Hundreds of thousands of Texans could lose insurance when public health emergency ends

The pandemic had few silver linings. But one of them was a federal emergency program that automatically renewed Medicaid coverage for those who qualified. It’s unclear when the program will expire, but health advocates fear people could be kicked out of their health insurance without realizing it.

The end date is a bit of a moving target. When the emergency was declared two years ago, automatic renewals were put into effect for 90 days. Since then, the federal government has renewed the program in 90-day increments.

The federal government says states will receive 60 days notice of a decision to end the program. The last 90-day period should expire soon, but the program should be renewed again.

Advocates are urging states not to wait for the inevitable notification of the program’s end, but to start reaching out to Medicaid beneficiaries now. People covered by Medicaid may need to update their contact information so they can be notified if they lose their eligibility for Medicaid, which primarily covers low-income families, and have the opportunity to find other options, such as than the Affordable Care Act plans.

“It’s hard to create a sense of urgency when there’s no set expiration date,” said Diana Forester, director of health policy at nonprofit Texans Care for Children. who advocates for the well-being of Texas children and families.

In the spring, the federal government said states must determine who is still eligible for Medicaid and who is not, and then begin notifying people who lose coverage. In April, Texas released a plan to update the eligibility status of Medicaid recipients and notify everyone within six months. The Texas Department of Health and Human Services estimates it needs to review the eligibility of about 3.7 million people.

“It’s an ambitious plan at the best of times,” Forester said, “and it’s not the best of times.”

Once the public health emergency is over, hundreds of thousands of Texans will no longer be eligible for the program. In Texas, the program primarily covers children, pregnant women, and people with disabilities. Individuals must earn less than $26,900 per year to qualify.

Proponents predict that the largest groups of people to lose coverage will be women who were pregnant in March 2020 and have since had their children, children who have outgrown the program and those whose incomes have increased in the past two years.

Since individuals have not needed to renew in the past two years, Texas Health and Human Services anticipates that many of the addresses it has are obsolete. The agency expects to receive a high rate of return mail during the outreach process.

For that reason, the outreach process should start now, Forester said, especially as Texas Health and Human Services has struggled with staffing shortages. During the pandemic, the ministry had to close eligibility offices, which are signing people up, and some have not reopened. People calling 211, the statewide social services hotline, to renew have reported being put on hold for an hour, Forester said.

“We should use this time to aggressively raise awareness so that it’s not up to the member to understand the complexity of the situation,” Forester said.

Texas has the highest rate of uninsured people in the country, and it has for years. About one in six Texans does not have health insurance, according to census data. Researchers say increased pandemic benefits, such as automatic enrollments and Affordable Care Act plan market subsidies, have helped drive down the uninsured rate in Texas. But that won’t be confirmed until the census releases the data in the fall.

The low rate of uninsured is unlikely to last. After the public health emergency ends, eligible children and their families may be inadvertently kicked out of Medicaid, said Joan Alker, executive director of the Center for Children and Families at Georgetown University. She is concerned that many eligible families are not being properly notified due to contact information that has not been updated or simply problems in an overwhelmed system.

“They could potentially lose the coverage they’re entitled to,” Alker said. “I am very concerned for children and families in Texas right now.”