Born and raised in Round Rock, Sandra, a 38-year-old mother of three and a full-time student at her local community college, signed up for the Supplemental Nutrition Assistance Program (SNAP) to help make ends meet for herself and her loved ones after she and her husband fell on hard times during the COVID-19 lockdown. That is, until she attempted to renew her benefits recently. Her paperwork is stuck in a backlog because Texas doesn’t have enough staff to process the forms. The significant paperwork delays means Sandra’s family is watching expenses pile up without SNAP benefits to help with food costs. She and her husband must rethink where they find meals as the school year begins.
Sandra’s story echoes throughout corners of Texas. In July 2022, a single mother in North Texas was still waiting on her benefits nearly two months after submitting her information. East Texans are reaching out to their local news stations with their concerns. At the end of August, there were 198,025 new SNAP applications waiting to be processed. State workers themselves are accessing food banks while waiting for their own applications to go through. It’s not just SNAP — Texans applying for Medicaid are also facing delays. Health clinic staff members report trying to assist a pregnant woman who waited two months for her Medicaid application to be approved, delaying her access to prenatal care. The backlog is causing families to go without food and health benefits while they wait for their applications and renewals to go through the system.
Under normal circumstances, the Texas Health and Human Service Commission (HHSC) has consistently processed SNAP and Medicaid applications within federally required timeframes, with 90% or more processed in a timely manner. But a surge of new applicants through the pandemic and very high turnover of eligibility workers led to significant delays in processing applications. SNAP “timeliness” (i.e., processing within federal time standards) has been below the required threshold of 90% since July 2021, meaning thousands of families were unable to get the help they needed to feed their children within 30 days. Kids are waiting longer than 45 days for new Medicaid applications as timeliness has continued to drop since February of this year.
Since 2020, federal pandemic-related flexibilities have enabled states to make it easier for people to keep their benefits and for workers to maintain manageable workloads. During the federally declared COVID Public Health Emergency (PHE), Texas received billions more in federal funding to keep people enrolled in Medicaid, and people haven’t been getting kicked off that program due to continuous coverage provisions. But families that need SNAP had to keep renewing their food benefits and have been hit harder by the backlog.
Unlike in most states, Texas requires people to renew their SNAP enrollment every 6 months. When Texas HHSC took the rare step in October 2021 of requesting federal SNAP waivers to delay scheduled SNAP renewals by 6 months and waive client interviews because of the strain on the system, timeliness improved temporarily through January 2022. However, trends quickly reversed once the one-time delays stopped being used and the system again became overwhelmed.
HHSC reinstated the SNAP waivers pushing out renewals and waiving interviews in June 2022 to help move through the backlog. Even with the waivers still in effect, in September 2022 only half of all new Medicaid applications were processed in a timely manner, and new SNAP applications are following a similar pattern with only 54% of applications considered timely. This means significant numbers of new applicants are waiting months for access to health care and going hungry, even though they may be eligible for help.
Despite agency use of these federally allowed flexibilities, the system is failing to meet the needs of too many Texans. Like many other employers and other state agencies, Texas HHSC is critically understaffed as a result of the Texas Legislature continuously underinvesting in state programs, particularly in the area of wages. There were four times as many eligibility worker vacancies in February 2022 as there were at the beginning of the pandemic. Continued budget cuts, starting salaries of only $2,300 a month, and no pension plan options for new employees have hobbled HHSC’s efforts to compete for employees in the current labor market. HHSC recently implemented new incentives for promotions and pay increases to recruit and retain eligibility staff, which has helped reduce staff shortages, but the Legislature must take more action to fully fund state agencies.
When the Public Health Emergency Ends
The COVID PHE declaration currently extends to mid-October, and we anticipate another extension that will continue until at least January 2023. When the accompanying Medicaid continuous coverage ends, Texas will have to renew coverage for at least 2.7 million Texans who have kept their Medicaid. A recent report predicts nearly 3 of 4 kids who will lose Medicaid at the end of the PHE will still be eligible. People of color will disproportionately lose Medicaid despite remaining eligible, caused in large part by administrative burdens in the enrollment process. Millions of Texans are likely to hit enrollment barriers and to overwhelm the already struggling eligibility system. At the same time, families will see reduced monthly amounts for their food benefits.
The end of the flexibilities enacted during the PHE will be devastating both for people that have been hit the hardest during the pandemic and for the state’s eligibility system.
Texas Leaders Must Take Action
Now and during the 2023 Texas Legislative session, leaders must give Texas HHSC the support it needs to end the massive delays in the eligibility system and minimize the harms at the end of the PHE.
1. Address Critical Workforce Needs
During the next legislative session, policymakers need to provide HHSC with enough funding to hire eligibility staff and sustain contractor staff support to restore application processing to within federal timeliness guidelines. HHSC has already taken numerous steps to improve retention and recruitment of its eligibility workforce and likely has few additional levers to improve staffing levels without legislative action. The end of the PHE will greatly increase workloads and exacerbate challenges for Texans and agency staff. Without adequate staffing of and training for critical positions like call center contractors and eligibility workers, HHSC will not be able to successfully resume normal, orderly renewal operations.
2. Authorize Texas HHSC to fully leverage federal flexibilities and best practices
Texas HHSC has proven that using SNAP waivers to push out renewals and waiving interviews can be effective tools to improve or prevent backlogs. The agency should continue to use these waivers now and when the PHE ends, as allowed by federal flexibilities. In addition, Texas leaders should authorize HHSC to take up additional available flexibilities Texas has not yet used, including telephonic signatures and auto renewal of Medicaid clients already verified by SNAP. These flexibilities are available for circumstances exactly like what Texas is currently in. Using these waivers will help families get the health care and food assistance they need in this period of high inflation, and help HHSC to get back into compliance.
An overwhelmed eligibility system is a problem as big as Texas. But we can fix it — with action from Texas leaders and the legislature, we can reverse the recent delays and minimize the potential harm to come. Sandra and her family shouldn’t have to figure out where their next meal is coming from, especially not while they wait on paperwork. Texans deserve state agencies that are fully funded, and workers deserve to be compensated fairly. Every Texan, regardless of race or zip code, deserves to receive and keep their health care and food benefits.