During the height of the COVID-19 pandemic, the federal government stepped in to make it easier for poor Americans to enroll and stay on Medicaid. Those protections sunsetted this year, and now Texas leads the nation in disenrollment.
To be sure, loss of Medicaid benefits is a problem across the country. Even states that have expanded Medicaid coverage under the Affordable Care Act are seeing huge numbers of people kicked off the rolls. Some of these are because of changing circumstances, some because of miscommunication, but all having a deep and significant impact on the health of the most vulnerable Americans. Even patients in urgent care are suddenly finding themselves without a guarantee of treatment.
In Texas, the largest state to refuse the Medicaid expansion, the numbers are truly grim. Disenrollment is higher than every other state and the District of Columbia. In terms of raw numbers, 1.2 million Texans have been kicked off the rolls since Kaiser Family Foundation began tracking the numbers in May. That’s 64 percent more than California, a state with 32 percent more people. Even worse, 2 million Californians have been able to re-enroll in Medicaid. Only 668,800 Texans have.
Texas also has the highest rate of disenrollment in the county at 65 percent. Of the ten states with the highest rates of disenrollment, a third of the states that haven’t expanded Medicaid are included.
Most disturbingly, Texas also ranks first in the number of children disenrolled. Almost 70 percent of Texans that lost coverage since May are minors.
Texas does rank dead last in one regard: people who were able to renew their coverage in Medicaid through ex parte. That means that the state used existing documents to determine coverage instead of demanding new ones. Only 9 percent of Texans were able to renew their Medicaid coverage this way. Texas ranks fourth (a tie with Idaho) in most people deemed subsequently ineligible, trailing South Dakota, Wisconsin, and Massachusetts, and fourth again for most people terminated procedurally.
In September, President Joe Biden accused some states of disenrolling people without proper procedure. Federal guidelines say that states are supposed to review existing documents before sending out letters of renewal. It’s clear that this is not be followed, though not to wat extent. Regardless, 10 million Americans have lost Medicaid coverage since the loss of federal protections, and 12 percent of them are in Texas alone.
Some states, like California, have transferred large numbers of their disenrolled residents automatically to ACA marketplace plans, which explains their high level of re-enrollment in coverage. Texas is not doing this. The dreaded coverage gap between state eligibility and eligibility for federal plans is still in place because of Texas’s refusal to expand Medicaid. As such, more than a million Texans are do not qualify for free or reduced plans. Despite some increased support for expanding Medicaid in the state among Republicans, Governor Gregg Abbott has stood firmly against it, calling it a “tax increase waiting to happen.”