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Millions of Texans could lose Medicaid coverage as pandemic protections end

A nurse talks to a patient in the emergency room at Salem Hospital in Salem, Ore., on Aug. 20, 2021.
Andrew Selsky/AP
/
AP
A nurse talks to a patient in the emergency room at Salem Hospital in Salem, Ore., on Aug. 20, 2021.

Here’s what to know about the end of emergency health care coverage for low-income Texans.

When the COVID-19 pandemic began in 2020, the federal government declared a public health emergency, which helped expand access to testing, treatment and telehealth options. It also increased funding to state Medicaid programs and ensured no one would lose coverage during the pandemic.

But continuous Medicaid enrollment is set to end on March 31, which means millions of Texans could lose coverage for the first time in three years. Here are some key things to know as protections come to an end.

How many people does this affect?

The latest data from January 2023 shows about 5.8 million Texans are currently enrolled in Medicaid. That includes parents, children, the elderly, people with disabilities and pregnant people. About 2 million people have been added to Medicaid since December 2019, and have retained coverage since then.

Diana Forester, the director of health policy for Texans Care for Children, said there are a few reasons for the increase in enrolled Medicaid patients.

“We have a bigger population,” she said. “We keep having people move to Texas. And then we know COVID affected families financially, and with inflation, people are struggling a lot more than they were before. I think a lot of people who are eligible since we’ve been in this time period haven’t been on benefits before.”

What’s happening now that continuous enrollment in Medicaid is ending?

Continuous enrollment is set to end on March 31. The Texas Health and Human Services Commission, which oversees enrollment in public health programs in the state, sent out information online and through the mail on this deadline and ways to re-enroll for people who are eligible.

But Forester has some worries about the process: this is the first time many people will have to do a renewal, which she says can be daunting. She's also worried people might not get notice of the change in the mail if they've moved.

“The bad address thing really hampers the ability for people to receive information timely and to be able to respond timely,” she said.

Another issue is processing time: HHSC usually has 45 days to approve or deny an application. The latest data on timeliness from February 2023 shows that’s accurate for about half of applications, but the other half are taking beyond 45 days.

“They’re not doing any renewals right now, and they still have a backlog,” said Forester. “I don’t think we’re in the best place that we could be in preparation for this, and it’s this huge, monumental task. It’s the perfect storm, unfortunately.”

Who is most at risk?

Forester said she’s concerned for pregnant people, who will now lose coverage two months after giving birth. That’s because Texas has yet to expand Medicaid coverage. About a half million Texans are currently on pregnancy Medicaid, according to HHSC data from January 2023.

Texas is in the top 15 states in the country for maternal mortality, with bleeding, mental health issues and chronic conditions as some of the leading causes of death.

“People are coming into pregnancy not healthy, and so they're having really rough outcomes with their pregnancies,” she said.

Texas lawmakers have introduced bills extending pregnancy Medicaid coverage to 12 months postpartum this legislative session. Forester said extending coverage will help improve pregnancy and infant health.

“Extended coverage in other states has been around for a while now,” she said. “There’s a lot of data out there that shows that having continued access to health care leads to less preterm babies, less low birth weight babies, less maternal mortality, and overall, a better first year of life for that baby.”

What can people do if they’re on Medicaid now or unsure of their eligibility?

People can begin the renewal process online at YourTexasBenefits.com, over the phone by calling 2-1-1 or 877-541-7905, or in person at an HHSC office or community partner. The state’s website has a tool to find an office or a community partner based on county and zip code. But Forester encourages people to start early.

“If you can get electronic access to your case, that is the best way to get timely updates on what's happening,” she said.

She encourages people to make sure HHSC has all their updated information, including address, cell phone number and email, plus if anyone has changed jobs or already had their baby.

If people wait, Forester said it might take a while to get connected to someone who can help.

“We know wait times are going to be crazy, and we know it’s going to be really hard,” she said. “We have this cushion right now. March is our golden month. Let's try to get our updated info in so that we don't have to freak out when we get those notices in April.”

Got a tip? Email Elena Rivera at erivera@kera.org. You can follow Elena on Twitter @elenaiswriting.

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Elena Rivera is the health reporter at KERA. Before moving to Dallas, Elena covered health in Southern Colorado for KRCC and Colorado Public Radio. Her stories covered pandemic mental health support, rural community health access issues and vaccine equity across the region.