Texas’ recent unwinding of Medicaid and CHIP has been criticized, dropping more than a million people eligible for the health insurance programs. Decades ago, Texas officials got kids health insurance in record time.
August Johansen looks through the glass door of the birthday venue while cradling a balloon on Dec. 9, 2023. He had inoperable brain cancer and depended on Medicaid to pay for full-time home nursing care from a private agency to help his mother take care of him throughout years of health crises. Last December, he became one of 810,000 children dropped from Texas’ Medicaid program in the previous five months, but was reinstated through his mother's efforts.An impossible task.
At the time, the massive Texas Children’s Health Insurance Program, or CHIP, existed only on paper, the Legislature having just passed it weeks earlier as the state version of a 1997 federal program. “We were told in no uncertain terms that our careers would suffer if we didn’t deliver,” Fritz said. “He provided no context or explanation for that directive, but we didn’t need that. We knew why he was putting the screws to us.”
“It was a scenario where Democrats and Republicans and the governor, especially, said, ‘This is what needs to happen for children. We're going to get some bureaucrats to figure out how to actually operationalize it. And we're not going to worry about all the details. We just know that the job is getting as many kids enrolled for that program as possible because they need it. It's very important,’ ” Fritz said.
“It was a public relations star for some folks, it was good government for some folks, and it was, ‘It satisfies my constituents’ for some folks,” Laney recalled. Had the program kept pace with the California timeline, which was typical of the rollouts in other states, it would have taken the state until 2004 to reach that level of enrollment.
But when these protections were lifted a year ago, the state began rechecking the eligibility of all adults and children on Medicaid and CHIP and requiring everyone to reapply for benefits through a system that had not dropped anyone for the past three years.August opens his birthday presents while surrounded by friends, a few with similar diagnoses, on Dec. 9, 2023. It was his first birthday party — August spent three of his five birthdays in the hospital.
When the state couldn’t determine whether a person was eligible, the person was dropped from the rolls. That can happen when people don’t receive or respond to renewal notices or are not clear on what’s required to renew. It can also happen when enrollment workers can’t process the application in time.
As examples, she pointed to how changes in agency rules, like requiring kids to re-enroll once a year starting in 2014, and a lack of focus on how to better educate immigrant parents about the right to Medicaid and CHIP for US citizens and immigrant kids who have legal documentation can have great impact, advocates say.For a frightening moment last summer, 5-year-old August Johansen was one of the kids to lose coverage.
“Medicaid is a critical function for us being able to provide the care that he needs between the pharmacies and the private duty nursing and then, of course, the actual care itself that he receives for the acute situation,” said his mother, Erica Olenski Johansen. “I mean, there's a lot involved, obviously, when you have a kid with medical complexity.
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