Uninsured Texans. challenges and policy solutions

This is part 2 of a blog series examining data from the 2022 Census and providing insight into the uninsured rate in Texas. Read part 1 here.

Policy solutions

All Texans, regardless of our race, income or hometown, deserve to be able to see a doctor when we get sick. When Texas leaders fail to invest in our people and the programs that keep us fed and healthy, Texans and our families suffer. There are several policy solutions at the state level to increase access to health care for all Texans.

Medicaid expansion

It’s Texas One of ten US states which did not expand Medicaid to low-income adults. The federal government has offered billions of dollars to Texas to provide Medicaid coverage to both low-income parents and adults without dependent children at home. Experts evaluate 1.4 million The uninsured in Texas could get coverage if the state takes this step, the majority are people of color.

Improving the compliance system

At least 495,000 uninsured Texas children were eligible for Medicaid or CHIP coverage in 2021 but were not enrolled. The Texas Legislature and the Health and Human Services Commission (HHSC) must work to remove barriers to enrollment for qualified children and adults. To ensure that all Medicaid and CHIP eligibles can easily enroll and remain enrolled, the state must operate the eligibility system appropriately, increase efficiency by streamlining the system and using reliable data sources to extend coverage, and establish a clear eligibility pathway for children. , and invest in upgrading the website and mobile app they use for public benefits in Texas (Your Texas Benefits).

The Texas Legislature had an opportunity to address the large number of eligible but uninsured children during the 88th legislative session. HB 1599, which would have allowed HHSC to use already-approved information from other state programs to enroll eligible children in Medicaid and CHIP using the express-lane option. This bill passed the House overwhelmingly, but later died in the Senate without a hearing. It is quite difficult to get Medicaid coverage in Texas, but keeping it comes with its battles. No state does worse than use data matching reduce red tape for families renewing Medicaid. Texas has been successful in matching verified data alone, accelerating updates at discharge by 3%, just one-tenth of the national average. This means parents must fax, mail or upload their pay stubs at almost every renewal, even in some cases when HHSC already knows what the family is making from the state wage data it has on hand. The lack of data consistency and simplification not only burdens families, but also places an undue burden on an already overburdened state jurisdiction system.

In addition to the hurdles for families enrolling in Medicaid and CHIP, HHSC’s Access and Eligibility Division has struggled for years to process Medicaid and SNAP applications without delays and backlogs. During the 88th session, lawmakers appropriated an additional $123 million to HHSC, part of which was intended to increase staffing during the Medicaid discharge. HHSC recently reports its jurisdiction’s labor force vacancy rate fell to 3.9% in September 2023 (from 21.1% in March 2022). However, only 318 of the 642 temporarily liquidated positions have been filled as of this month. Even with this increase in staffing and salary increases, Medicaid and SNAP filing wait times and delays are currently increasing, highlighting the need to streamline the system in addition to staffing efforts.

Keep registrations growing in the market

In recent years, Texas has seen record enrollment in the Affordable Care Act (HealthCare.Gov) market, thanks to increased subsidies for families, enrollment assistance, marketing campaigns and federal investment. state action which made market coverage more affordable earlier in the year. By 2023, approx 2.4 million Texans insured through the Marketplace, a 31% increase from 2022. About 2 of our 5 million uninsured are eligible for Marketplace subsidies, suggesting that even stronger communication and marketing could boost enrollment in the coming years. It is important to continue this enrollment growth as the discharge process pushes Texans out of their health insurance.

Challenges

Unloading Fallout

Earlier this year, the Texas HHSC began the monumental process of retesting Medicaid eligibility for everyone currently enrolled after pandemic-era coverage protections ended. This process is called Medicaid discharge and for Texans it will mostly end in December. Despite warnings from lawyers several months before the liquidation process, the process has been chaotic and damaging. About 1.2 million Texans have dropped their Medicaid coverage since the process began, two-thirds of whom lost coverage without HHSC determining whether they remained eligible (called a “procedural denial”). : We expect the number of Texans losing Medicaid to continue to grow. Alarming, approx 500,000 Texas children were kicked off Medicaid even though they weren’t determined to be eligible. There are several reasons why this already difficult process is going so poorly in Texas, including the state’s unprecedented speed without the right staff or technology to do the job right, and the failure to adopt best-practice streamlining measures that could have eased already the workload. an overburdened and overwhelmed jurisdiction system. The 2022 uninsured figures discussed in Part 1 do not reflect the large number of Texans who will be dropped from health insurance in the coming months despite remaining eligible during the repeal. The impact of this chaotic process on Texas’ uninsured rate likely won’t be seen until the 2023 U.S. Census data is released next year.

A chilling effect on immigrant and mixed-status families

One in four US citizen children living in Texas has a parent who is not a US citizen (of any immigration status, legal or undocumented). Parents often have questions about enrolling their US citizen or legal immigrant children in available coverage. Ensuring strong Medicaid access that addresses the concerns of families with mixed immigration status will help ensure that all eligible children are successfully covered.

HHSC outreach information should include updated materials that clearly explain eligibility rules for both noncitizens and their citizen and eligible immigrant family members. Outreach must also make clear that children’s eligible access to health care will not affect their parents’ immigration status, as fear of access to government services in the immigrant community has caused families to forgo coverage. Tens of thousands of US citizens and legally introduce children in recent years. Without sound, accurate information provided to legally represented immigrant families, eligible children will remain uninsured.