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Fight To Cover Uninsured Texans Continues: Health Care Leaders Lobby To Keep Medicaid Extension

Photo of Parkland Hospital
"As the public hospital for Dallas County 75% of our patients are uninsured or on Medicaid," Margaret Roche, Director of 1115 Waiver Activities Parkland Health & Hospital System said.


The fight to cover uninsured Texans isn't new. For a decade, Texas Republican leaders have said no to Democrats in Washington who want them to expand Medicaid coverage.

Now, the Biden administration might cut off Medicaid coverage unless Lone Star State leaders change their mind. Federal funding of Medicaid in Texas is set to expire in October of next year.

In Dallas on Wednesday, health advocates and uninsured Texans talked to officials from the Texas Health and Human Services Commission about the need for longterm health care in the state.

They are urging the federal government to extend their so-called 1115 waiver,which Texas has had with the U.S. Centers for Medicare and Medicaid Services since 2011.

Texas HHSC is holding three public hearings where Texans have a chance to comment on the extension as part of the application process.

"One in 5 Texans has no health insurance. So when you walk down the street, every fifth person has no health insurance. We need comprehensive coverage," Steve Love, the President of the Dallas-Fort Worth Hospital Council said.

He leads a coalition of 90 hospitals across North Texas, who are in support of the extension of the existing Medicaid program.

Love adds that losing funding would put many health care programs that help low-income families, children and individuals with disabilities in jeopardy.

"We have over 4 million people in Medicaid in Texas," Brittani Bilse, director of strategy at the Texas Health & Human Services Commission. "Almost 95% are in Medicaid managed care."

Last month, a bill that would have expanded billions of federal dollars in health coverage for uninsured Texanswas declined during this year’s legislative session by Texas lawmakers.

The Texas Tribune reports that several health officials say the number of uninsured Texans has grown since more than a million Texans lost jobs and, in many cases health coverage, because of the COVID-19 pandemic.

Later, Texas Attorney General Ken Paxton filed a lawsuit against the Biden administration over its decision to rescind the Trump administration's extension of the 1115 waiver.

That decision does not stop the funding immediately or in the current waiver, but will after October 2022. The lost funding will result in Texas hospitals ceasing to provide health care to uninsured individuals and to continue innovative health care projects that serve low-income Texans — often mental health services.

The 1115 waiver was originally granted to Texas as a temporary funding bridge. Meanwhile the state was tasked with developing a plan to expand its Medicaid program under the Affordable Care Act of 2010, but that never happened — the U.S. Supreme Court ruled in 2012 that states couldn't do that.

If not extended local hospitals will take a hit.

"As the public hospital for Dallas County 75% of our patients are uninsured or on Medicaid," Margaret Roche, Director of 1115 Waiver Activities Parkland Health & Hospital System said.

"This waiver has been a critical funding stream for the health system. Without it, Parkland would be unable to provide the level of outpatient care that we currently provide."

Roche hopes the Biden administration will step in and provide the funding needed to continue serving Texans.

Dallas' public hearing was the first of three. The next one will be held virtually on June 10. And the following will be in Austin on June 15. You can register to participate at

Got a tip? Alejandra Martinez is a Report For America corps member and writes about the impact of COVID-19 on underserved communities for KERA News. Email Alejandra at You can follow Alejandra on Twitter @alereports.

KERA News is made possible through the generosity of our members. If you find this reporting valuable, consider making a tax-deductible gifttoday. Thank you.

Alejandra Martinez is a reporter for KERA and The Texas Newsroom through Report for America (RFA). She's covering the impact of COVID-19 on underserved communities and the city of Dallas.