, Dr. Smith mentioned a patient whose emergency surgery and subsequent care saved her life. Last week, that mother lost her insurance coverage. Another patient was diagnosed with ADHD but couldn’t begin care because he lost coverage as well.

Heartbroken and choking up, Dr. Smith urged resuming coverage for these patients.

Some states are doing that. In Kentucky, whose Democratic governor was just reelected in that very red state, children are currently exempt from the “unwinding.” In North Carolina, the Democratic governor in the otherwise Republican state implemented a similar rule.

But in Texas, Pogue said there’s been no similar leadership on the issue.