To Support Healthy Kids and Moms, Texas Must Prepare for the End of the PHE and the Start of Medicaid Disenrollments


Under the COVID-19 “Public Health Emergency” (PHE) declaration initiated by the Trump administration and continued by the Biden administration, Texas and other states have paused disenrolling children, mothers, and others from Medicaid health insurance.

Texas and other states will restart Medicaid disenrollments — requiring a review of five million enrollees in Texas alone — when the PHE ends or when Congress ends the PHE disenrollment policy.

When the PHE ends, it will be appropriate for the state to begin removing from Medicaid those Texans who are no longer eligible: women who are more than two months past childbirth and children whose family income rose. We want to ensure Texas leaders have a plan to manage that review and removal process in an orderly, efficient, and responsible manner — and avoid chaos that could create a tidal wave of Texans missing out on the health care they are eligible for and urgently need.

Getting that process right will help ensure that children and new moms can consistently access health programs for which they are eligible so they can keep seeing their doctor, afford their medications, attend mental health appointments, catch cancer before it spreads, and more.



1. Ensuring still-eligible kids can stay enrolled in Medicaid health insurance

During the 2021 legislative session, Texas leaders — including Speaker Phelan, Rep. Cortez, Chair Frank, and Chair Kolkhorst — took important steps to reduce the number of eligible children who mistakenly lose their Medicaid health insurance due to procedural errors. Legislators recognized that when eligible children repeatedly fall off and on their health insurance, it results in missed routine care like check ups, medicine when they are home sick from school, mental health support, therapy for speech delays or Down syndrome. That leads to increased costs like emergency room visits, mental health crises, delayed development, and other challenges.

If Texas does not adequately prepare for Medicaid disenrollments to begin again, the chaos could lead to a huge spike in eligible children losing their insurance, dwarfing the problem the Legislature addressed.

Utah serves as a cautionary tale: The state suspended renewals for its Children’s Health Insurance Program (CHIP) at the beginning of the pandemic. When renewals resumed, an unprecedented 41% of Utah children in the CHIP program lost coverage, the vast majority (around 89%) because of a procedural issue, not because the state determined they were no longer eligible

2. Ensuring moms, kids, and others who are no longer eligible for Medicaid are removed from the program in an orderly manner and transitioned smoothly to programs like CHIP and Healthy Texas Women.

Many Texas women who enrolled in Medicaid for Pregnant Women will lose their Medicaid eligibility when the PHE policies expire. Texas should ensure women are able to transition smoothly to other health programs for which they are eligible, such as Healthy Texas Women (HTW) or insurance available through the Marketplace, to continue to receive consistent health care. Many Texas women who exit Medicaid for Pregnant Women will be eligible for the limited, important services available through HTW but will become uninsured because Texas has not implemented Medicaid expansion for adults with jobs below the poverty line.

The time period after pregnancy is particularly critical to the health of moms and infants. The Texas Maternal Mortality and Morbidity Review Committee reports that 31% of pregnancy-related deaths occurred 43 days to 1 year after pregnancy.

There will also be children who are no longer eligible for Medicaid but are now eligible for the Children’s Health Insurance Program (CHIP). Texas should ensure a smooth transition to CHIP for these children.

3. Avoiding chaos that could overwhelm doctors, safety net providers, rural hospitals, state eligibility workers, and others.

Texas has already struggled to meet federal guidelines for processing Medicaid and SNAP applications in a timely manner. The process in place for Medicaid members to update their contact information is burdensome and inefficient. Current wait times for state operators at 2-1-1 average 45 minutes, and getting disconnected is common, according to first-hand information provided to Texans Care for Children by community organizations. 


  1. On October 13, 2022, the Biden administration extended the current PHE for another 90 days. If that is the last extension, the PHE would expire January 11, 2023 and Medicaid disenrollments would start February 1, 2023. If the administration is planning to let the PHE expire in January 2022, it would make an announcement in November 2022.
  2. In January, the Biden administration could extend the PHE for an additional 90 days.
  3. It is also possible that Congress passes legislation to restart disenrollments regardless of the PHE declaration, as the House-passed version of the Build Back Better bill would have done.


In February 2021, advocates delivered these recommendations to HHSC on ways to prepare for the start of disenrollments.

In March 2021, 10 Texas organizations delivered a letter to HHSC with these recommendations and concerns about the state’s plan.


Health care providers, community organizations, and other stakeholders will have an important role to play in communicating to families how to renew their Medicaid enrollment, starting with ensuring that the state has an updated mailing address for them.


For more information, contact Diana Forester, Health Policy Director for Texans Care for Children, at