Ensuring Eligible Texas Kids Can Enroll in Health Coverage and Stay Covered

We appreciate that Texas leaders have shown a growing interest in ensuring eligible children can enroll in health insurance and remain enrolled while they are eligible. In 2021, the Legislature passed a bill to take an important first step on this issue, and in 2022 the Speaker of the House directed the Select Committee on Health Care Reform to study the issue in preparation for the 2023 session.

Health insurance plays a critical role in ensuring children can attend regular check-ups; identify disabilities or developmental delays and receive early interventions; address mental health challenges; get healthy and back to school when they’re out sick; and even catch cancer before it spreads.

While the state’s income eligibility policies for Medicaid exclude most adults below the poverty line, Texas kids in families with low incomes typically are eligible for insurance either through Medicaid or Children’s Health Insurance Program (CHIP) if they are U.S. citizens or lawfully present in the U.S. Unfortunately, Texas lags behind when it comes to eligible children’s enrollment: Nationally, about 91.9% of eligible children participate in Medicaid or (CHIP), but only 84.5% of eligible kids in Texas participated in these programs in 2019. As a result, Texas has by far the nation’s highest children’s uninsured rate, reaching 12.7% in 2019.

State leaders could slash the Texas children’s uninsured rate by improving enrollment of currently eligible kids. Of the 995,000 uninsured Texas children in 2019, over 400,000 (40 percent) were eligible for Medicaid or CHIP but not enrolled.

Texas leaders can ensure more eligible children are able to enroll and stay enrolled while they are eligible by: 

  1. Proactively enrolling eligible children by revitalizing the state’s health coverage outreach effort, implementing Express Lane Eligibility (ELE), and taking other steps; and
  2. Addressing unintended bureaucratic barriers and delays that families encounter when they attempt to apply or remain enrolled, including barriers in the state’s online, phone, mail, and in-person enrollment systems; the shortage of state eligibility staff; and barriers facing newborn babies.

It is particularly urgent for state leaders to take these steps before the pandemic Public Health Emergency (PHE) ends and Texas begins executing its plan to process 3.7 million Medicaid renewals in just six months.