*Update: The PHE is currently slated to end Oct. 13, 2022.
Texas is one of six states where children enrolled in Medicaid and in the Children’s Health Insurance Program (CHIP) are especially at risk of losing their health insurance when the public health emergency (PHE) ends.
That’s among the key findings of a new report published by the Georgetown University Center for Children and Families.
As a result, Texas pediatricians and other physicians caring for children face a potential increase in uncompensated care when the PHE expires.
“The lack of access to services for the patient, that’s the primary concern,” Louis Appel, MD, chief medical officer and director of pediatrics for People’s Community Clinic in Austin and president-elect of the Texas Pediatric Society, told Texas Medicine earlier this year. “[But] it does take considerably more effort to try to find the workarounds, if they can be found, for children that don’t have coverage.”
The federal Families First Coronavirus Response Act increased federal Medicaid matching dollars by 6.2% for states that agreed to maintain Medicaid coverage for anyone enrolled in the program from March 20, 2020, through the end of the PHE, including Texas. Children’s Medicaid and CHIP enrollment increased by 717,559 patients – nearly 23% – in Texas between February 2020 and December 2021, according to the latest available data from the Texas Health and Human Services Commission (HHSC).
The PHE has been extended multiple times. (The Biden administration announced last year that it would give states 60 days’ notice before the PHE ends.) But when it does expire, at least 6.7 million children nationally stand to lose their Medicaid coverage in one of two ways, according to the Georgetown report. Either they will become eligible for another program, such as CHIP, and get lost in the transition; or they will remain eligible for Medicaid but lose their coverage for procedural reasons, such as if a state verification request is sent to an out-of-date address.
This coverage cliff is steepest in states that have separate CHIP programs, charge premiums for CHIP coverage, do not provide 12 months of continuous coverage for children in Medicaid, or process less than half of their renewals using existing data sources, study authors wrote. Texas is among six states – along with Delaware, Florida, Georgia, Missouri, and Nevada – with all these risk factors.
While most children enrolled in Medicaid and CHIP will remain eligible for these programs after the PHE ends, the status change has the potential to be very disruptive to families and practices that care for children, says Helen Kent Davis, associate vice president of governmental affairs for the Texas Medical Association.
She encourages Texas physicians to prepare for this possibility by scheduling services as soon as possible for patients who might lose coverage; familiarizing themselves with potential coverage options for their patients; and evaluating the financial impact of a potential increase in uncompensated care.
Practices also should expect to reverify patients’ Medicaid eligibility when the PHE expires, which can be done through the:
HHSC encourages physicians to remind families to update their contact information with Medicaid to facilitate the renewal process when the PHE ends.
TMA is working with specialty societies and child welfare organizations to address administrative challenges – such as long caller wait times for HHSC’s 211 phone-help program – including asking HHSC to establish a dedicated toll-free hotline for this purpose.
Texas lawmakers also passed a TMA-backed bill during the 2021 legislative session that directs Texas Medicaid to provide eligible children two consecutive six-month periods of coverage, reducing the chances of children losing coverage for procedural reasons.
The Georgetown report encourages such steps, asking states to promote retention of coverage by following up with enrollees when action is required to maintain coverage, and by working with managed care organizations to update contact information, among other strategies. It also recommends states increase CHIP funding for outreach and enrollment efforts and boost their workforce capacity if a large share of disenrollment occurs because of procedural reasons.
“States run Medicaid and CHIP, so that’s where responsibility lies to ensure that millions of children don’t lose coverage during this process,” said Joan Alker, executive director of the Georgetown University Center for Children and Families and co-author of the report, in a Feb. 17 news release.