Houston Leads U.S. In Uninsured Children, While Texas Struggles with Medicaid Access and Coverage Gaps

Houston has the highest rate of uninsured children of any metropolitan city in the U.S. Overall, Texas holds the worst coverage rate for children in the country, with nearly 12% of kids going uninsured in 2023 — up from nearly 11% in 2022. 

Many of these uninsured children are actually eligible for public insurance, highlighting gaps in the state’s enrollment and outreach system, as reported by The Texas Tribune.

Thousands of families applying for Medicaid or the Children’s Health Insurance Program (CHIP) in 2024 are stuck in a growing backlog. For most of the year, the average wait time for a decision exceeded two months, prompting a federal investigation under the Biden administration. The application process remains tedious and confusing, often requiring families to gather dozens of documents to prove eligibility. Frustrated by the complexity and delays, many simply give up.

Since Texas resumed reviewing Medicaid eligibility in 2023 after a pause during the COVID-19 pandemic, over 1 million children have been dropped from the program, frequently due to procedural issues like missing renewal packets, rather than ineligibility. These procedural errors underscore the flaws in the state’s enrollment system, which many families struggle to navigate.

Despite bipartisan support, Texas lawmakers have rejected or stalled proposals aimed at easing access to Medicaid and CHIP for children. A 2023 bill to streamline enrollment using verified information from other state benefit programs failed to advance but has been reintroduced in 2024.

In addition to stalling bills that could improve access, Texas has continued to resist efforts to adopt policies that have helped other states increase coverage for low-income families. Many of these efforts, such as expanding Medicaid for adults, have been shown to have a positive effect on children’s enrollment. Experts argue that addressing these gaps would not only ensure more children get the health coverage they need but would also alleviate long-standing barriers to care.

Texas has also rejected broader health initiatives, such as Medicaid expansion for low-income adults, which research shows helps increase enrollment for eligible children. Advocates emphasize that without access to these programs, many Texas children miss out on critical healthcare services and screenings, leading to poorer health outcomes.