Report: Texas Medicaid removals exceed projections
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Texas removed far more children from its Medicaid rolls last year than observers expected, per a new report, but state officials say the numbers are in line with their own projections.
Why it matters: Even brief gaps in insurance can disrupt care and worsen health outcomes — especially for children, whose rapid development makes them more vulnerable than adults, a new analysis from the Urban Institute says.
- In Texas, many children and adults lost coverage for procedural reasons like missed paperwork — not necessarily because they were ineligible.
Catch up quick: States paused Medicaid disenrollment during the pandemic, allowing people to keep coverage. They began disenrollment again in April 2023.
- That led to a cascade of problems in Texas and some other states stemming from overwhelmed technology, outdated information about Medicaid recipients, and a lack of resources for state employees.
- The federal government sent a letter to Texas detailing concerns about the large number of children the state disenrolled, per the Urban Institute.
Zoom in: As of November, eight states — including Texas — disenrolled more than 100% of the Urban Institute's projected numbers over the last year.
- Texas' net overall disenrollment exceeded 117% of the think tank's projections — and exceeded projections by 178% for disenrollment of children alone.
What they're saying: "This suggests that many eligible people may be among those losing Medicaid," Matthew Buettgens, senior fellow at the Urban Institute, said in a statement. "And raises the possibility that this problem may increase."
The other side: "Our Medicaid enrollment is in line with our … projections and what we anticipated our disenrollments to be at this time," Texas Health and Human Services Commission spokesperson Tiffany Young tells Axios.
- Rechecking eligibility has been a "monumental" task, Young says, one the state learned many lessons from.
By the numbers: Texas has removed more than 2 million people from its Medicaid program since last April, per the most recent state data.
- Of those, nearly 1.4 million people were removed for procedural reasons.
- About 992,000 of those removed for procedural reasons were children.
Reality check: It's unclear if people who were disenrolled for procedural reasons are still eligible, and how many eventually re-enrolled in Medicaid, found coverage elsewhere or remained uninsured.
Between the lines: Texas has the highest percentage of uninsured residents in the nation.
The big picture: Last fall, Texas had the highest disenrollment rate of any state. It has since fallen to No. 7 nationwide for the percentage of people the state has removed from Medicaid (49%), per the most recent data from KFF.
What's next: Texas has until the end of the month to finish eligibility checks, Young says.
- Plus, a new Medicaid rule set to take effect in June aims at simplifying enrollment with less paperwork.
- That move was supported by the nonprofit Every Texan, which said the large numbers of people dropped from Medicaid coverage in Texas is connected to enrollment policies.
Go deeper: Where to find help navigating Medicaid loss in Texas
Editor's note: This story has been corrected to say states paused Medicaid disenrollment during the pandemic (not eligibility checks) and that Texas began disenrollment in April 2023 (not that it began rechecking eligibility then).