Texas is the epicenter of Medicaid losses after the end of the pandemic coverage guarantee

Juliette Vasquez gave birth to their daughter in June with the help of Medicaid, which she said had covered the prenatal medications and tests that kept her pregnancy on track.

But as she rocked her daughter Imani in southwest Houston one afternoon this month, she described her fear of forgoing the health insurance that helped her give birth to her child.

This month, Ms. Vasquez, 27, joined the growing band of Americans whose lives have been disrupted by the repeal of a policy that prohibited states from taking people out of Medicaid in exchange for additional federal funds during the coronavirus pandemic.

Since the policy was lifted in early April, over half a million people have been excluded from the program in Texas, more than any other state has previously reported. according to KFF, a health policy research organization. Health experts and state advocacy groups say many of those in Texas who have lost insurance coverage are new mothers like Ms. Vasquez or children who have little, if any, alternative to getting affordable insurance.

Ms Vasquez said she needed to stay healthy while breastfeeding and be able to see a doctor if she became ill. “When you're taking care of someone else, it's a whole different thing,” she said of the need for health insurance as a new parent.

Enrollments in Medicaid, a joint state health insurance program for low-income people, surged to record levels during the pandemic-era and the country's uninsured rate rose fell to a record low Beginning of the year. However, according to the KFF, since the so-called rollback began, states have reported more than 4.5 million people have been excluded from Medicaid.

This number will increase in the coming months. The Congressional Budget Office has appreciated that more than 15 million people will be disqualified from Medicaid within a year and a half and that more than 6 million of them will end up without insurance coverage.

While some individuals, such as Ms. Vasquez, lose their coverage because they no longer meet eligibility criteria, many others are denied for procedural reasons, suggesting some individuals may lose their coverage while still qualifying for it.

The turmoil is particularly acute in Texas and nine other states that have not adopted the Affordable Care Act's expansion of Medicaid and whose state governments are either partially or fully controlled by Republicans. Under the Health Care Act, states can expand their Medicaid programs to adults earning up to 138 percent of the state poverty line, which is about $41,000 for a family of four.

But in Texas, which had the highest uninsured rate of any state in 2021, the Medicaid program is far more restrictive. Many of the insured are children, pregnant women or people with disabilities.

The ongoing run-off has renewed concerns about the so-called coverage gap, where some people in states that have not expanded Medicaid have incomes that are too high for the program but incomes that are too low for subsidized coverage through Affordable Care Act marketplaces.

“It will highlight the need for expansion, especially when we see these very poor parents uninsured, falling into the coverage gap and having nowhere to go,” said Joan Alker, executive director of the Georgetown University Center for Children and Families.

Texas' Medicaid program grew significantly during the pandemic when the state was banned from removing people from the program. Nearly six million Texans were enrolled in the program when the winding up began, accounting for about one in five in the state, up from nearly four million before the pandemic.

Now the program is shrinking significantly. Legacy Community Health, a network of clinics in and around Houston that provides affordable health care to uninsured people, has been inundated in recent weeks by panicked parents whose children suddenly lost Medicaid coverage, said Adrian Buentello, a Legacy Employee who helps patients with their health insurance eligibility forms.

“Moms are frantic,” he said. “You are in trouble. They want their child to get the immunizations they need, those yearly exams that schools require.”

Texans are losing Medicaid for a variety of reasons. Some people now have too much income for their children to be entitled to, or earn too much to maintain their own insurance coverage. Some young adults dropped out of the program.

Some new moms like Ms. Vasquez are losing insurance coverage because they are two months away from giving birth, a stricter limit than most states. Gov. Greg Abbott, a Republican, recently signed legislation extending postnatal coverage to one year, which would bring Texas consistent with most parts of the country. However, the new regulation is not expected to come into force until next year.

Kayla Montano, who gave birth in March, said she is suffering from an umbilical hernia and pelvic pain as a result of her pregnancy and will lose her insurance coverage later this month and will most likely fall into the insurance gap. Ms. Montano, a mother of three in Mission, Texas, said she only works part-time to care for her young children, a schedule that has meant she is not eligible for insurance from her employer.

“My health is on hold until I return to full-time work,” she said.

Health experts are particularly concerned about the many Texans losing Medicaid protection for procedural reasons, such as not returning documentation confirming their eligibility, even though they may still qualify for the program.

Of the 560,000 people Texas reported were disfellowshipped from Medicaid in the first few months of eligibility reviews, about 450,000, or about 80 percent, were disfellowshipped on procedural grounds. According to the KFF, in states nationwide where data is available, three-fourths of those who lost Medicaid during processing were excluded from the program for procedural reasons.

In a statement, Tiffany Young, a spokeswoman for the Texas Health and Human Services Commission, which oversees the state's dissolution process, said Texas has prioritized conducting proficiency tests for those most likely no longer eligible for the program. She said the agency uses a range of tactics to reach people, including text messages, robocalls and community events.

Ms Young said the first few months of proficiency testing went broadly as expected, although she said the state is aware of some instances where people have been wrongly excluded from the scheme. “We are working to restore insurance coverage to these individuals as soon as possible,” she said.

Adrienne Lloyd, health policy manager at the Texas branch of the Children's Defense Fund, an advocacy group, said Texas' size and rural spread makes it a particularly difficult state to reach people whose security may be at risk.

Many rural residents lack stable Internet access or nearby health departments where they can seek help re-enrolling in Medicaid in person, Ms Lloyd said, while there can be long waits on a state hotline. Others, she said, may not be comfortable using technology to renew their insurance coverage or may have difficulty filling out paper forms.

The workload for those not registering online or over the phone can be challenging. Earlier this month, Luz Amaya drove about 30 minutes to a Houston Food Bank branch for help filling out an application to reenroll her children in Medicaid. Her hands were affected by her arthritis, which made the ride difficult, she said.

Ms. Amaya was among dozens of parents who visited the food bank as part of an event partially sponsored by the state and offered help with registration.

Ms. Amaya became emotional at the event when she learned that her eldest daughter would soon be out of Medicaid and may not be able to receive the therapy she needs. Ms Amaya said she was there, among other things, to confirm insurance coverage for another daughter who needed therapy.

Another attendee, Mario Delgado, said he came to re-enroll in Medicaid after he and his wife suddenly lost coverage early in the state's resolution. Both are disabled and unable to work, he said. Since money is tight, they've scraped together payments for medication.

His wife needed back surgery, he said, and he needed medication to manage his diabetes, which left his hands swollen. “When you cry, the pain stays the same,” he said, describing the resignation they felt as they struggled to afford health care.

Soon he received good news. He and his wife were back on Medicaid. “I'll sleep better,” he said as he exited the building and headed out into the scorching Texas summer heat.

Healthcare experts have warned that many of those who lose their insurance coverage as a result of the settlement may not know their fate until they are notified by a healthcare provider or are billed for a medical service.

Perla Brown, the mother of a boy with autism, came to the Tafel event shortly after her son's therapist told her her child had lost Medicaid, she said. She soon discovered letters in the mail she'd missed warning her of the impending loss of his cover. She said she was afraid to pay the bill for the therapy appointment.

Ms Vasquez, the new mom, said that having a baby “opens a heart in a whole different way.” She had learned to enjoy changing her daughter's blankets when too much spit had accumulated in them. The way her daughter learned to play on her stomach made her happy, she added.

But the joy of parenthood, she said, was marred by morbid thoughts about the consequences of losing her Medicaid. Healthcare, she said, “is always about cost.”

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