Democrats Continue Urging Federal Investigation Into Medicaid Coverage Losses

Another recent error resulted in 24,000 children who should have been enrolled in the Texas Children’s Health Insurance Program (CHIP) losing coverage (Photo by Getty Images)

In the wake of nearly 1 million Texans losing Medicaid coverage since April, Texas’ Democratic congressional delegation asked the Biden administration to pause all automatic redetermination of eligibility for Medicaid. They answered on Thursday, ordering 30 states to halt procedural disenrollments until errors are fixed.

While automatic renewal generally kicks people off of Medicaid, a procedural error by the Texas Health and Human Services Commission cut at least 100,000 eligible Texans’ coverage by mistake.

The congressional delegation, including U.S. Reps. Lloyd Doggett, Greg Casar, Colin Allred, and Joaquin Castro, doubled down on their request earlier this month for a federal audit of HHSC as well, as a third whistleblower from the commission sent a letter to Gov. Greg Abbott this week providing further evidence of significant issues within HHSC.

The whistleblower letters come from anonymous employees at HHSC who are appalled at the coverage cancellations. They report that it is mostly pregnant women or new mothers who have lost coverage, along with elderly citizens, and people with disabilities. The most recent whistleblower letter raises concerns about how long it’s taking for the agency to process applications for food assistance. According to the whistleblower, it is, at present, taking 75 days from the time the agency receives an application until it is assigned for evaluation by an HHSC employee.

“This means that once someone applies for food assistance, it just sits in our system for over three months before anyone even looks at it,” the letter states. “As of September 1, 2023, the waiting period surpassed 100 days.” The letter describes how, taking into account waits in September and August, the whistleblowers anticipate the delay to exceed 200 days by year-end. “In practical terms, this translates to individuals in need of food or medical assistance enduring an agonizing six-month wait before their application is assigned to someone for review.”

The letters have urged Abbott – who has stayed completely silent on the issue in the face of appeals by the whistleblowers and the Democratic delegation – to step in to fix leadership issues at HHSC. “Our current leadership, from Chief Program and Services Officer Michelle Alletto to Interim Deputy Executive Commissioner Molly Lester-Regan, appear to be grappling with a lack of comprehension and an absence of a clear strategy to address the ongoing crisis,” the most recent whistleblower letter states. “Chief Alletto delivered a disheartening blow to morale by asserting that we should not expect an improvement in our circumstances; instead, we should accept this as our new norm.”

The letter goes on to say that Alletto has expressed her intention to learn the identities of the whistleblowers. “The healthy work culture we once prided ourselves on having has been systematically eradicated. The environment is toxic, and we are in a constant state of fear.”

The letters cast doubt on the accuracy of Texas’ coverage renewal process, which culls data from other public benefits programs to automatically renew coverage; only 2.4% of beneficiaries were deemed eligible through that process this year. A staggering 69% of all beneficiaries screened were dropped from coverage – the highest rate of any state in the nation – and three-quarters of those were denied erroneously, instead of for actual ineligibility. “Texas’s shockingly low ex parte renewal rate, the second worst in the nation, demonstrates a clear failure to comply with federal law,” wrote the Democratic delegation in a letter urging a federal investigation into that process by the Centers for Medicare & Medicaid Services (CMS). In a press release Wednesday urging federal investigation, Doggett wrote: “Until CMS acts, Texas will continue to lead the Nation in disenrollment rates under Abbott’s indifferent leadership. Vulnerable and marginalized Texans are being denied access to a family physician, essential medications, maternity and postpartum care, mental health treatment, and more – endangering their lives and financial wellbeing.”

So far, CMS has restored coverage for 100,000 people who were mistakenly dropped, but another recent error resulted in 24,000 children who should have been enrolled in the Texas Children’s Health Insurance Program (CHIP) losing coverage. And the state sent another notice Sept. 9 to 1 million more Texans to begin the redetermination process.

View the whistleblower reports here, here and here. The delegation’s most recent letter is available here.

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