Texas’ history with streamlining enrollment into public benefits has been a roller coaster of ups and downs. In the early 90s, Texas was one of the first states to take the innovative step of trying to create a single application for multiple public benefit programs. But after “welfare reform” in 1996, participation in Medicaid dropped to historic lows as families, no longer eligible for cash assistance, did not realize their children were still eligible for health care coverage. Then in 2000, with the creation of the Texas Children’s Health Insurance Program (CHIP), came a wave of energy and state investment into outreach and enrollment, which had spillover effects into children’s Medicaid and enrollment improved overall. However in 2006, the entire eligibility and enrollment system came crashing down as Texas Health and Human Service Commission (HHSC) was transitioning to a newer system which would integrate all programs. It took years but eventually the Texas Integrated Enrollment Redesigned System (TIERS) became the modern, efficient, eligibility system promised by the state. In 2014, the Affordable Care Act raised the bar and required states to streamline eligibility even further by using available technologies to reduce administrative burdens on clients.
Instead of fully embracing the ideas set forth by the ACA, Texas HHSC responded by changing eligibility policy and essentially eliminating continuous coverage for children in Medicaid. This led to 3 years of flat enrollment in the children’s Medicaid program between 2014 and 2017. Beginning in December 2017, enrollment in Medicaid/CHIP and SNAP has been on a steady decline. Recent declines likely result from lack of funding for outreach and enrollment efforts, fears of mixed-status families to enroll themselves and their children in benefits, and deliberate decisions made by state leaders which stymie enrollment and increase churn.
