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• Texas has removed nearly 1.7 million people from Medicaid, the highest number of any state.
• Most removals were due to procedural reasons, such as incomplete renewal processes.
• This move has created significant backlogs in Medicaid and SNAP applications.

Quick Brief

2-Minute Digest

Essential Context

During the COVID-19 pandemic, federal rules prevented states from removing people from Medicaid. As these rules expired, Texas began the process of reviewing Medicaid eligibility, leading to the removal of nearly 1.7 million people from the program.

Core Players

• Texas Health and Human Services Commission (HHSC) – Oversees Medicaid and SNAP programs in Texas.
• U.S. Rep. Lloyd Doggett – Criticized the state’s handling of Medicaid unwinding.
• Stacey Pogue – Senior policy analyst at Every Texan, advocating for improvements in the Medicaid renewal process.
• Diana Forester – Director of Health Policy at Texans Care for Children, highlighting the impact on children.

Key Numbers

• 1.7 million – Texans removed from Medicaid.
• 65% – Percentage of removals due to procedural reasons.
• 5 million – Texans who had continuous Medicaid coverage during the pandemic.
• 207,465 – Pending SNAP applications as of Dec. 8.
• 288,939 – Pending Medicaid applications as of Dec. 8.

Full Depth

Complete Coverage

The Catalyst

The expiration of federal pandemic-era rules allowed Texas to review Medicaid eligibility, leading to the massive removal of people from the program. This process, known as the “unwinding,” has been marked by significant challenges and criticism.

“The state handled this with an incredible amount of incompetence and indifference to poor people,” U.S. Rep. Lloyd Doggett said.

Inside Forces

The Texas Health and Human Services Commission (HHSC) faced overwhelming backlogs in processing Medicaid and SNAP applications. The agency’s limited use of automated eligibility checking systems exacerbated the issue, with only 6% of Medicaid renewals processed through this method.

HHSC’s efforts to manage the workload, such as a “6 Days of Merry Service Challenge” for employees, were criticized as insufficient.

Power Dynamics

The state’s approach to unwinding Medicaid coverage has been heavily influenced by its restrictive eligibility criteria and the lack of technological investment in the eligibility system. Advocates like Stacey Pogue and Diana Forester have called for significant reforms to prevent such crises in the future.

“Texas leaders keep falling behind when it comes to making sure eligible kids are able to sign up without delay for the health care they need,” Pogue said.

Outside Impact

The removal of 1.7 million people from Medicaid has broader implications for healthcare access in Texas. The state already has the highest children’s uninsured rate in the nation, with 10.9% of children without health insurance in 2022.

Advocates argue that the state’s failure to address these issues could worsen the healthcare crisis, particularly for vulnerable populations like children and families.

Future Forces

Looking ahead, Texas faces ongoing challenges in managing its Medicaid program. Advocates are pushing for legislative changes, such as increasing the use of data-driven administrative renewals and investing in community partners to help Texans enroll in Medicaid.

A proposed bill, Senate Bill 232, aims to create a state-specific approach to extending Medicaid coverage, but its passage remains uncertain due to Republican opposition to Medicaid expansion.

Data Points

• April to November 2023: 1.7 million Texans removed from Medicaid.
• 1.1 million: Removed due to procedural reasons.
• 557,000: Removed due to ineligibility.
• 150,000: Families waiting more than 45 days for Medicaid application processing.
• 48,000: Medicaid applications submitted before March still unprocessed.