Texas congressional Democrats call for federal intervention for states' Medicaid problems

"Federal officials should be on the ground in Austin, not just talking over the telephone, before we have another million Texans lose their coverage," U.S. Rep. Lloyd Doggett, D-Austin, said recently.
"Federal officials should be on the ground in Austin, not just talking over the telephone, before we have another million Texans lose their coverage," U.S. Rep. Lloyd Doggett, D-Austin, said recently.

Texas leads the country in the number of people who have lost Medicaid coverage, with more than 917,000 individuals and families impacted since May, when new eligibility requirements mandated that former recipients reenroll for benefits, according to the Kaiser Family Foundation.

The report, from the nonprofit and nonpartisan foundation, comes as families continue to struggle with the state's reenrollment process, which they say is archaic, is dependent on the postal delivery, is not user-friendly, has a website prone to error messages and is a system not built for the realities of working families.

In recent weeks, families have shared their despair and frustration on the Facebook page of the Texas Health and Human Services Commission, the state agency charged with the reenrollment verification process. Among the chief complaints: They can't reach the agency via the benefits website or phone.

"My son's Medicaid was cancelled because they (HHS), could not get a hold of me ... they supposedly sent a letter out and got it returned to them. I never got a call, an email, a message on the app or site. Now my son has no coverage," a mother wrote on the site.

"How do we renew benefits if the website constantly gives an error every time I try to submit the renewal?" asked another recipient.

"Hours long holds. No one works the phones!!!!" wrote another person.

The HHSC leaders have said the agency is operating a quickly as possible, noting that the state has approved 474,692 people since April for benefits renewal. The commission also said it has reenrolled people who were dropped because of a computer glitch this summer. Agency directors said they encourage people to call 211, use the website or the app Your Texas Benefits, or go to their local benefits office if they encounter problems.

Despite criticism that it is moving too slowly, HHSC said the agency expects to take the full 12 months to verify eligibility for the 6 million people in Texas who receive Medicaid and not rush the process.

"HHSC has employed a proactive, multi-pronged communications campaign to inform recipients, health care providers, advocates and other stakeholders about its plan to unwind continuous Medicaid coverage," the commission said in its September End of Continuous Medicaid Coverage Dashboard report.

Texas congressional Democrats have asked for an intervention from the federal Centers for Medicare and Medicaid Services and now the U.S. Department of Agriculture, which handles the Supplemental Nutrition Assistance Program since families are complaining that food benefits have been affected.

The commission declined repeated requests for an interview with the Statesman and did not answer questions, including about the length of the waiting period for SNAP benefits, whether people who were part of the foster care system have been dropped from Medicaid before age 26, and whether noncitizens who qualify for Medicaid have been dropped. Whistleblowers inside the agency have raised those concerns.

Medicaid is medical insurance available for pregnant women, children and people with disabilities who make below a certain income. For a family of four in Texas, their income must be less than $3,083 a month. For a pregnant woman with a family of four, it is less than $4,579 a month.

For SNAP benefits, a family of four must be making less than $3,816.

Plea for help: Texas Democrats send letter to federal agency over state dropping people from Medicaid

What is the scope of the Medicaid renewal process?

The state's latest End of Continuous Medicaid Coverage Dashboard says it has initiated renewals for 59% of Medicaid recipients since April, or 3.5 million people. The other almost 2.5 million people will go through by June 2024, the dashboard says.

Of 1.4 million people who have seen their Medicaid renewal make it through the entire process, 63%, or 917,573, were denied benefits — 73% of those, or 668,434, because of procedural reasons. Only 27%, or 249,139, were denied coverage because they were determined to be ineligible.

"We keep hearing that there was pressure for getting rid of people as quickly as possible," U.S. Rep. Lloyd Doggett, D-Austin, said of the recipients who have been denied coverage for procedural reasons.

"The children are the ones suffering the consequences," said Michelle Castillo, deputy director of the advocacy group Children’s Defense Fund-Texas. "Across the state families are taking their children to the doctor and finding they no longer have Medicaid."

One of the biggest criticisms is that Texas is not fully using other databases such as for SNAP benefits or the Texas Workforce Commission to verify eligibility. That process of using other databases is called ex parte.

According to the Kaiser Family Foundation, Texas' use of the ex parte system was the worst in the country, with only 9% of people being verified through it. The national average is 56%.

How much time?: Texas says it needs 12 months to properly reverify everyone receiving Medicaid

Inside Medicaid unwinding: Texas among states being audited by federal CMS for Medicaid terminations. What we know.

How could the federal government get involved?

The Texas Democrats in the U.S. House of Representatives have asked CMS to begin formal enforcement procedures to halt procedural denial terminations of Medicaid in Texas until the state is in compliance with federal law.

CMS spokesperson Dan Trucil said when the agency becomes aware of incorrect disenrollments, it is prepared to act immediately to require states to pause disenrollments and/or reinstate those affected.

Trucil did not comment specifically on Texas and referred the Statesman back to the state.

"CMS needs to be more forceful," Doggett told the Statesman. In a press conference with advocacy groups in September, he said, "Federal officials should be on the ground in Austin, not just talking over the telephone, before we have another million Texans lose their coverage."

The Texas Democrats also have asked the USDA to find the state out of compliance with SNAP benefits laws and bring about corrective actions. They say that Texas has not met the 30-day requirement to process applications since July 2021.

The scope: What's gone wrong with Texas' Medicaid unwinding? Inside the problems with state agency.

What could Abbott do?

Gov. Greg Abbott does have the authority to order the commission to pause procedural denials and reactivate people with lost coverage until the commission fixes system problems and can catch up with its backlog of applications. Abbott's office did not respond to the Statesman's requests for comment.

Castillo, from the Children's Defense Fund-Texas, said the state needs to pause the reverification process and give the commission more resources to reduce the backlog.

"And they need to stop kicking children off," she said.

This article originally appeared on Austin American-Statesman: Texas' Medicaid problems spur calls for federal intervention