The Medicaid Disenrollment Crisis

The global health crisis of the COVID-19 pandemic forced a widescale reevaluation of social services and systems across the country. This response included Congress’ Families First Coronavirus Response Act (FFCRA), that prohibited states from removing people from Medicaid and thus kept people continuously enrolled through the end of the COVID-19 public health emergency, while providing enhanced federal funding. This Act allowed individuals to remain enrolled in Medicaid, avoiding the need to reenroll or renew their coverage during that challenging time of uncertainty.

In the Lone Star State, this meant that nearly three million Texans—mostly young adults, children, and new mothers—had consistent access to health insurance, allowing them to manage chronic conditions, receive early prenatal care, preventative and primary care, and treatment for health issues that arise. That reality changed in April 2023 when the public health emergency declaration expired and states across the country were able to adopt different approaches to determine who still qualifies for Medicaid. This unwinding has resulted in the loss of health insurance for more than 900,000 individuals in Texas—by far the largest total of any state, and those numbers continue to grow.

The issue of disenrollment is a health crisis—one that directly impacts already vulnerable populations and will be felt for years to come, as access to care is limited or denied. The national predictions are sobering, with an estimated 15 million low-income individuals losing Medicaid/CHIP coverage—half of those terminations occurring due to administrative processes, despite the ongoing eligibility of those individuals. Most impacted would be children, Black and Latino populations, and young adults. If the projections are realized, our most marginalized populations will experience large-scale coverage loss, further increasing health disparities in Central Texas and nationally.

While some individuals who recently lost coverage had legitimately become ineligible during the pandemic (due to reasons like aging out of the program, mothers who were past the time of pre-natal or post-natal coverage, or people who exceeded Texas’ income limit), 73 percent of Texans were terminated from Medicaid for procedural reasons only. This could be a result of not receiving a renewal notice or facing barriers to the reenrollment process. For many, notice of insurance disenrollment was not discovered until they sought treatment, visited a doctor, or renewed a prescription. This bleak reality leaves hundreds of thousands of Texas individuals, many of whom are children, to navigate an already frustratingly complex process of determining what their options are as they search for health coverage.

What’s Next

The growing numbers and rapid pace at which Texans are being disenrolled from Medicaid coverage will undoubtedly have negative long-term implications on the health of our communities and further increase health disparities. However, advocates and experts in our community are already working hard to support those impacted by this issue in Texas.

We are committed to improving the health of all Central Texans, especially those who are uninsured or have inadequate health insurance. We, as a community, have an opportunity to take action to ensure that more Central Texans have access to care and coverage. In this direction, the Foundation will continue to support community organizations who serve as trusted messengers helping community members to navigate the dizzying enrollment process to retain their health coverage.

Resources

• 2023 Scorecard on State Health System Performance (Commonwealth Fund, June 2023)
• The High Cost of Texans Losing Health Insurance (The Perryman Group, July 2023)
• State Unwinding Renewal Data (Georgetown University Center for Children and Families, July 2023)
• Medicaid Enrollment and Unwinding Tracker (KFF, updated regularly)