State Wrapping Up Removal Of Texans From Medicaid, But New Data Show Persistent Roadblocks For Texas Families

Cross-posted from Cover Texas Now.

For Immediate Release
December  14, 2023


Austin – The state is wrapping up its review of Medicaid eligibility for Texans who benefited from pandemic-era “continuous coverage” rules, but state data show that months-long delays in reviews of Medicaid health insurance applications and other problems persist for Texas families. Advocates are warning that state leaders must take action to ensure that children who are eligible for Medicaid health insurance are able to enroll, stay covered, and get the health care they need in a timely fashion.

“Texans are now up-to-date with their Medicaid paperwork. Just like before the pandemic, Texans with Medicaid health insurance have either proven they qualify or submitted paperwork that’s stuck in the state’s backlog,” said Stacey Pogue, senior policy analyst with Every Texan. “Texas leaders keep falling behind when it comes to making sure eligible kids are able to sign up without delay for the health care they need.” 


The state released its latest monthly report on the results of renewals conducted during the “unwinding” of Medicaid continuous coverage. The November data from the Texas Health and Human Services Commission (HHSC) includes the review process results for the final cohort of Medicaid enrollees who had coverage extended due to the pandemic-era policy, although half a million renewals were still listed as “pending” in the most recent state report, due to long delays at HHSC. Every Texan analysis of the April-November monthly reports by HHSC reveals:

  • Texas removed 1.1 million people from Medicaid health insurance for procedural reasons, from April to November, meaning the state did not confirm whether they were still eligible. In addition, 557,000 Texans have been removed from Medicaid because HHSC determined they were no longer eligible. In total, 1.7 million Texans have been removed from Medicaid from April to November. “Procedural denials” happen when a Medicaid enrollee does not complete every step in the renewal process, often because the state sends renewal information to the wrong address or people encounter other paperwork barriers in the process.
  • Texas completed only 3 percent of renewals through the data-driven “ex parte” or “administrative” renewal process — the worst rate in the nation, according to KFF. The data from KFF indicate that 30 percent of Medicaid renewals nationwide have been conducted through the ex parte process. The ex parte process utilizes third party data, such as data that other state programs have regarding families’ income, to confirm ongoing eligibility. Ex parte renewals help the state to improve accuracy, reduce procedural denials, and ensure eligible children can keep their health insurance.

Additional data broken down by demographic group, but only covering the time period through November 10, is available on the Dashboard recently released by HHSC.


Separate data from HHSC show that children and other Texans — including children who may have been mistakenly removed from Medicaid by the state — are stuck waiting for months for the state to process their Medicaid health insurance applications.

  • 39 percent of Medicaid applications processed by the state in November were delayed beyond the federal 45-day standard for timely completion.
  • 150,000 families in Texas have been waiting more than 45 days for the state to process their Medicaid applications 
  • HHSC’s latest monthly report shows that the state still has not processed more than 48,000 Medicaid applications submitted in or before March. The report does not indicate how many additional applications submitted since March are still waiting to be processed. 
  • Many of these families are also waiting months for the state to process their applications for SNAP food assistance. There is a backlog of unprocessed SNAP applications from 138,000 Texas families. The same HHSC eligibility workers manage applications for Medicaid and SNAP.

“Kids who got kicked off Medicaid health insurance this year due to mistakes by the state — or kids who need to apply for the first time — should be able to count on Texas to process their applications on time,” said Diana Forester, Director of Health Policy at Texans Care for Children. “It’s tragic to think that children are missing their check ups or medications because their Medicaid application is collecting dust in a state office.” 

The state’s rushed plan to unwind Medicaid continuous coverage contributed to these challenges, but there were significant challenges with delayed paperwork prior to the unwinding, which will continue if state leaders fail to address this challenge. In March 2023, the month prior to the start of unwinding, 46% of Medicaid applications processed by HHSC were delayed beyond the 45-day timeline.

“Let’s be very clear: there is a health care crisis in our state that Governor Abbott and state leaders could have addressed at any point during the regular and many special sessions we’ve seen this year,” said Michelle Castillo, Deputy Director of Children’s Defense Fund – Texas.  “Texas continues to have the highest number of uninsured children in the country, a crisis now exacerbated by the end of the pandemic-era continuous Medicaid coverage. If Texas children and families have to wait for the health care they deserve, it’s because of a failure by their state leaders to prioritize their basic needs. Texas children deserve better.”


Advocates are calling on the Governor, Legislature, and HHSC to take immediate action to ensure that eligible children are able to sign up for health coverage and remain enrolled if they are still eligible. In particular, in the weeks ahead, state leaders should:

  • Take necessary steps to immediately reduce paperwork backlogs for Medicaid and SNAP applications.
  • Ensure Texas families can reach state eligibility staff. The state can address that challenge by offering evening and weekend hours at local offices and through 2-1-1, and improving the 2-1-1 call system.
  • Support community organizations that are helping Texans enroll in Medicaid.
  • Investigate why the state has such a low rate of data-driven administrative renewals (also known as ex parte renewals) that reduce paperwork by using other databases the state has on family income and other data.

In the longer term, next year and in 2025, advocates are calling on state leaders to:

  • Increase the use of data-driven administrative “ex parte” renewals.
  • Remove unintended barriers that families face when attempting to apply or renew their coverage. Specifically, invest additional funding in upgrading the technology within the Texas Medicaid eligibility system, the 2-1-1 call system, and the state’s YourTexasBenefits website and app.
  • Invest in community partners who are helping Texans enroll in Medicaid.
  • Invest additional funding in maintaining a stable, experienced workforce of state eligibility workers.
  • Pass legislation to establish an “express lane” option to enroll currently eligible children in Medicaid, with affirmative parental consent, using other state data sources on income and other eligibility criteria. During the 2023 legislative session, the Texas House overwhelmingly passed HB 1599 by Reps. Bucy, Harless, Oliversion, Jetton, and Bonnen to establish the express lane option, but it did not pass the Senate.


The new data on Medicaid removals and delays in Texas come on the heels of a national report showing that lack of access to health insurance is a problem in many different communities across the state. The report, drawing on U.S. Census Bureau data, confirms Texas has the highest children’s uninsured rate in the nation at 10.9% in 2022, totaling 854,000 Texas kids without health insurance that year. The report reveals that numerous Texas communities have children’s uninsured rates over 10%, more than double the national rate of 5.1%, including Abilene, Beaumont, Brownsville, Dallas-Fort Worth, El Paso, Houston, Laredo, Longview, McAllen, Midland, and Waco.

Texans Care for Children, Every Texan, and Children’s Defense Fund – Texas are all members of the Cover Texas Now coalition.