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2023 Texas State of Enrollment Conference

What You Need to Know


Review key takeaways from the 2023 Texas State of Enrollment Conference. Topics included open enrollment, Medicaid unwinding, immigrant accessibility, and more.

St. David’s Foundation is proud to partner with Every Texan and others leading work in this area and celebrate the cross-sector efforts that support our community through education, outreach and accessible resources to inform our community on the latest information related to health care access and enrollment.  

As a place-based, community-focused, equity-driven funder, 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.

This is particularly urgent as thousands of Texans are impacted by the issue of Medicaid disenrollmenta crisis that directly impacts already vulnerable populations and will be felt for years to come, as access to care is limited or denied.

In partnership with Every Texan, we invite you to learn more and dig into resources featured at this year’s Texas State of Enrollment Conference aimed at supporting application counselors, navigators, advocates, and many others who are deeply engaged with health coverage in Texas.

Key Takeaways from 2023 Texas State of Enrollment Conference 

Background: Since 2014, the Texas State of Enrollment (TSOE) conference has brought together people who perform outreach and enrollment for health coverage and benefit programs such as Medicaid, CHIP, the Health Insurance Marketplace, Healthy Texas Women, SNAP, WIC, and TANF to share best practices, improve the effectiveness of Texas’ enrollment networks, and celebrate the incredible work that is being done across the state.  

From October 10-12, 2023 people involved in outreach and enrollment for health coverage and food and nutrition programs across Texas gathered online for six sessions on a wide variety of topics for education, training, policy updates, and more. Each year this conference convenes about one month before open enrollment starts for Marketplace health plans on Application counselors, navigators, advocates, and many others who are deeply engaged with health coverage in Texas prepare for their busiest time of year. 

Different circumstances influence the topics and content each year, some more directly than others. In the recent past we’ve grappled with issues like the public charge and other policies targeting immigrants, the COVID public health emergency (PHE), and changes to eligibility for subsidies and other financial help. This year the heavy specter of Medicaid unwinding after the end of continuous eligibility haunts millions of Texans. The ripple effects it creates through the Texas Medicaid eligibility system and other related systems and programs within the Health and Human Services Commission affects many whose time with Medicaid or SNAP might run out, as well as those who work to help as many people as possible keep their benefits. 

The opportunities for learning at the conference are always rich, and this year also brought good news and welcome policy changes for Texans. New laws have made SNAP more accessible for some Texans, and new mothers will benefit from 12-month postpartum Medicaid coverage in the new year. The sessions covered a lot of ground, giving participants a chance to deepen their knowledge in their specialist areas, make connections between subjects, and learn about new laws and policies affecting their work. The State of Enrollment Conference can leave participants feeling that they’re making progress and encountering setbacks at the same time, but it’s always full of energy and vigor. The enthusiasm for a new season of open enrollment is tempered by the heartbreak of clients enduring the unexpected loss of Medicaid coverage or SNAP benefits as about 6 million Texans go through a renewal and redetermination process fraught with problems. 

Read and learn more:

Latest Updates on and Open Enrollment 

A few changes to for PY 2024 should make choosing and enrolling in a health plan options more transparent and easier to navigate.  Consumers can make an attestation for income verification when IRS data isn’t immediately available, and those who are a little behind on their tax returns won’t automatically be determined ineligible for financial help.  The session recap includes some potentially big things on the horizon for the Marketplace and the ACA. 

Click here to download the full summary

What’s New with Texas Medicaid, SNAP, and Healthy Texas Women 

The biggest news going forward is the passage of 12-month postpartum Medicaid for new mothers during the 88th legislative session. Prior to the PHE postpartum Medicaid was limited to 60 days, and that policy is currently back in force. Starting in March 2024 postpartum Medicaid coverage will run for 12 months, and mothers who are still in their 12-month postpartum period will have coverage reinstated. The women’s health budget received a healthy increase to help more eligible women get enrolled in Healthy Texas Women, and a new law allows women to get a 12-month supply of birth control in one visit. Key changes to SNAP mean people leaving the criminal justice system can get instant access to SNAP benefits, and families have a little more leeway on the value of their cars when qualifying for benefits. 

Click here to download the full summary

Texas Medicaid Unwinding: Updates, Challenges, and Successes 

Medicaid unwinding is a massive undertaking fraught with problems. A constellation of issues has caused about 900,000 Texans to lose Medicaid coverage since April. Of those, 670,000 are estimated to have received a procedural denial (denial for bureaucratic reasons vs. a true loss of eligibility), and most of them are children. Three out of four who lost coverage are likely still eligible. Additionally, ongoing computer system problems and an understaffed workforce have resulted in a backlog of applications and incorrect denials of coverage. The SNAP program is also enduring a tremendous backlog as the staffing limitations affect both programs. HHSC is taking steps to mitigate the problems, but the vast scope of unwinding seems greater than the resources available. 

Click here to download the full summary

Step-by Step Walkthrough of Your Texas Benefits 

This lively (and live) session took participants through the process of applying for SNAP and pregnant women’s Medicaid on the Your Texas Benefits portal. For participants who help clients fill out applications this session provided a live tutorial. For others who aren’t involved in enrollments through Your Texas Benefits it provided insight into the wealth of information applicants must provide for eligibility determinations. 

Click here to download the full summary

Immigrant Access and Eligibility 

Immigrant access and eligibility for public programs in Texas hasn’t changed significantly in the last few years. Overall, immigrants (regardless of status) are eligible for fewer public programs than U.S. citizens, but undocumented people—including children—are shut out of almost everything. Lawfully present immigrants who meet certain requirements have access to many public programs including various types of health coverage and food and nutrition benefits, but immigrant communities continue to be plagued by fear of using public programs as a result of policies in effect from 2016-2020. An exciting development on the horizon is the inclusion of DACA recipients as qualified immigrants for Medicaid, CHIP, and Marketplace health coverage. The federal rule is pending finalization. 

Click here to download the full summary


Storytelling has been an important part of the fight for getting and keeping health coverage. This session explored the importance of narrative in shaping attitudes and behaviors in an effort to shift perceptions and “common sense” on issues, including health coverage. A strong narrative plus policy advocacy can result in new programs and new laws. The second half of the session explored some best practices for collecting and curating stories and supporting the people who are generously sharing their stories as part of the process of narrative creation. An example of a policy “win” through the use of storytelling and narrative is the establishment of 12-month postpartum Medicaid coverage. 

Click here to download the full summary

Medicaid Unwinding Background for Context 

In 2020, as part of Congress’ response to the COVID public health emergency (PHE), people who were on Medicaid were able to maintain “continuous eligibility.” In Texas, many adults and children were able to keep Medicaid coverage for up to three years (March 2020-March 2023) who might ordinarily be terminated after a short time, and to maintain their coverage without submitting renewals. Congress also increased benefits for the Supplemental Nutrition Assistance Program (SNAP) during the PHE. In March 2023 these benefits ended and Texans are being disenrolled from Medicaid and SNAP at a brisk rate. The documents from HHSC provide additional information about Medicaid and SNAP changes: 


Every Texan (formerly Center for Public Policy Priorities)

St. David’s Foundation is proud to partner with Every Texan and others leading work in this area and celebrate the cross-sector efforts that support our community through education, outreach and accessible resources to inform our community on the latest information related to health care access and enrollment.  

Meet our Contributors


Amy Einhorn, MPP

Senior Program Officer