When the coronavirus pandemic emerged in March 2020, the US government issued a requirement that states could no longer de-enroll people from Medicaid during the public health emergency. The goal was to prevent people on Medicaid — a government-run health care policy — from going without insurance on short notice.
That requirement is still in effect two years later, but health care advocates in Texas and Houston said they’re worried about what might happen when it ends and millions of people see their safety nets. safety at risk.
The Urban Institute, a Washington, DC-based think tank, estimated that up to 1.3 million Texans could be deemed ineligible for Medicaid once the public health emergency ends. According to the Texas Health and Human Services Commission, about 3.7 million of the 5.2 million Texans enrolled in Medicaid will have their eligibility redetermined once the emergency ends. Ezreal Garcia, public information manager for the Community Health Network, which is a system of health clinics located in Galveston, Harris, and Brazoria counties, said clinic operations have been impacted by COVID-19.
“We continue to work with our patients to get them processed for recertification so that when the time comes, we can move on and process that information,” Garcia said.
The pandemic has also brought to light a debate that has been going on in Texas since 2010: Should the state expand Medicaid to cover more people? That debate will return when the state legislature convenes in January, and some local lawmakers have said they’re ready for change.
“We don’t have to go back to the pre-pandemic situation,” said state Rep. Ann Johnson, D-Houston.
The public health emergency was still in place in June with an expiry date of July 15. The government requires 60 days notice before Congress can authorize the emergency to expire. That notice was not given on May 15, which means the emergency should be extended until October, according to the Center on Budget and Policy Priorities, a nonpartisan research institute that analyzes fiscal policy.
Since the emergency was declared, Medicaid enrollments have reached their highest level ever in Texas, reaching 5.3 million in March, up from 4.2 million in March 2020, according to HHSC. In the Bay Area, the number of registered people hovered around 680,000 in Harris County and 37,000 in Galveston County before the pandemic. Since then, Harris County listings have grown to 898,000 as of October 2021, the most recent confirmed data available, and Galveston County listings have grown to 49,000.
Preliminary HHSC data from February estimates that about 931,000 Harris County residents and about 51,000 Galveston County residents are now enrolled in Medicaid.
At the end of the public health emergency, a portion of Medicaid enrollees will have their coverage automatically renewed if they are found eligible. There will also be a rollout period of up to 12 months during which states must work with individuals who were not automatically re-enrolled to help them maintain coverage if they are still eligible, although a May 5 HHSC presentation on the end of Medicaid coverage said Texas plans to use only six months.
For states to succeed, they will need to focus on two key areas, said Farah Erzouki, senior policy analyst at CBPP: streamlining the application renewal process and communicating effectively with enrollees.
“These steps will be essential to ensure people can be contacted, know what changes are coming, and know what they need to do to maintain their coverage,” Erzouki said.
CBPP recommends that states increase capacity for renewals that are determined using electronic data matches, which will avoid having to rely on enrollees to complete a renewal form or submit documents, Erzouki said. Texas uses these types of renewals in less than 25% of its processes, according to data from the Kaiser Family Foundation, a nonprofit organization focused on health issues.
Additionally, Erzouki said it will be crucial for states to allow enrollees to renew their policies through a variety of methods, including online, by phone, fax, mail and in person. Texas is among 33 states to allow renewals by all five methods, according to the KFF.
A looming crisis
There is no estimate from HHSC at this time on how many people may be deemed ineligible and unenrolled through this process, HHSC press secretary Kelli Weldon said. Officials will have a better idea of that number after conducting a comprehensive analysis during the unwinding period, she said. The continued coverage requirement in the public health emergency has been very beneficial for those on Medicaid, Garcia said.
Before the pandemic, people with Medicaid had to renew their policy every year, Garcia said, unlike those with private health insurance.
“The certification process is annual for Medicaid, so they have to go through the eligibility process again,” Garcia said. “They can just opt for recertification, which is not as long as for new applicants.”
Garcia said he had concerns about the timing of the recertification process.
“We’re talking about millions of Texans who didn’t go through the recertification process, and I’m confident the state will run into trouble with the recertification process,” Garcia said. “That’s why we’ve done our due diligence to make sure we educate our members and our patients.”
Children are most at risk of being unenrolled when the public health emergency ends, said Laura Dague, an associate professor in the Department of Public Service and Administration at Texas A&M University who specializes in the economics of public health insurance.
“The vast majority – and that means, of course, the people who somehow stayed [Medicaid] longer than expected — are low-income children. I think we will see the most unsubscribes in this group,” Dague said.
Certain population groups must be covered by Medicaid under federal law, including people who are below a certain income level and who 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 health care costs for those with Medicaid coverage and the states paying 10%, according to the KFF. When the federal government enacted the Affordable Care Act in 2010, every U.S. state was given the ability to expand Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level, a annual income of $17,774 for an individual in 2021, according to the KFF.
Texas is among 12 states that have not expanded Medicaid. Of those 12 states, Texas also set the highest bar for people to qualify based on income, only allowing people to enroll if they earn less than $103 a month. Adults who do not have dependents or are not disabled are not eligible for Medicaid at all.
As a result, Texas has the highest rate of uninsured people of any state, according to the KFF. Nationally, about 10.9% of people are uninsured, compared to 20.9% in Texas.
Researchers at Texas A&M University published a study on the economic effects of Medicaid expansion in 2019.
The study found that expanding Medicaid would make nearly 236,900 more people eligible in Harris and Galveston counties, and result in nearly 177,200 new enrollments. It would cost the federal government about $1 billion and Texas $112 million.
Ahead of the next legislative session, which begins in January, several local officials said Medicaid was a priority. Those opposed to the expansion said Texas would still be responsible for about $500 million in program costs and questioned the effects it would have on improving health care outcomes in the state. ‘State.
“Expanding Medicaid … does not necessarily equate to expanded access to care,” said state Rep. Cody Vasut, R-Angleton. “Many providers in Texas are not accepting new Medicaid patients.”
State Representative Dennis Paul, R-Houston, and Greg Bonnen, R-Friendswood, did not respond to requests for comment.
Johnson said that while Medicaid isn’t expanded, there are things that can be done at the legislative level to improve the system. “I think more and more lawmakers are realizing that even if we don’t expand Medicaid, there are improvements to the current system that can be created,” she said.