May 8, 2024 - News

Report: Texas Medicaid removals exceed projections

Illustration of a red cross made from childrens' blocks toppling over.

Illustration: Maura Losch/Axios

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 regular Medicaid eligibility checks during the pandemic, allowing people to keep coverage. They began rechecking 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  • That led to a cascade of problems in Texas and some other states stemming from overwhelmed technology, outdated information about Medicaid recipients, and a lack of resources for state employees.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


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