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WHAT IS MEDICAID? Medicaid is a government-run health care policy. In Texas, eligibility requirements vary by program.
enrolled in Medicaid will have their eligibility redetermined once the emer- gency ends, according to the Texas Health and Human Services Commis- sion. Roughly 73.2% of Texas Medicaid enrollees are children, according to the latest HHSC data. “Our main concern is you are look- ing at huge numbers having to reap- ply, and that’s going to take a lot of time to go through,” said Brian Sasser, chief communications o cer with the Houston-based Episcopal Health Foun- dation, which works with health care nonpro ts across Texas. The pandemic also shined a spot- light on a debate that has been ongo- ing in Texas since 2010: whether the state should expand Medicaid to cover more people. That debate will come up again when the state Legislature meets in January, and some local lawmakers said they are ready for change. State of Medicaid The public health emergency was still in place as of May with an expira- tion date of July 15. However, the gov- ernment also requires a 60-day notice before Congress can allow the emer- gency to expire. That notice was not given May 15, meaning the emergency is likely to be extended into October, according to the Center on Budget and Policy Priorities, a group that analyzes federal and state budget policies. In Harris County, the number of people enrolled in Medicaid hovered in the high 600,000s prior to the pan- demic with little change between 2017 and 2020. Since then, the county rolls grew to 898,567 as of the most recent con rmed data from October 2021. The HHSC’s preliminary data from Febru- ary estimates around 932,000 county residents are now enrolled in Medicaid. When the public health emergency ends, a portion of Medicaid enrollees will have their coverage automatically renewed if they are deemed eligible. There will also be an unwinding period of up to 12 months during which states are to work with individuals who were not automatically re-enrolled to help them keep their coverage if they are still eligible, though a May 5 HHSC presentation on the end of continu- ous Medicaid coverage indicated that Texas plans to only use six months. For states to succeed, they will have to focus on streamlining the applica- tion renewal process and communi- cating e ectively with enrollees, said Farah Erzouki, senior policy analyst
covered by, Sasser said. That was a bur- den for many families, he said. “If you had to keep reapplying to that and updating your income, that’s a hassle,” Sasser said. “This pandemic emergency act allowed that to go away for a bit.” Sasser said he is concerned about the state giving itself enough time to ade- quately review each case. If Texas does not plan ahead, it could result in people getting kicked o Medicaid for paper- work reasons when they are otherwise still eligible. “With Medicaid, you are dealing with pregnant moms and children,” he said. “You are dealing with folks who need the care the most and who need timely care the most.” Children are most at risk of being unenrolled when the public health emergency ends, said Laura Dague, associate professor with the Texas A&M University Public Service and Administration Department who spe- cializes in the economics of public health insurance. “The vast majority—and that means, of course, the people who kind of stayed on [Medicaid] longer than expected—are low-income kids. I think we will see the most disenrollment in Certain population groups are eli- gible for Medicaid in Texas if they fall below a certain income level that varies by program. People who are pregnant, are children, have a disability or are over age 65 all may be eligible depend- ing on family income. The health care policy is jointly funded by states and the federal gov- ernment with the federal government paying 90% of the cost of health care for those insured by Medicaid and states paying 10%, according to the KFF. When the federal government signed the A ordable Care Act into law in 2010, each U.S. state was given the option to expand Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, an annual income of $17,774 for an indi- vidual in 2022, according to the KFF. Texas is among 12 states that have not expanded Medicaid. Of the 12 states that did not expand Medicaid, Texas generally has set the highest bar for people to qualify based on income, according to KFF. Based on a single parent household with family size of that group,” Dague said. Debate over expansion
with the CBPP. “These steps will be key to make sure people can be reached, that they know what changes are coming and they know what they need to do to keep their coverage,” Erzouki said during a May 18 press brie ng. The CBPP recommends states increase capacity for renewals that are determined using electronic data matches, which will help avoid hav- ing to rely on enrollees to complete a renewal form or submit documenta- tion, Erzouki said. Texas uses those kind of renewals in less than 25% of its processes, according to data from the Kaiser Family Foundation, a nonpro t focused on health care issues. Additionally, Erzouki said it will be crucial for states to allow enrollees to renew their policies through a vari- ety of methods, including online, by phone, by fax, by mail and in person. Texas is among the 33 states to allow renewals by all ve methods, according to the KFF. Looming crisis There is no estimation from the HHSC at this time for how many peo- ple could be determined ineligible and unenrolled when protections expire, HHSC Press O cer Kelli Weldon said. O cials will get a better idea after they conduct a full analysis during the unwinding period, she said.
WHO QUALIFIES IN TEXAS?
Children from low-income families, determined based on monthly household income and size: To obtain Children’s Medicaid, a two-person household must make less per month than $2 ,034
$3,083 And a four-person household must make less than INCOME REQUIREMENTS VARY FOR OTHER GROUPS:
Pregnant Responsible for child age 18 or younger
Have a disability or a family member in the household with a disability Blind
Age 65 or older
All adults with incomes up to 138% OF THE FEDERAL POVERTY LEVEL THE FOLLOWING INDIVIDUALS MAY BE ELIGIBLE IN OTHER STATES BUT NOT IN TEXAS Individuals receiving HOME AND COMMUNITY BASED SERVICES CHILDREN IN FOSTER CARE who are not otherwise eligible
“THE VAST MAJORITY ... OF PEOPLE WHO KIND OF STAYED ON MEDICAID LONGER THAN EXPECTED ARE LOW INCOME KIDS. I THINK WE WILL SEE THE MOST DISENROLLMENT IN THAT GROUP.” LAURA DAGUE, TEXAS A&M UNIVERSITY ASSOCIATE PROFESSOR, PUBLIC SERVICE AND ADMINISTRATION DEPARTMENT
More than 5.3 MILLION people were enrolled in Medicaid statewide as of March.
Up from 4.2 MILLION in March 2020
of Medicaid enrollees in Texas are children.
73%
SOURCES: TEXAS HEALTH AND HUMAN SERVICES COMMISSION, U.S. CENTERS FOR MEDICARE AND MEDICAID SERVICES COMMUNITY IMPACT NEWSPAPER There is NO ESTIMATION as of mid-May of how many people will be determined ineligible. State o cials said they will conduct a full redetermination during the unwinding period. or 3.7 MILLION Texans, will need to have their Medicaid eligibility redetermined when the public health emergency ends, according to May 5 estimates. 70%
The continued coverage require- ment in the public health emergency has been vital to those on Medicaid, Sasser said. Before the pandemic, individuals on Medicaid had to regularly renew their policies, sometimes as often as every three months, depending on the type of Medicaid program they were
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COMMUNITY IMPACT NEWSPAPER • COMMUNITYIMPACT.COM
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