Legislative Checklist to Support Orderly Medicaid Unwinding

Keeping Eligible Texans Enrolled in Medicaid in 2023 and Beyond

View this checklist as a PDF here.

Download an Unwinding tip sheet here.

Children and pregnant women face multiple barriers when enrolling in and keeping Texas Medicaid or CHIP. Pre-pandemic data show at least 400,000 Texas children were uninsured in 2019 despite being eligible for Medicaid or CHIP, making it harder for them to go to doctor check-ups, get needed medicine, access mental health support, and more.

In the 2021 session, Texas leaders took a critical first step to reduce the number of eligible children who mistakenly lose Medicaid. During the interim, the House Select Committee on Health Care Reform built on that work, recommending steps to help eligible kids and pregnant women enroll and stay covered.

In April 2023, the Texas Health and Human Services Commission (HHSC) will start the enormous task of “unwinding’ — re-checking eligibility for all 5.8 million Texans with Medicaid following a 3-year nationwide pause on disenrollments during the pandemic. HHSC will start unwinding with a shortage of eligibility workers and backlogs of Medicaid and SNAP paperwork that have persisted for over a year. HHSC has worked to fill eligibility worker vacancies, leverage temporary federal flexibilities to reduce the workload, increase outreach to clients, and equip Medicaid health plans to help clients renew, but legislative action is needed to support the agency’s efforts and ensure efficiencies and innovations that help keep eligible kids covered can be maintained.

Legislative Checklist to Support Orderly Medicaid Unwinding:

The 2023 Session is a critical time for the Legislature to act, to help Texas avoid a huge spike in eligible kids losing coverage in 2023 and 2024:

Increase pay for eligibility workers and fund unwinding-specific agency needs.

An effective eligibility and enrollment system forms the foundation for meeting food and health care needs of eligible Texans. A shortage of HHSC eligibility workers throughout 2022 and 2023 has created backlogs and caused families to go without food and health benefits while waiting for their paperwork to be processed. Eligibility worker positions have a high turnover rate, are often hard to fill, and require substantial training. Hold times at HHSC’s 2-1-1 call center often exceeded an hour in 2022.

  • The state budget as filed prevents a pay cut for eligibility workers. It maintains raises HHSC implemented in summer 2022 that helped HHSC hire and retain eligibility staff, reducing vacant eligibility worker positions from 1,000 at the beginning of 2022 to 300 at the end of 2022.
  • Fund HHSC’s updated Exceptional Item #5. It identifies unwinding-specific funding needs, including 642 temporary staff and the state’s call center contractor staff.

Increase efficiencies in Medicaid/CHIP enrollment and renewal using reliable data, as recommended by the House Select Committee on Health Reform.

HHSC does not fully leverage reliable income data it has on-hand, either from the Texas Workforce Commission or data already verified by HHSC for other programs. As a result, Texas completes Medicaid renewals using an efficient, data-driven process just 5-10% of the time — among the worst rates in the nation — while Arizona uses data-driven renewals more than 75% of the time. During unwinding, HHSC will pilot a method of using verified SNAP-income data to make Medicaid renewals more efficient, easing the workload of Texas’ strained eligibility system.

  • Pass Express Lane Eligibility, HB 1599 (Bucy)/SB 550(Johnson), a data-driven approach to streamline enrollment and renewal for kids. States using it have cut the staff time needed to process each application or renewal by 20-30 minutes, creating administrative savings.

Improve HHSC outreach to mixed-immigration-status families with eligible kids.     
One in four Texas children has a parent who is not a U.S. Citizen (of any immigration status: lawfully present or undocumented). Fear of accessing benefits in mixed-immigration-status families keeps eligible children uninsured.

  • Pass SB 630 (Menéndez)/HB 3237 (Campos), directing HHSC outreach that clearly explains eligibility rules for mixed-immigration-status families and informs parents that eligible children’s use of health services will not harm a parent’s immigration status.

Address language barriers that prevent eligible Texans from enrolling.         
More than one in three Texas households speaks a language other than English and 13% of Texans have limited English proficiency. Texas cannot reach all eligible children if Medicaid, CHIP, and SNAP applications and accompanying services remain available consistently only in English and sometimes in Spanish.

  • Pass SB 2080 (Menéndez)/HB 5166 (Morales Shaw) directing HHSC to make key resources, including applications, notices, and Your Texas Benefits, available in multiple languages, including Spanish, Vietnamese, Korean, Chinese, and Arabic.

Restore state grant funding to community organizations that conduct outreach and provide application assistance, as recommended by the House Select Committee on Health Care Reform.           
HHSC’s Community Partner Program provides important training resources for community-based outreach and application assistance, but related local and regional grants available in the 2000s.

  • Restore funding for state grants for community-based application assistance to enable smaller health centers and other community organizations to play a big role in their area in getting children signed up and renewed.

For additional information, contact Anne Dunkelberg at dunkelberg@everytexan.org or Stacey Pogue at pogue@everytexan.org

View this checklist as a PDF here.

Download an Unwinding tip sheet here.

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