Where We Stand Now: Texas Updates Medicaid and CHIP Policies in Response to COVID-19, but More is Needed

In response to the COVID-19 pandemic, Texas has taken important steps that will improve access to Medicaid and the Children’s Health Insurance Program (CHIP) for low-income children, pregnant women, and people with disabilities. Access to health care is essential during this crisis because people without health care may delay seeking testing and treatment if they become sick. We are grateful for the progress made so far, but there are still essential steps that Texas leadership must take to remove barriers to coverage, testing, and treatment.

CPPP joined other Texas organizations calling on the Governor, the Health and Human Services Commission (HHSC) and the Texas Department of Insurance (TDI) to take swift actions to ensure access to testing and treatment. You can read that original report from March 23, 2020, and more recent details on actions taken to improve private insurance coverage.

This newest post updates where we stand a month later, highlighting key state responses and critical steps still needed. Read the full update on Texas’ progress to create access for private insurance, the uninsured, and to adjust Medicaid and CHIP in response to the COVID-19 pandemic.

Keeping people continuously enrolled in Medicaid

The Families First Coronavirus Response Act (FFCRA) provides an automatic 6.2 percentage point increase in our federal Medicaid matching funds, retroactive to Jan. 1, 2020, and lasting through the last day of the calendar quarter in which the emergency ends. Texas’ 2020 Federal Medical Assistance Percentage (FMAP) was 60.89; this provision increased it to 67.09.

In order to remain eligible for this increase the state must ensure that any person enrolled in Medicaid on March 18, 2020, or who newly enrolls during the public health emergency remains in Medicaid until at least the end of the quarter when the public health emergency. Under the FFCRA a state can terminate coverage for an individual only if they voluntarily request the coverage to end, or if they move out of the state.

Texas Health and Human Service Commission (HHSC) has taken the following steps to ensure compliance with this provision:

• Suspended Medicaid renewals. Current clients will not be required to renew coverage or provide any documentation, their coverage will remain active. While not required by the law, HHSC has also suspended CHIP renewals so children in CHIP will also remain covered. At publication time, HHSC was still waiting for official approval of this CHIP request.
• Suspended periodic data checks between renewals for children’s Medicaid and the small number of parents covered in Texas Medicaid. These problematic automated checks have resulted in about 50,000 children losing Medicaid each year, without the agency determining whether they remain eligible.
• Keeping all Medicaid recipients continuously enrolled. HHSC has stated that during the emergency period, it will not act on any changes in circumstances that would normally end eligibility. Once a person is found eligible and enrolled, their Medicaid will not be terminated unless he or she moves out of the state or voluntarily withdraws. Note: There have been instances of Texans’ Medicaid being terminated for a variety of reasons that would not be allowed under the law. The agency is actively trying to address those issues and has encouraged reporting of incorrect terminations so coverage can be reinstated. Reports can be made to the HHSC COVID-19 email inbox or the Office of the Ombudsman.

Streamlining enrollment and focusing resources on new applications

As thousands of Texans are furloughed and losing weeks of income, many more will need to apply for public benefits such as the Supplemental Nutrition Assistance Program (SNAP, formerly “food stamps”) and Medicaid to care for their families. This spike in applications comes at a difficult time when Texas HHSC is struggling with the same workforce constraints as other Texas businesses, such as staff with children at home because of school closures. The fact that Texas cannot terminate coverage for Medicaid and will not require clients to renew their benefits is helpful because it allows staff to focus precious time and resources on new applications. Texas has taken the following additional steps to reduce workloads and streamline enrollment into Medicaid and CHIP:

• Allows households to self-attest to their income if the normal verification methods like paystubs or contacting employers are unavailable.
• Waived the interview requirement for Medicaid for parents and caretakers.

Additional positive steps

Once enrolled it is essential that Medicaid and CHIP clients can access the care they need without financial burden. Also, such care must be available in a manner that acknowledges the need for social distancing to slow the spread of COVID-19. Texas HHSC has taken positive steps towards these goals:

• Medicaid and CHIP will cover COVID-19 testing for Medicaid and CHIP clients with no prior authorization or cost-sharing required. This is required by the FFCRA.
• Texas Medicaid applied on April 17, 2020 to accept special Medicaid COVID-19 testing for uninsured Texans. Congress provided this funding to cover COVID-19 testing and related visits for the uninsured on March 18, 2020, but states had to opt-in to receive the funding. 
• CHIP co-payments for office visits and telemedicine are waived through the end of April 2020.
• HHSC has encouraged Medicaid and CHIP health plans to take full advantage of existing flexibility to provide telehealth services.

Urgent Next Steps Still Needed

While the state of Texas has taken meaningful action to ensure compliance with the FFCRA and to streamline enrollment into Medicaid & CHIP, there remain urgent steps our state leaders must take to ensure every Texans who needs to access testing and treatment for COVID-19 can do so without concern for financial hardship.

• Take additional steps to make COVID-19 testing available to uninsured Texans who are not U.S. citizens (both lawfully present and undocumented). Congress allocated funding to the Public Health and Social Services Emergency Fund cover COVID-19 testing and related visits for the uninsured through the FFCRA and the CARES Act. Several states are also paying for this testing through “Emergency Medicaid.”
• Texas should join the 37 other states and D.C. that have expanded Medicaid as allowed under the Affordable Care Act. Doing so would create coverage estimated to reach 1.5 million currently uninsured Texas adults. With over 1 million Texans filing for unemployment benefits in four weeks, we can expect many families will find themselves newly uninsured.
• For the Children’s Health Insurance Program (CHIP), waive enrollment fees, the 90-day waiting period, 6-month income checks, and copays for all covered medications and services.
• Texas should minimize paperwork required from applicants by relying on the client’s statement and electronic data sources for all eligibility criteria (for example, residency, age, and relationships) allowed under federal Medicaid law to the maximum extent possible.
• Texas must include in their statewide public awareness campaign information on
  1. the availability of COVID-19 testing without cost-sharing and regardless of immigration status and,
  2. available coverage options and where to get enrollment assistance.
• HHSC must allow flexibility for community-based organizations to provide enrollment assistance remotely, in a manner that meets the needs of clients and supports continued social distancing.

Reminder: This blog is just a summary update on progress made in Texas to adjust Medicaid and CHIP in response to the COVID-19 pandemic. See the full update to our original report from March 23, 2020.

This blog was written by CPPP Senior Policy Analysts Melissa McChesney and Stacey Pogue, and CPPP Health & Wellness Team Program Director Anne Dunkelberg.