Texas Medicaid Unwinding:
Information and Resources
Attention Texas Families!
From April 2023 to May 2024, Texas HHSC staff put a significant amount of time and work into rechecking the eligibility of millions of Texans who were enrolled in Medicaid during the COVID-19 pandemic but who no longer qualified for the program after eligibility and enrollment rules, which loosened during the pandemic, tightened up again. HHSC disenrolled 700,000 Texans after determining those enrollees were no longer eligible for the program. However, HHSC also disenrolled 1.4 million on Medicaid for “procedural” reasons, meaning a missed phone call, full voicemail inbox, or lack of enrollee response to a document request from HHSC leading to the denial. These procedural denials amount to an additional 1.4M in Texas who lack health insurance even though they may be eligible for no-cost coverage through Medicaid. To make matters worse, since Texas has not expanded Medicaid to low-income adults, all those 1.4 million on Medicaid were either children under 19, young adults just 19+ who aged out of Medicaid, disabled people, and pregnant people.
It will take an all-hands-on-deck approach to keep eligible Texans covered.
Most Texas households with members currently enrolled in Medicaid should expect to complete a renewal once a year from now on. The process can be confusing, and Every Texan is concerned that families with members who still qualify for Medicaid but who lost it for procedural reasons may fall through the cracks if the state can’t find them or they don’t know what steps to take.
Are You Still Covered?
Take these steps to find out:
- Call 2-1-1 and press option 2 to get to HHSC;
- Ask for the coverage status of your family members who were previously enrolled;
- If previously covered people are not enrolled, ask the HHSC representative if it has been over 90 days since the HHSC made the final determination. If not, you may still be able to renew instead of reapplying.
For anyone not currently enrolled and who needs to reapply because the 90-day renewal window has passed, or for those applying for the first time, the best platform to use is YourTexasBenefits.com.
Using the website or the YourTexasBenefits app, applicants can follow these best practices for speedy application processing:
- Opt for paperless communication so you can check for letters and follow-up from HHSC in the website or app;
- Submit ID cards, proof of residence, rent agreements, vehicle values, or anything that this list indicates you should, based on the programs you’re applying for;
- All members of the household will need to be on applications for most HHSC programs. For data security reasons, leave identifying information (birthdates, SSNs, Individual Taxpayer Identification Numbers, immigration status or numbers, etc.) off the application for household members who are not applying for enrollment into benefits programs; and
- If you’d like to talk with someone about the application, program eligibility, submission, acceptance or denial, appeals, etc., Texas Community Partner Program staff are experts. Try to select a Tier 3 CPP if there’s one nearby;
- Make a plan for follow up:
- If you applied for Pregnancy Medicaid, mark your calendar for 15 days after submitting the application, and call HHSC to check on its status and to check and see if you need to submit any more verifying documents;
- If you applied for SNAP food stamps, mark your calendar for 30 days after submitting the application, and call HHSC to check on its status and to check and see if you need to submit any more verifying documents;
- If you applied for CHIP or Medicaid (not pregnancy Medicaid), mark your calendar for 45 days after submitting the application, and call HHSC to check on its status and to check and see if you need to submit any more verifying documents.
If you have any trouble navigating this process, contact Every Texan’s Director of Health and Food Justice, Lynn Cowles, at 512-522-3220 or cowles@everytexan.org.
Did You Lose Coverage?
You may lose coverage if the state can't find you or you missed a deadline. If you lose Medicaid because you didn't submit your renewal or information, you can submit within 90 days for your case to reopen. After that, you have to reapply.
- Families may lose coverage because the state couldn’t find them or they missed a deadline – even though they might still be eligible. Families may also be incorrectly denied due to immigration status, income, or other errors. To get these cases corrected, please escalate them through the Office of the Ombudsman. If the case still can’t get corrected, families have the right to a fair hearing.
- If HHS denies you Medicaid because you didn’t submit your renewal or needed information, after losing coverage, you have a 90-day window to send the renewal or missing information without needing to fully reapply. Unfortunately, the renewal link on YourTexasBenefits.com is currently not active during the 90-day reconsideration period. To submit information to complete a renewal after a denial, you can submit during this time period by calling 2-1-1 Option 2 or completing a paper application and either faxing, mailing, or bringing it into a local HHSC office.
Resources
- If you are denied Medicaid but think you should still be eligible, you may be able to get this corrected. Community organizations are standing by offering free assistance renewing health coverage or exploring new options. Find help near you to see what your options are.
If you are no longer eligible for Medicaid, there may be other affordable health coverage options for you and your family:
The Children’s Health Insurance Program (CHIP) is available for eligible children in families who saw an increase in their income – No extra application is needed! During the Medicaid renewal process, HHSC evaluates eligibility for other HHSC health care programs, including the Children’s Health Insurance Program (CHIP). CHIP does require people to select a plan and there is a sliding scale of fees based on income.
High-quality insurance is available on HealthCare.Gov for eligible adults and children. If you are no longer eligible for Medicaid, HHS will send your information to HealthCare.Gov. You can apply now for HealthCare.gov, or wait for your notice that your case has been transferred. To enroll in Marketplace health insurance outside of the regular enrollment period (Nov. 1 to Jan. 15), you must have a life event that qualifies you for mid-year enrollment.
Job-Based Insurance may be available for you and your family. Check with your employer! There’s a special enrollment period to enroll in job-based insurance within 60 days of losing Medicaid or CHIP. If insurance through your job isn’t affordable for your family, there’s a new rule that makes it easier for your family to qualify for help paying for premiums through HealthCare.Gov. Check with local help near you about your options.
Healthy Texas Women provides well-woman exams and family planning services for eligible women between the ages of 18-44 who are not pregnant. Some women losing Medicaid will be enrolled into HTW, if they submit all renewal information requested by HHSC. You should be sure to check all your options to see if you can qualify for more comprehensive coverage through the Marketplace. Eligible women should apply to the Marketplace and, once covered, report that change to HTW, so they can be disenrolled.
Federally Qualified Health Centers provide safety net services for the insured, under- insured, and uninsured. Find a health center near you.
Texans with Medicaid:
Take Action to Keep Your Health Coverage
- Keep an eye out for notices from Texas Health and Human Services. HHSC will mail you notices by paper, or you’ll get an electronic notice in your YourTexasBenefits.com account or YourTexasBenefits app. Respond to requests for information right away.
- Make sure you have access to your Medicaid case through YourTexasBenefits.com or through the YourTexasBenefits mobile app (available in major app stores).
- Keep your contact information with Texas Medicaid up to date by reporting any changes at YourTexasBenefits.com, the YourTexasBenefits app, or call 2-1-1, Monday through Friday, 8am–6pm Central time. Select a language, then press 2.
- You don’t have to go through this alone—local help is available. If you’re unsure about a notice or need help accessing your account, you can reach out to a Texas Community Partner Program. Find help near you.
- If you’re no longer eligible for Medicaid because you got older than program requirements allow; because you are no longer within 12 months of a former pregnancy while you were enrolled; because your household income increased above program requirements; or because you no longer have the disability that made you eligible for Medicaid, you may be eligible for coverage through an employer, a spouse’s employer, or the Affordable Care Act’s health insurance Marketplace at HealthCare.gov. See the “Local Help” links below.
- You do NOT have to pay anyone to apply for or renew Texas Medicaid, CHIP or HealthCare.Gov coverage. Watch out for scam phone calls, emails, and texts.
Resources
- Find free, local help to renew your Medicaid or switch to other affordable coverage.
- #SickOfItTX: Are you eligible for Medicaid or HealthCare.Gov coverage?
- Questions? Email cowles@everytexan.org for help.
Las reglas de Medicaid están cambiando, y todos deben tomar acción para que su familia no pierda el seguro médico. No espere.
- Asegúrese de tener acceso a su cuenta en YourTexasBenefits.com o la aplicación móvil de Your Texas Benefits.
- Actualice su dirección y información con Texas Medicaid, especialmente si se mudó desde 2019.
- Busque un aviso amarillo en el correo o una alerta en la aplicación móvil. Responda de inmediato a las solicitudes de Texas Medicaid.
- Si está confundido o inseguro sobre un aviso, encuentra ayuda cerca de ti.
Những quy định của Medicaid đã thay đổi và mọi người phải hành động ngay. Đừng chờ đợi.
- Đảm bảo rằng bạn có quyền truy cập vào tài khoản của mình trên trang YourTexasBenefits.com hoặc thông qua ứng dụng di động Your Texas Benefits.
- Cập nhật thông tin cho Texas Medicaid, đặc biệt nếu bạn đã chuyển nhà từ năm 2020.
- Hãy tìm thư thông báo màu vàng trong hòm thư hoặc thông báo trong ứng dụng di động. Trả lời những yêu cầu từ Texas Medicaid ngay lập tức.
- Nếu bạn không rõ hoặc không chắc chắn về một thông báo, hãy tìm sự trợ giúp gần bạn.