Report: Almost Half of Uninsured TX Kids are Eligible for Medicaid/CHIP

A new report by our colleagues at Texas 2036 clearly shows that state leaders can make progress to lower the children’s uninsured rate in Texas by focusing on kids who are uninsured but eligible for Medicaid health insurance. The data in the report reveal that almost half of Texas’ uninsured children — around 47% — are eligible for Medicaid or CHIP health coverage but are not enrolled. The good news is the Legislature can make a lot of progress by ensuring that kids who are already eligible are able to enroll in health coverage — an idea that has strong bipartisan support at the Legislature.

The Texas 2036 report shows that nearly 4.9 million Texans do not have health insurance, making Texas the state with the nation’s highest uninsured state. It shows that 17.4% of uninsured Texans are children and — further breaking down this lack of coverage — 8.3% of uninsured Texans are children who are eligible for Medicaid or CHIP but unenrolled. In other words, about 852,000 Texas kids are uninsured, and about 400,000 of those Texas kids are eligible for Medicaid or CHIP.

The findings in the report also highlight how important health insurance is, underscoring that state leaders should address the high uninsured rate. For example, the report notes that 48% of uninsured Texans do not have a “medical home” for receiving health care, a metric associated with better health outcomes. We know that health insurance is critical for reliable, consistent, timely health care for Texas children. It helps children attend regular check ups; identify disabilities or developmental delays and receive early interventions; address mental health challenges; and get healthy and back to school when they are out sick. 

Unfortunately, when kids are eligible for Medicaid health insurance, many families run into unintended bureaucratic barriers when they are trying to sign them up or renew their coverage. These barriers include issues within our state’s eligibility and enrollment systems. For families who overcome these barriers and properly submit their applications or renewals, there are still system challenges that can slow down the process or send them back to square one. These challenges in the state enrollment system have existed for many years, but they were exacerbated and exposed during the “unwinding” of pandemic-era Medicaid eligibility rules during 2023.

All of these issues contributed to Texas having the worst children’s uninsured rate in the nation at 10.9%, according to the Census Bureau data for 2022. A recent national report also found that 12 Texas metro areas — Abilene, Beaumont, Brownsville, Dallas-Fort Worth, El Paso, Houston, Laredo, Longview, McAllen, Midland, Sherman — have children’s uninsured rates over 10%, far exceeding the national average of 5.1%. The data are a reminder that children’s health coverage is a statewide problem, affecting lots of different kinds of communities, and requires statewide solutions from the Legislature. Furthermore, the Texas School Readiness Dashboard reports that Texas ranks among the worst states in the country in the percentage of young children who are uninsured but eligible for Medicaid health insurance. 

During the regular legislative session in 2023, Texas legislators showed strong bipartisan support for helping eligible children enroll in health coverage when their parents provide affirmative consent. Specifically, the Texas House overwhelmingly passed HB 1599 by Reps. John Bucy, Sam Harless, Tom Oliverson, Jacey Jetton, and Greg Bonnen to use already-verified information to facilitate health coverage enrollment for currently eligible children through an “Express Lane” option. Unfortunately, the bill did not pass the Senate. The bill should be a priority this interim as lawmakers prepare for the next legislative session.

The state should also invest in the technology and staffing needed to ensure the state’s Medicaid health insurance sign-up system is fully functional. This will help reduce the unintended bureaucratic barriers many families face when attempting to apply or renew health coverage for their children. 

We look forward to working with our partners and legislators to reduce the state’s shameful uninsured rate for kids and ensure that Texas kids can get the health care they need.