New Data Show Serious Problems with TX Medicaid Removals

For Immediate Release
July 17, 2023
Contact: Peter Clark,

Austin – The Texas Health and Human Services Commission (HHSC) has released data on the first cohort of Texans removed from Medicaid health insurance as part of the “unwinding” of the pandemic-era Medicaid continuous coverage rules. The state is expected to provide additional data in coming months as more Texans enrolled in Medicaid are subject to the removal process. 

“We’re deeply concerned that Texas kids who are still eligible for health insurance — either through Medicaid or another program — are losing their health coverage for bureaucratic reasons and are going to get turned away the next time they walk into a doctor’s appointment,” said Diana Forester, Director of Health Policy at Texans Care for Children. “State leaders must make sure that kids and moms who are still eligible for health insurance will be able to stay enrolled so they can go to their doctor’s appointments, keep taking their medications, and stay healthy.”

High Rate of Procedural Denials

“The high percentage of procedural denials should be setting off alarm bells,” said Ms. Forester. “When you see this many procedural denials, it means that the process is not working properly, whether the state is sending renewal information to the wrong mailing addresses or parents are running into bureaucratic delays with the state when they try to renew their children’s health insurance.”

The new data show 81 percent of disenrollments were due to procedural denials. These are cases in which the state terminated Texans’ health insurance before confirming whether they are still eligible. While some proportion of Texans who lost their Medicaid health insurance are no longer eligible, the state should be transferring them to other programs — such as HealthCare.Gov, Healthy Texas Women, or the Children’s Health Insurance Program — instead of just ending their health coverage through these procedural denials. HHSC has not released details about which Texans were in the first cohort of Medicaid renewals and disenrollments, but it appears that the first cohort includes more Texans who are likely no longer eligible — such as children who turned 19 or are in families whose income increased — compared to the upcoming cohorts.

“If the high percentage of procedural denials continues, then Texas is on the verge of knocking a lot of eligible kids off of their health insurance,” said Ms. Forester. “State leaders need to quickly improve the process to make sure it’s running smoothly and renewing health coverage for eligible kids. If state leaders can’t quickly pivot to a more effective process, then they should consider pausing the Medicaid removals until they can get this right.”

Low Rate of “Ex Parte” Renewals

“Additionally, we are concerned that the state underutilized the ‘ex parte’ process for renewing Medicaid coverage for Texans who are still eligible,” said Ms. Forester.

The ex parte process utilizes third party data, such as data that other state programs have regarding families’ income, to confirm eligibility. Using ex parte renewals allows the state to improve accuracy, reduce procedural denials, and ensure eligible children can keep their health insurance. Unfortunately, the Texas data show only 1 percent of renewals were completed through this process. By contrast, the majority of states are able to use the ex parte process to renew at least 25 percent of their renewals, and a quarter of states conduct over 50 percent of renewals through the ex parte process. The Texas House showed bipartisan support last session for increasing the use of the ex parte process, passing HB 1599 to allow HHSC to use already verified third party data to determine children’s eligibility for health insurance. This Express Lane option could streamline the application process for many children, reduce the burden on the eligibility workforce, and slash the uninsured rate for Texas children. The bill did not pass the Senate but is expected to be on the agenda for the 2025 legislative session.

HHSC Staff Working Hard, But Legislature Did Not Fully Fund Budget Request

“We appreciate that the staff at HHSC is working hard to address the challenges in the current Medicaid renewal process,” said Ms. Forester.

Unfortunately, during the recent legislative session, the Legislature provided only $111 million of the $143 million the agency requested to support outreach, staffing, technology, and support for the spike in Medicaid renewals this year.

Information for Texans Enrolled in Medicaid

Texans who are enrolled in Medicaid can visit to learn more about the steps they should take to keep their Medicaid coverage if they are still eligible or transition to a different program if they are no longer eligible.