Texas has disenrolled 1.4 million Texans from Medicaid during ongoing redeterminations


Maddie McCarthy


Since Medicaid redeterminations began in April 2023, 1.4 million Texans have been disenrolled from the program. Approximately 759,700 people in the state have had their coverage renewed. 

As of their most recently published redetermination dashboard from October, the Texas Health and Human Services Commission (HHSC) reported 24% of redeterminations had not been initiated, while 76% had been initiated or completed. HHSC expects to complete the remaining 24% of the nearly 6 million redeterminations by May 2024. 

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HHSC sent an updated statement to State of Reform regarding the state’s process for conducting redeterminations.

“In preparation for the redetermination process, HHSC implemented a multi-pronged communication effort to reach individuals during their renewal process. This includes sending notices, text messages and robocalls, hosting community renewal assistance events throughout the state as well as leveraging community partners to assist with outreach efforts.”

— HHSC statement, Nov. 21st, 2023

According to the Kaiser Family Foundation’s (KFF) Medicaid unwinding tracker, Texas is tied with Idaho for having the highest percentage of disenrollments at 64%. Children make up 58% of the disenrollments.

Out of the redeterminations that have been completed so far, 68% of the disenrollments were the result of a procedural issue, so many of those who have been disenrolled may still be eligible but no longer have coverage. 

Procedural disenrollments happen for a number of reasons, including paperwork not being completed or processed quickly enough, individuals not understanding the redetermination process, or people choosing not to apply for redetermination because they know they are ineligible. According to KFF, 32% of those disenrolled were deemed ineligible. 

Texas already has the highest rate and number of uninsured residents in the country, and they are also one of the 10 states that has not expanded Medicaid under the Affordable Care Act (ACA). 

An estimated 16.6% of Texans don’t have any form of health insurance. The state has 4.9% more uninsured people than Georgia and Oklahoma, who rank just behind Texas in uninsured rates, with both states having 11.7% of residents uninsured. Almost a quarter of adults in Texas aged 19-64 have no form of health insurance, which is also the highest such rate in the country. 

In their 2023 Scorecard on state health system performance, the Commonwealth Fund ranked Texas as 51st for healthcare access and affordability, behind the other 49 states and Washington D.C.

The high number of disenrollments occurring during redeterminations raises concerns about compounding Texas’s already-nation-leading rate of individuals without health insurance.

HHSC said they transfer the information of those ineligible for Medicaid renewal to the ACA marketplace so they can find other forms of health insurance. 

For those who have had their coverage renewed, 8% have been conducted on an ex parte basis—the national average for such renewals is 57%. Ex parte renewals are done automatically based on financial data available to the state; the beneficiary does not have to take action. States are required to use this information to conduct automatic renewals if enough information is available.

In regards to those who have already been disenrolled, HHSC said they are participating in community outreach to help those who no longer have coverage.

“We are also collaborating with healthcare providers, community organizations, and advocacy groups to reach a wide range of individuals who may be affected by the unwind.”

— HHSC, Nov. 21st, 2023