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The end is near

Updated: Mar 21, 2023

COVID-19 impacted our world in so many ways. Although the positives may be difficult to identify, the negative impacts seem to be glaring. In one example, what was created to mediate the negative effects of the pandemic, will now cause a severe disruption to health care coverage across the state. During the pandemic, the federal government declared a Public Health Emergency (PHE). In doing so, special exemptions were made to buoy access to health care coverage for a determined amount of time. These exemptions included a waiver of eligibility requirements for Medicaid members, leading to an increase in Texan Medicaid recipients of 41%, or 1.6 million people, since January 2020. Although the timeline has been adjusted more than once, the official end of the PHE is March 31, 2023, and millions of Texans will lose their health insurance coverage.


Typically, Medicaid recipients must annually recertify for benefits. During the standard recertification process, changes in income, household composition, or other circumstances must be reported to re-determine continued eligibility. However, during the PHE, Medicaid recipients were not required to recertify or report any changes. They were automatically re-enrolled for continued coverage. During this PHE, Medicaid recipients have been conditioned to ignore the mailouts and paperwork reminding them of their required renewal dates that have continued to be sent out. This will undoubtedly lead to a challenge, as the warnings about the need for renewal/recertification now need to be taken seriously.


According to an article in the Texas Tribune, there are an estimated 3.7 million Texans receiving Medicaid benefits that will have to reapply and meet the regular eligibility requirements, and anywhere from 550,000-730,000 Texans who will lose Medicaid coverage at the end of this month. According to two reports published by researchers working with the Episcopal Health Foundation, McLennan County had an increase of 9,543 Medicaid recipients, and it is estimated that 6,207 will not meet eligibility criteria for continued benefit coverage. Many will fall into the “coverage gap,” with incomes that are too high for Medicaid coverage but too low for affordable Marketplace plans. Unless they (or their parents if they are under 26 years old) have coverage available through their employer, they will have no available options for healthcare coverage.


There are three populations estimated to be most impacted by the ending of the PHE: children, pregnant women, and parents. 59% of those losing coverage are children, primarily those who were 15-17 years old at the start of the PHE, but who have now “aged out” of Medicaid eligibility. 29% of those losing coverage are pregnant women. Under standard Medicaid requirements, pregnant women are eligible for continued Medicaid coverage for up to 6 months following the birth of their child. Those women have been allowed continued coverage during the pandemic. The third category includes parents who receive Medicaid but no longer meet income guidelines, a category that makes up 9% of those losing coverage.


In addition to the lack of awareness of the need to renew their benefits, there are at least two other potential complications that are worth mentioning. First, the system for benefit application, approval, and renewal typically stays significantly backlogged. With the large number of members who will need to reapply (estimated 3.7 million), the backlog will impact the timeliness for everyone. Secondly, there is a high likelihood that a significant number of the current members’ contact information is outdated, and they may not even be aware of the need to renew benefits until they find out they have been denied coverage for a physician’s visit or a prescription medication.


Furthermore, to highlight the additional impact specifically for Texas Medicaid recipients, Texas is one of 9 states that opted to complete the PHE recertification process within six months rather than the federally recommended one year. To put it into perspective, this means that Texas has set a goal of processing 75% more applications than the federal recommendation. This seems to be a lofty goal considering that the system prior to PHE was already experiencing issues with wait times, call backlogs, and slower eligibility determination.


Luckily, here in our community, we have many partners who are invested in the health, wealth, and financial security of our residents. Our local Access to Health Care working group has actively been working to help provide education, awareness, and resource referrals for Medicaid and overall healthcare coverage for our community. Access to Health Care has partnered with a local Marketplace agent and created a website that will provide resources for healthcare coverage, including Medicaid and CHIP, Waco Family Medicine’s Good Health Card, McLennan County Indigent Care, and Healthcare.gov Marketplace plans. This website will provide information and referrals for community partners who can provide access to computers for benefit applications, as well as some who can also offer personal assistance in the process. Be looking in the upcoming weeks for the website to go “live.” Prosper Waco is a proud partner and happy to be in collaboration with “Unlock Health Care.” Stay tuned for more information.


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Telawna Kirbie is Director of Strategic Initiatives at Prosper Waco



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