The need for programs administered by Texas Health and Human Services (HHSC), such as Medicaid, CHIP and SNAP, has grown substantially during the COVID-19 pandemic as household incomes drop and people lose access to insurance. Since the beginning of the pandemic, 3.8 million Texans have filed for unemployment. SNAP enrollment grew by over 716,000 Texans between February and September. Many who lost jobs with employer-sponsored insurance either already lost coverage or risk losing it in the future when a temporary lay-off with benefits becomes a permanent termination. Researchers have estimated that nearly 660,000 Texans have already lost their job-based coverage in 2020, and estimates for 2021 are even higher. Many of these individuals, especially children, will be eligible for health coverage through Medicaid or CHIP.
On top of the increased demand for services created by the pandemic, Texas HHSC has proposed reducing the number of staff members that process applications for benefits.
Advocates and providers hope to stop or reduce those cuts. Nevertheless, we believe that Texas HHSC must prioritize opportunities for efficiency to meet the increased need for services created by the pandemic. A clear and attainable option to improve efficiencies and reduce burden on clients is leveraging and improving the Medicaid “administrative renewal” process, to reduce the number of renewals that eligibility staff must process manually.
Federal rules and regulations allow states to implement administrative renewals that allow eligible families to be enrolled in Medicaid and other programs without Texas HHSC staff intervention or additional paperwork from families. However, Texas’ current system of administrative renewal is ineffective. According to Texas HHSC, fewer than 9% of Medicaid and CHIP clients have their coverage automatically renewed by HHSC at the end of their certification period. This low rate of administrative renewals means Texas HHSC staff must spend time processing the applications manually.
Our top three recommendations to improve administrative renewals are as follows:
- HHSC should allow the use of Texas Workforce Commission (TWC) quarterly wage data from the two quarters prior to the current quarter.
- Stop using New Hire Report data during the automated administrative renewal process.
- Continuously evaluate the administrative renewal process to identify and correct additional barriers.
Details on these recommendations and additional recommendations for improvement to the administrative renewal process are in a memo Every Texan provided to Texas HHSC.
In addition to improving efficiency and reducing the administrative burden on clients, a more streamlined renewal process would help reduce client confusion that has resulted from Texas HHSC attempting to renew Medicaid coverage during the Public Health Emergency, despite the guarantee of coverage through the end of the crisis. Substantial improvements to the administrative renewal process will also be imperative to mitigate the impact of eliminating auto-enrollment from Medicaid for pregnant women into Healthy Texas Women (HTW) under the 1115 Waiver. Increased barriers to HTW enrollment for postpartum mothers will make the new HTW Plus benefits directed by Senate Bill 750 less effective. Now that the public health emergency has been extended until January 20, 2020, Texas HHSC should use the additional time and flexibility to make much-needed process improvements.
For a detailed look at the needed improvements for Medicaid renewals, read our memo. Every Texan also joined a group of 40 organizations that signed a letter urging Texas HHSC to make these improvements and outlining other issues that should be addressed before the public health emergency ends. Read more about that here.