Juliette Vasquez gave birth to her son in June with the help of Medicaid, which she said covered prenatal medications and checkups that kept her pregnancy on track.
But as she hugged her daughter, Imani, in southwest Houston one afternoon this month, she described her fear of losing the health insurance that helped her deliver her baby.
This month, Ms. Vasquez, 27, joined the growing ranks of Americans whose lives have been disrupted by the repeal of a policy that barred states from removing people from Medicaid during the coronavirus pandemic in exchange for additional federal funding. .
Since the policy was lifted in early April, more than half a million people in Texas have been removed from the program, more than any other state has reported removing so far, according to KFF, a health policy research organization. Health experts and state advocacy groups say many of those in Texas who have lost coverage are young mothers like Ms. Vasquez or children with few, if any, alternatives for obtaining affordable insurance.
said Ms. Vasquez that she needs to stay healthy while breastfeeding and see a doctor if she gets sick. “When you’re taking care of someone else, it’s a lot different,” she said of needing health insurance as a new parent.
Enrollment in Medicaid, an integrated federal-state health insurance program for low-income people, has risen to levels recorded while the pandemic-era policy was in place, and the uninsured rate in the country. fell to a record low early this year. But since the so-called unwinding began, states have reported dropping more than 4.5 million people from Medicaid, according to KFF.
That number will increase in the coming months. The Congressional Budget Office is estimated that more than 15 million people will be removed from Medicaid in a year and a half and more than six million of them will lose insurance.
While some people like Ms. Vasquez are losing their coverage because they no longer meet eligibility criteria, many others have been dropped for procedural reasons, suggesting that some people may lose their insurance even if they still qualify. also for this.
The unrest is especially acute in Texas and the nine other states that did not adopt the Affordable Care Act’s Medicaid expansion, all of which have state governments partially or fully controlled by Republicans. Under the health law, states can expand their Medicaid programs to cover adults earning up to 138 percent of the federal poverty level, or 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 more restrictive. Many of those with coverage are children, pregnant women or people with disabilities.
The continued unwinding has renewed concerns about the so-called coverage gap, where some people in states that did not expand Medicaid have incomes that are too high for the program but too low for subsidized coverage. through the Affordable Care Act marketplaces.
“This will present the need for expansion, especially when we see these poor parents are uninsured and fall into the coverage gap and have nowhere to go,” said Joan Alker, the executive director of the Georgetown University Center for Children. and Families.
Texas’ Medicaid program grew significantly during the pandemic when the state was barred from removing people from it. At the start of the unwinding, nearly six million Texans were enrolled in the program, or about one in five people 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 offers low-cost health care to the uninsured, has been flooded in recent weeks by panicked parents whose children have suddenly lost Medicaid coverage. , said Adrian Buentello, a Legacy employee who helps patients with their health insurance eligibility forms.
“Moms are furious,” she said. “They are struggling. They want their child to have the immunizations that are required, these annual exams that schools require.”
Texans are losing Medicaid for a variety of reasons. Some people now have incomes that are too high for their children to qualify, or they now earn too much to maintain their own coverage. Some young adults are already out of the program.
Some new mothers like Ms. Vasquez loses coverage because they are two months apart from giving birth, a stricter cutoff than most states. Gov. Greg Abbott, a Republican, recently signed legislation extending postpartum coverage by one year, which will bring Texas consistent with most of the country. But the new rule is not expected to take effect until next year.
Kayla Montano, who gave birth in March, said she suffered an umbilical hernia and pelvic pain from her pregnancy and is set to lose coverage at the end of this month, likely falling into the coverage gap. A mother of three children in Mission, Texas, Ms. Montano said she only works part time so she can care for her young children, a schedule that has caused her to not receive insurance from her employer.
“My health will hold up until I start working full time again,” he said.
Health experts are particularly concerned about the many Texans losing Medicaid coverage for procedural reasons, such as not returning paperwork to confirm their eligibility, even though they could still be qualified for the program.
Of the 560,000 people Texas reported being dropped from Medicaid in the first months of eligibility reviews, about 450,000, or about 80 percent, were dropped for procedural reasons. Nationwide, in states where data is available, three-quarters of those who lost Medicaid during the unwinding period were removed from the program on procedural grounds, according to KFF.
In a statement, Tiffany Young, a spokeswoman for the Texas Health and Human Services Commission, which is overseeing the state’s unwinding process, said Texas has prioritized conducting eligibility checks for those likely to no longer be eligible for the program. He said the agency uses a range of tactics to try to reach people, including text messages, robocalls and community events.
said Ms. Young said the first few months of eligibility checks have generally gone as expected, though he said the state is aware of some instances where people have been wrongly removed from the program. “We are working to restore coverage for those individuals as soon as possible,” he said.
Adrienne Lloyd, the health policy manager for the Texas branch of the Children’s Defense Fund, an advocacy group, said that because of its size and vastness, Texas is a difficult state for outreach to people whose coverage may be in danger.
Many rural residents lack continuous internet access or nearby health department offices where they can seek help re-enrolling in Medicaid in person, Ms. Lloyd, while the state hotline can have long wait times. Others, he said, may not be comfortable using technology to renew their coverage or may struggle to fill out paper forms.
The work required for those who do not enroll online or over the phone can be difficult. Earlier this month, Luz Amaya drove about 30 minutes to a Houston Food Bank branch for help filling out an application to re-enroll her children in Medicaid. His arthritis has weakened his hands, making it difficult to drive, he said.
Ms. Amaya was among dozens of parents who visited the food bank for a state-sponsored event offering enrollment assistance.
Ms. became emotional. Amaya was in the event when she learned that her oldest son was about to age out of Medicaid and may not be able to get the therapy he needed. said Ms. Amaya was there in part to confirm coverage for another daughter who needed therapy.
Another attendee, Mario Delgado, said he came to re-enroll in Medicaid after his wife suddenly lost coverage at the start of the state’s unwinding. Both are disabled and unable to work, he said. Due to tight money, they pooled payments for drugs.
Her husband needs back surgery, she said, and she needs medication to keep up with her diabetes, which causes her hands to swell. “If you cry, the pain stays the same,” she said, describing the resignation they felt struggling to pay for health care.
Soon he received good news. He and his wife are back on Medicaid. “I’ll sleep better,” he said as he stepped out of the building into the scorching Texas summer heat.
Health experts warn that many of those who lose coverage in the unwinding may not realize their fate until they are notified by a health provider or billed for a medical service.
Perla Brown, the mother of a boy with autism, came to the food bank event after her son’s therapist told her her son had lost Medicaid, she said. Soon after, he discovered letters in the mail he had missed warning him of the impending loss of his coverage. She said she was worried about paying the bill for the therapy appointment.
said Ms. Vasquez, the new mother, said having a child “just opens your heart in a different way.” She has learned to enjoy changing her child’s sheets as soon as they accumulate too much drool. The way her daughter learned to play on her belly, she added, made her happy.
But the joy of her parenthood, she said, was washed away by negative thoughts about the consequences of losing her Medicaid. Health care, he says, “has always been about cost.”
