More than 40,000 pregnant people in Texas waited more than a month for the state to process their Medicaid applications – which an advocacy group said could delay vital prenatal care.
Texans Care for Children recently released data it received from the Texas Health and Human Services Commission, or HHSC, that shows between March 2025 and this February almost 24,000 people waited more than 60 days. A 2025 external quality review of Texas Medicaid also found once pregnant people were enrolled in the program they could face wait times for appointments.
“When our moms miss out on prenatal care or start prenatal care late, they're more likely to have complications with their pregnancy and their babies are less likely to be healthy,” said Diana Forester, director of health policy at Texans Care for Children.
Medicaid covers almost half of all births in Texas – representing more than 185,000 births in 2023. That’s why Forester said it’s so important to pay attention to what’s happening with the program.
“It’s an indicator of how our healthcare system is functioning,” she said. “It’s a red flag. If something’s wrong, we need to fix it.”
Long processing times can contribute to delayed prenatal care
Texas is one of 10 states that hasn’t expanded Medicaid to include low-income adults that are considered “able-bodied” – which makes it one of the most restrictive states for coverage, according to Forester.
That means the “traditional” Medicaid populations, or the populations that states have to cover – like people with disabilities, children and pregnant people – are some of the only groups that have access to the program in Texas.
Because Texas has the highest uninsured rate in the country, Forester said getting enrolled in Medicaid quickly can play an important role in getting access to care earlier in someone’s pregnancy.
“Medicaid is the only viable way to get health insurance when you're pregnant, if you are uninsured,” she said.
Federal standards require states to process Medicaid applications within 45 days of an individual applying. Between March of last year and this February, almost 27,000 pregnant Texans waited for longer than that for their application to be approved or denied.
In an email to KERA, HHSC said it is working as quickly as possible to issue benefits to eligible Texans.
While more than 90% of applicants were processed within 45 days, Forester said lack of access to quality care for some Texans shouldn’t be brushed off.
“There’s a subset of our population that we know is not able to access [prenatal care] timely,” she said. “That’s going to lead to a lot more problems for us that are more costly, honestly, later down the road. The state’s going to end up paying for it.”
Delays getting appointments
Forester emphasized that there is “no single reason” why prenatal care is delayed. She said people can face a series of barriers, but people using Medicaid health insurance face additional barriers.
Medicaid enrollees often run into issues like finding providers and appointments for OB-GYN care. Forester said Texas has a provider shortage that means there aren’t enough doctors to meet the growing demand in the state.
“It's just like the nature of the beast,” Forester said. “There's so much work and there's only so many providers.”
But, finding a provider that takes Medicaid can be an additional challenge for Texans.
“We make it really hard for the providers to enroll and stay enrolled in that,” Forester said.
She said the heavy administrative burden placed on providers contributes to fewer options and less access for people enrolled in Texas Medicaid programs.
The 2025 External Quality Review of Texas Medicaid used a secret shopper approach to assess whether Managed Care Organizations, or MCOs – the insurance companies that facilitate Medicaid health plans – met state standards on appointment availability and timeliness of several types of care, including prenatal care.
Just over half of callers with low-risk pregnancies were able to get prenatal care appointments within the standards set by the state – which is 15 days.
“Fifteen days doesn't sound like a lot,” Forester said. “But when you're pregnant, if it's taking you 15 to 20 days to get on Medicaid, and then another 15 to 20 days to get an appointment, I mean, we're running out of time as far as you being able to get seen in that first trimester. Especially with the thing that we keep seeing with women coming into pregnancy with unmet healthcare needs.”
In addition, less than 20% of callers with high-risk pregnancies were able to get a prenatal care appointment within the state standard of five days.
Both the high-risk and low-risk groups saw a lower percentage of calls meeting the standard in 2025 than in 2024.
“This data shows that those MCOs that are getting paid to coordinate care for our moms on Medicaid and our children on Medicaid are not able to fulfill these contract requirements,” Forester said. “They’re getting a lot of money to do that.”
How can Texas address the issue?
HHSC said it can subject MCOs that aren’t meeting the standards to “corrective action plans and liquidated damages.”
Forester said the agency has the “levers [it] needs” to enforce consequences.
“They have been told that they can't do liquidated damages that are punitive, and so that really limits kind of the consequence that they could assess on the MCO,” she said. “There needs to be some sort of other accountability measure.”
The Texas legislature plays a critical role in the oversight of Texas Medicaid. Forester said lawmakers decide how much doctors get reimbursed for taking Medicaid patients, and they determine what resources HHSC has to address concerns or problems.
“If we want to make Texas a place that people want to have families, we need to make sure that we are investing in and incentivizing providers to come and practice here in our state,” she said.
Forester said the state’s eligibility system for Medicaid needs to be updated since it relies on old technology and heavy manual input from HHSC employees – meaning it takes longer for the state to process applications and opens up opportunities for more human error in data entry.
She said HHSC is aware of the issue. Last year, it listed improving customer service as the top issue in its self-report for the Sunset Review Commission process.
Forester said the agency is doing the best with what they have available but need support from lawmakers to address the underlying issues.
“There are a lot of ideas out there,” she said. “The interim is a great time for the legislature to take a look at these issues a see what other people are doing that Texas could figure out a ‘Texas’ way to do it.”
Forester said the issues in Texas’ Medicaid system add more stress to a population that’s already vulnerable.
“Being pregnant isn’t easy,” she said. “We really want to try to make the process for those that are eligible for the benefits as streamlined as possible.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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