Houston Chronicle: Medicaid disenrollment skyrockets in Texas, amid reports of system errors

WASHINGTON — Texas is disenrolling Medicaid recipients at the fastest rate in the country, raising questions about how carefully the state health department is analyzing patient's financial data as the nation moves to return Medicaid rolls closer to pre-pandemic levels.

More than 600,000 Medicaid recipients in Texas have lost coverage since April, a 72 percent disenrollment rate that dwarfed a 36 percent rate in Louisiana and 41 percent in New Mexico, according to a recent report by the nonprofit healthcare research organization KFF, formerly the Kaiser Family Foundation.

The Biden administration earlier this year lifted a ban put in place during the COVID-19 outbreak that restricted states from removing people from Medicaid rolls, part of a larger strategy to rein in surging healthcare spending.

Experts predicted close to 1 million people, or 20 percent of Texas's Medicaid enrollment, would no longer qualify and lose their coverage. So far, the disenrollment rate has been much higher than that. State health officials said from the outset there would be a surge in disenrollments during the first six months of their year-long review process, as they focused on those recipients most likely to have fallen outside the program's income limits, as have other states.

But the fact Texas is disenrolling so many of the cases it has reviewed could be sign the computer systems and bureaucratic processes set up to review the eligibility of the 5.9 million people enrolled in Medicaid in Texas in April could be breaking down, said Bradley Corallo, a senior policy analyst at KFF.

"Are workers going to be overwhelmed, and can the system handle that volume of renewals? It's a super complicated process to make these determinations," he said. "It's early in the unwinding. On the other hand, we know states that are also prioritizing those recipients most likely to lose coverage have not seen such high rates."

A spokesperson for the Texas Health and Human Services Commission declined to make officials available for an interview, but in a statement said they had hired more staff to handle the high workload and were working closely with the Biden administration to "ensure that the redetermination process operates as smoothly as possible."

"Redetermining Medicaid eligibility for approximately 6 million Texans over 12 months is a massive undertaking, and (the commission) has planned this unwinding effort for more than a year." the spokesperson said in an email.

Hanging over the state health department is a whistleblower letter sent to Texas Health Commissioner Cecile Young last month, warning that 80,000 people had erroneously lost coverage during the review due to a computer error, including several thousand pregnant women. The health department subsequently reinstated coverage for most of the 80,000, but in a follow up letter last week the whistleblowers, who have remained anonymous, said, "there have been minimal changes in the situation."

Last week, every Democratic in the state's congressional delegation signed a letter to the head of the Center of Medicare and Medicaid Services asking for a pause the state's Medicaid review to "prevent the catastrophic loss of coverage occurring in Texas."

Rep. Lloyd Doggett, D-Austin, said the rapid rate of disenrollment was indicative of a Republican state government that had a "general indifference to poor and disadvantaged people."

"The priority is, 'Lets keep cost at a minimum,'" he said. “Eliminate as many as possible from these rolls without regard as to whether there is significant collateral damage.”

The Center for Medicare and Medicaid Services did not respond for a request for comment on the call for a pause, but at a meeting between Doggett's staff and CMMS officials last week no solutions were offered, Doggett said.

"I wouldn't say there was total disinterest like the state, but the response has been entirely too weak," he said.

Under Texas' strict Medicaid rules, rolls are almost entirely made up of children, pregnant women and new mothers, experts say.

The loss of coverage for children whose parents are likely uninsured themselves is likely to cause greater difficulty for low-income families who already struggle to get access to healthcare, said Adrienne Lloyd, health policy manager at the nonprofit Children's Defense Fund of Texas.

The state health commission has said it is working to get children who lose Medicaid coverage into the Children's Health Insurance Program, which provides similar coverage to Medicaid.

But the approximately 400,000 children who lost coverage for procedural reasons — whether because of missing paperwork or necessary documentation — could not be moved to CHIP, Lloyd said. And once coverage is lost, getting back on Medicaid rolls is an arduous process, requiring lengthy forms and documentation that many low income families have difficulty completing.

"There are a lot of people in Texas losing their coverage, and there's not a good door to get back in," she said. "The system is in chaos."