August Johansen looks through the glass door of the birthday venue while cradling a balloon on Dec. 9, 2023. He had inoperable brain cancer and depended on Medicaid to pay for full-time home nursing care from a private agency to help his mother take care of him throughout years of health crises. Last December, he became one of 810,000 children dropped from Texas Medicaid program in the previous five months, but was reinstated through his mother's efforts.
At the time, the massive Texas Children’s Health Insurance Program, or CHIP, existed only on paper, the Legislature having just passed it weeks earlier as the state version of a 1997 federal program. “We were told in no uncertain terms that our careers would suffer if we didn’t deliver,” Fritz said. “He provided no context or explanation for that directive, but we didn’t need that. We knew why he was putting the screws to us.”
State officials said they worked hard to keep eligible people enrolled, and hired new staff to get the job done. But advocates for the poor and disabled say other states did more — and they found themselves wishing for a 1999-like effort from Texas again. Pete Laney, a Panhandle Democrat who was state House speaker at the time — during which every statewide office holder was a Republican — said that while the program had its detractors, it generally had bipartisan support.
That’s an average of nearly 800 kids per day, a triumph for the politicians who needed a win — and a heady victory for the social advocates who had long been frustrated by the the state leadership’s lack of energy behind addressing the uninsured crisis. The state has a May 31 deadline for the year-long process of updating its rolls in the aftermath of the COVID-19 pandemic, during which time federal regulations barred states from removing people from Medicaid or CHIPs. Some 6.1 million Texans were able to access health care continuously, a 50% increase from the typical estimated 4 million recipients.
Lawmakers last year earmarked funding for HHS to hire additional eligibility workers to help with the workload created when they began the unwinding. HHS has been able to fill some 97% of those positions, and has also leveraged outside contractors, technology and increased training to meet the workload, Young said.decline of 31.6% — second highest decline in the country.
Texas has notoriously tight restrictions on who may use Medicaid. The vast majority of recipients are low-income children or medically complex kids. It also covers new mothers under a certain income level and some low-income adults with disabilities. Most Medicaid recipients areThe limitations have served to keep the rolls low, but the lack of eligibility requirements is only part of the reason Texas has lower participation.