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WHAT IS MEDICAID? Medicaid is a government-run health care policy that is jointly funded by states and the federal government.
years later, but health care advocates in Texas and Houston said they are wor- ried about what could happen when it ends and millions of people have their safety nets put into jeopardy. The Urban Institute, a Washington, D.C.-based think tank, estimated as many as 1.3 million Texans could be deemed ineligible for Medicaid once the public health emergency ends. Roughly 3.7 million of the 5.2 mil- lion Texans enrolled in Medicaid will have their eligibility redetermined once the emergency ends, accord- ing to the Texas Health and Human Services Commission. Ezreal Garcia, public information o cer for Community Health Net- work, which is a system of health clin- ics located in Galveston, Harris and Brazoria counties, said clinic opera- tions have been a ected by COVID-19. “We continue to work with our patients in getting them processed for recerti cation so that when that time does come, we can go ahead and pro- cess that information,” Garcia said. 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. “We don’t have to go back to the way things were before the pandemic,” said state Rep. Ann Johnson, D Houston. State of Medicaid The public health emergency was still in place as of June with an expi- ration date of July 15. The govern- ment requires a 60-day notice before Congress can allow the emergency 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 Prior- ities, a nonpartisan research institute that analyzes budget policies. Since the emergency was declared, Medicaid enrollment has increased to its highest mark ever in Texas, hit- ting 5.3 million as of March, up from 4.2 million in March 2020, according to the HHSC. In the Bay Area, the number of peo- ple enrolled hovered around 680,000 in Harris County and 37,000 in Gal- veston County prior to the pandemic. Since then, Harris County’s rolls grew to 898,000 as of October 2021, the most recent con rmed data available, and
Before the pandemic, individuals on Medicaid had to annually renew their policies, Garcia said, whereas those on private health insurance did not. “The certi cation process is annual for Medicaid so they have to go through the eligibility process all over again,” Garcia said. “They can just go for the recerti cation, which is not as lengthy as it would be for rst-time applicants.” Garcia said he does have con- cerns about the timeline of the recerti cation process. “We’re talking about millions of Texans that have not gone through the recerti cation process, and I am con dent that the state will encounter challenges with the recerti cation pro- cess,” Garcia said. “That’s why we have done our due diligence to make sure that we’re educating our members and our patients.” 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 required to be covered by Medicaid under federal law, including people who are below a certain income level and are also pregnant, are children, have a disability or are over age 65. The health care policy is jointly funded 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 2021, according to the KFF. Texas is among 12 states that have not expanded Medicaid. Of those 12 states, Texas also has set the high- est bar for people to qualify based on income, only allowing people to enroll if they make less than $103 per month. that group,” Dague said. Debate over expansion
Galveston County’s grew to 49,000. The HHSC’s preliminary data from February estimates around 931,000 Harris County residents and around 51,000 Galveston 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 be successful, they will have to focus on two key areas, said Farah Erzouki, senior policy analyst with the CBPP: streamlining the appli- cation renewal process and communi- cating e ectively with enrollees. “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. 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 kinds of renewals in less than 25% of its processes, according to data from the Kaiser Family Foundation, a non- pro 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, accord- There is no estimation from the HHSC at this time for how many peo- ple could be determined ineligible and unenrolled as part of that pro- cess, HHSC Press O cer Kelli Weldon said. O cials will get a better idea of that number after they conduct a full analysis during the unwinding period, she said. The continued coverage require- ment in the public health emergency has been quite bene cial to those on Medicaid, Garcia said. ing to the KFF. A looming crisis
WHO QUALIFIES IN TEXAS?
Low-income families, determined based on household income and size Two-person household must make less than $36, 254
$54,945 Four-person household must make less than AND ONE OF THE FOLLOWING:
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
More than 5.3 MILLION people are enrolled in Medicaid statewide as of March.
Up from 4.2 MILLION in March 2020 75.9% of Medicaid enrollees in Texas are children.
There is NO ESTIMATION as of mid-June of how many people will be determined ineligible. State o cials said they will conduct a full redetermination during the unwinding period. Estimates as of May 5 are that 3.7 million Texans will need to have their Medicaid eligibility redetermined when the public health emergency ends.
SOURCES: KAISER FAMILY FOUNDATION, U.S. CENTERS FOR MEDICARE AND MEDICAID SERVICES COMMUNITY IMPACT NEWSPAPER
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COMMUNITY IMPACT NEWSPAPER • COMMUNITYIMPACT.COM
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