Did you get kicked off Medicaid this year? Here's how to reapply in Texas
More than 5 million Texans rely on Medicaid coverage to access doctor’s appointments and manage chronic conditions. About 2 million of those people were added to Medicaid since 2020, and due to pandemic-era protections, they had continuous coverage throughout the last few years.
Those protections, which were a part of the federal public health emergency, ended in March. Since then, more than 917,000 Texans have been kicked off Medicaid, and more will lose coverage as the Texas Health and Human Services Commission (HHSC) continues the unwinding process.
People can renew their coverage online at YourTexasBenefits.com or by calling 211. There are also community partners to help with applications, in addition to Texas Health and Human Services Commission offices to apply in person.
Navigating public health options for care can be overwhelming, but here’s what you need to know to apply for and renew your coverage, plus tips from community providers and enrollment specialists.
In this article:
- Eligibility and income limits for Medicaid in Texas
- Process to renew Medicaid coverage in Texas
- Medicaid denials
- Other health programs Texans can access
Who is eligible for Medicaid in Texas? What are the Texas Medicaid income limits?
Medicaid in Texas covers children younger than18 years old and their caretakers, foster care youth, pregnant people, people with disabilities and mental health issues, and adults 65 years and older. The Centers for Medicare and Medicaid Services (CMS) federally manages the program, which covers low-income adults, children and families.
Each state sets its own income requirements for Medicaid eligibility, as a percentage of something called the Federal Poverty Level, or FPL. The FPL is calculated every year and determined by how many people are in a family and their combined income level.
Income is calculated by adding up things like wages, Social Security payments, pensions, and any school fellowships and scholarships. FPL is an administrative tool for federal programs like Head Start, SNAP, and WIC, along with the federal health programs like Medicaid and Medicare.
In Texas, income guidelines are based on family size and monthly income before taxes. For Children’s Medicaid, families have to make at or below this amount for their child to qualify for coverage:
|How many in your household? (Adults plus kids)||How much does the entire family make a month?|
|2||$2,186 a month|
|3||$2,756 a month|
|4||$3,325 a month|
|5||$3,895 a month|
|6||$4,465 a month|
|7||$5,035 a month|
|For more people in your house, add per person:||$570 a month|
Caretakers and parents can access Medicaid for their own health care coverage, but the income requirements are limited because Texas has not expanded Medicaid, which would cover an additional 1.4 million adults who don’t currently have health care coverage.
For example, an adult in a family of three in Washington, D.C., must make at or below $4,578 a month to qualify for Medicaid coverage. In Texas, that same person has to make at or below $251 a month to qualify.
Medicaid, including Children’s Medicaid, is free, and includes services like inpatient and outpatient hospital care, doctor’s visits, labs and x-rays, and transportation to medical appointments. It also includes mental health services, prescriptions, ambulance services, and comprehensive coverage for pregnant people like midwives.
Right now in Texas, pregnant people only qualify for two months of postpartum coverage, although lawmakers approved a 12-month Medicaid extension earlier this year that has not gone into effect yet.
How do you renew Medicaid coverage in Texas?
Diana Forester, the director of health policy for the statewide advocacy organization Texans Care for Children, said the state grouped people into three main cohorts for Medicaid renewals.
The first two cohorts, Forester said, were most likely made up of people who were no longer eligible, like kids who aged out, or people who were pregnant and already gave birth. She added the third cohort is probably kids who are still eligible for Medicaid coverage.
Even before someone gets a renewal letter or notice, Forester recommends people assemble their documentation, which includes:
- Something to confirm your identity and any other person in your house: a driver’s license, school ID, passport, birth certificate and any citizenship paperwork
- Something to confirm you live in Texas (must be from the past two months): a utility bill, rent receipt, letter from landlord, ID or mail with your name and address
- Something to confirm income from your job (must be from the past two months): a completed employment verification form from your employer, last two paychecks or pay stubs, or self-employment paperwork; the state will also need the most recent income tax return to verify income.
- Unemployment paperwork (if unemployed and receiving benefits)
- Any health care bills from the past three months that you want Medicaid to consider covering
People have 30 days to respond to renewal notices, but, Forester said, if people receive applications through the mail, the clock starts counting down when HHSC mails the application, not when the person receives it.
“Let's say it takes a week, week and a half for you to get that piece of mail that has that due date,” she said. “Now you have like two and a half weeks to upload those documents, might be a pay stub, might be proof of address. They're asking for a lot of personal information and it's hard to gather that stuff and get it in a timely manner.”
HHSC can take up to 45 days to process most Medicaid applications, and up to 90 days for “renewals based on disability status,” according to CMS guidelines. The state still has more than 331,000 renewals to complete since continuous Medicaid enrollment ended back in March.
“If you had a baby in March 2020, and you’ve been on Medicaid this whole time, and your baby’s going on Medicaid, you haven’t had to do a renewal for three years,” Forester said. “This process can seem very confusing and overwhelming. I am worried that those individuals are just going to be so frustrated with it, and they just can't get through the process and give up.”
How many Texans have lost Medicaid coverage this year?
As of Oct. 16, more than 917,000 Texans have lost coverage, 68% of those being kids. According to the Kaiser Family Foundation, Latino children, older adults, people with disabilities and people with limited English proficiency are most at risk for losing their Medicaid coverage.
“I think the unwinding shed a lot of light on a lot of the existing limitations and barriers in our eligibility system,” Forester said. “None of those are new.”
Some of those barriers, Forester said, are also issues with overall health care access.
Eligibility offices are only open during business hours, limiting availability for working parents or people without reliable transportation. The automated Texas phone system that helps answer questions about Medicaid 211 doesn’t have wait times when people call.
“The first page (will state) you have no activities for, you know, case one, two and three,” Forester said. “And then the second page will be like case one, two and three are about to lose coverage. Their notices contradict each other, it's not clear what they're asking. It's incredibly confusing.”
Her biggest piece of advice is to keep contact information, including people’s mailing addresses, up to date because that’s how Texans receive updates on their application and reminders to renew.
“This is part of the process,” Forester said. “It’s going to happen every 12 months.”
For the third cohort of renewals, HHSC announced earlier this month that those people have an additional 30 days to complete their paperwork.
Forester said that’s something she and other advocates have been asking the state to implement from the beginning, but the problem is people’s forms and renewal notices won’t have that extended timeline until after the original 30-day window has passed.
“It was decided last minute,” she said. “It's just kind of the continuing this trend of crisis mitigation. We could have done these things with enough time to make them really effective, but instead we did it at the very last minute and it's not going to go well.”
Tips on filling out a Medicaid application or renewal in Texas
Director of Patient Access Bethanne Keating works with the team at Parkland Health in Dallas to check patients’ eligibility for federal programs and charity funds.
She encourages people when filling out new or existing Medicaid applications to not leave anything blank, because the HHSC system requires all spaces in the forms to be filled.
“If there’s a blank, (the workers) won’t know what to put in,” she said. “It won’t let them process it. That’s the first thing, make sure you answer all the questions.”
Keating also said to double-check that every page of the application has been signed.
“People will forget,” she said. “The people that are processing applications are like, ‘We can’t process it. It’s not dated, it’s not signed, you’re missing a signature.’ They send it back. Those kinds of things slow (the process) down.”
Keating said people should find help if they don’t understand any part of the process. 211, or 877-541-7905, is the Texas number to call about health care benefit questions.
“Call them and say, ‘What do you need from me?’” she said. “Don’t ignore it because that will get things turned off quick.”
While it can be complicated to apply or renew, Keating said it’s important to “at least try,” even if people’s financial or family situations have changed and the case needs to be reworked.
“What harm does it do if you apply and then they tell you you're not eligible?” she said. “You'd be surprised how many times people are eligible. There are people out there that have answers for you.”
What happens if your Medicaid application has been denied?
Both Keating from Parkland Health and Forester from Texans Care for Children said a denial doesn’t necessarily mean someone can’t get Medicaid coverage.
“Sometimes when they deny a case, it’s just that either they don’t have all the information or they misapply the rule,” Keating said. “You need to push back a little bit and say, ‘Hey, wait a minute, can you look at this again? Why are you saying I’m denied? This doesn’t make sense to me.’”
Keating said HHSC workers are “processing cases after cases after cases, the volume is just tremendous,” which can lead to errors.
“We have a ton of new eligibility workers, and people are still learning,” Forester said. “It’s a lot to learn. I would encourage [people] to keep fighting and trying to get through even if you do get denied.”
Forester said people have 90 days from the date of the denial or reduction in services to appeal the decision. It’s still possible to appeal a decision after 90 days, but there’s no guarantee the state will review the case, according to HHSC.
The appeals process is called a “fair hearing,” which can take up to 90 days to complete. According to HHSC, most hearings are over the phone and last about an hour, where the agency will go over paperwork and the person’s application.
“The tricky thing is you can't do this online,” Forester said. “Because if you look online, your case is denied, and so it won't let you do anything else. And it’s easier to reinstate a case than to process a new application. If you do a completely new application, you get bumped to the back of the line.”
What are procedural denials?
Of the more than 917,000 people who have lost coverage in Texas, more than 70% of those were “procedural denials,” which Forester said means “the state did not have enough information by the deadline to determine if you were eligible.”
That could be anything from missing a signature on one page of the application to not attaching the right income paperwork.
“I think there’s a lot of emphasis on ‘procedural denial means the person didn’t respond, and that’s their fault,’” she said. “I think it’s a lot harder to talk about why they didn’t respond—are there unintended barriers in our system?”
Forester said the procedural denial rate is concerning because Texas already has one of the highest uninsured rates in the country.
The latest census data showed more than 16% of Texans are uninsured, which is “the highest uninsured rate for the second year in a row.” Dallas-Fort Worth and Houston-The Woodlands-Sugarland are two of the most uninsured metropolitan areas in the country.
“I think anybody who interacts with the health care system in our state knows that it is strained,” she said. “The uninsured rate affects all of us in ways that we don't directly see.”
A few of those impacts, Forester said, are provider shortages, hospital closures, more severe chronic illnesses and overcrowded emergency rooms.
“I think as a state, our goal is to not use taxpayer money to pay for anybody who’s not eligible,” she said. “And if that’s your goal, we are doing that. We’re also inadvertently kicking off a lot of people that probably are still eligible.”
What other kinds of health insurance can you access in Texas?
If you no longer qualify for Medicaid in Texas, you do have options—but they’re limited.
Children who don’t qualify for Medicaid might still qualify for CHIP, the Children’s Health Insurance Program. The income levels for CHIP are slightly higher, and enrollment fees and copays are based on income. According to HHSC, enrollment fees are $50 or less yearly for an entire family, with doctors’ visits and other health costs varying anywhere from $3 to $35.
Families have to make at or below this amount for their child to qualify for CHIP coverage:
|How many in your household? (Adults plus kids)||How much does the entire family make a month?|
|2||$3,304 a month|
|3||$4,165 a month|
|4||$5,025 a month|
|5||$5,886 a month|
|6||$6,747 a month|
|7||$7,608 a month|
|For more people in your house, add per person:||$861 a month|
Pregnant people who no longer qualify for Medicaid may still be eligible for Healthy Texas Women, which is available to Texas women between 15 and 44 years old who don’t have health insurance and meet specific income requirements.
The program does not provide comprehensive coverage like Medicaid, but does offer free women’s health and family planning services, like STI testing, mammograms, contraceptives and screening and treatment for postpartum depression.
People can also search for plans on the Affordable Care Act Marketplace, said Forester, “but if you don’t feel like you can afford that, or your immigration status might not be legal, there aren’t a ton of options in Texas. We have the highest uninsured rate for a reason.”
With the large number of procedural denials, Forester is also concerned people who would qualify for Healthy Texas Women aren’t getting transferred.
“If you're choosing to go to the marketplace to get full coverage, that's awesome,” she said. “But I'm just skeptical that's what's happening. I'm skeptical 90,000 women chose that over Healthy Texas Women. I just don't think they're getting the info.”
Keating with Parkland Health said there are options outside of health insurance, like charity hospital programs, or sliding scale clinics like Federally Qualified Health Centers, but her team works to connect people with federal programs first if they’re eligible.
“It’s hard,” she said. “Day in and day out, these patients come in crying, and they're just like, ‘What do you want me to do? You just want me to die? No one wants to help me.’ And sometimes it's as simple as no one's explained things to them. They're just looking for some information, some knowledge, some guidance.”
Texas will review Medicaid applications through June 2024. Forester hopes the issues with this process will lead to more funding and resources for HHSC during the next legislative session.
“It's complicated, and it could be better,” she said. “But all that takes time and funding and energy and resources. And we haven't really invested a lot in our eligibility system in a long time.”
Contact information to apply for Medicaid and CHIP
Apply and renew benefits online at YourTexasBenefits.com. Benefits can include Medicaid, CHIP, SNAP, and support services like resources for caregivers and mental health programs.
Call 211 or 877-541-7905 for help over the phone with applications. To apply in person, find a Texas Health and Human Services benefits office by searching at this link.
Medicaid-enrolled clinics, hospitals, and community partners can also help you fill out an application. You can search for these places at this link, but here’s a sample list:
Parkland Health Patient Financial Services – 214-590-8831
Los Barrios Unidos Community Clinic – 214-540-0300
Mosaic Family Services - 214-821-5393
The Concilio - 214-818-0481
Children’s Defense Fund: East Texas office (Smith, Cherokee, Rusk and Gregg counties) – 903-253-8325
Rio Grande Valley (Hidalgo, Cameron and Willacy counties) – 956-483-1544
If you have questions or tips, email firstname.lastname@example.org
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