In this interview, Marisa Bono, CEO of Every Texan, spoke with State of Reform about the challenges of Medicaid redeterminations, her priorities for the next legislative session, and the future of her organization.
Bono will be speaking on the “Housing, Food Insecurity, & More: Supporting the Social Service Needs of Texans” panel at the 2024 Texas State of Reform Health Policy Conference coming up on Feb. 27th. You can register for the event here!
State of Reform: Can you speak to any policy that passed during the 2023 legislative session that Every Texan was following?
Marisa Bono: House Bill 12, that was a rare bipartisan win for low-income Texas families last session. That was a bill that extended Medicaid healthcare coverage for Texas mothers from just 60 days after giving birth to a full year. That was a really exciting victory. It capped an effort that lasted more than a year to extend coverage for low income moms.
Currently in Texas, Medicaid covers half of all births and before this bill was passed, coverage expired after two months. Anyone who has a family can tell you that mothers’ health needs are much more comprehensive and nuanced than the 60-day cutoff.
It was really exciting especially since, in recent years, Texas has seen increasing maternal mortality rates [in a place] where one in four women of childbearing age don’t have access to health insurance outside of pregnancy. When you look at that backdrop, legislation like this is really important in terms of ensuring care for all Texans and ensuring that care isn’t limited solely by income or where you happen to live in the state.
This bill in particular was the top recommendation from the state’s Maternal Mortality and Morbidity Review Committee and I would argue that it was especially important in the wake of the overturn of Roe v. Wade. In Texas, women do not have legal access to abortion and so that access to postpartum medical care is especially important as women are forced to have children.
SOR: Was there any legislation you supported that didn’t pass or wasn’t introduced?
MB: I don’t know if legislation is the right term, but we were really disappointed in the state’s failure to prepare our state agency for Medicaid unwinding. As part of the federal process to reinstate restrictions on access to Medicaid and other benefits like SNAP post-pandemic, the state was required to recheck eligibility for all the six million Texans who have Medicaid.
Texas, even before unwinding, had a massive eligibility worker shortage, really concerning Medicaid and SNAP paperwork backlogs and when unwinding was announced we knew that the state agency had set an unrealistic timeline that just crammed too many Medicaid renewals, millions of Medicaid renewals, into too few months for such an under-resourced, short-staffed agency.
Ahead of the session, during the budget’s last process, we were really raising the alarms, trying to get the state to focus on what was certainly going to be an impending crisis and the legislature did nothing. The agency didn’t even get its full funding request and certainly didn’t receive any of the support that it needed to ensure that this rechecking process happened in an orderly way that wasn’t unfairly taking people off the roll.
As a result, to date, around 1.8 million Texans have been removed from Medicaid since April 1st. Of that 1.8 million, only 35 percent have actually been confirmed ineligible. The rest have likely been kicked off due to administrative error. Perhaps it was a failure to submit paperwork, all factors that are attributed to sort of the rushed nature of the agency’s process and the inability to implement a system that actually checks eligibility.
In fact, only 2.9 percent of our renewals to date have been data-driven and that actually makes Texas the worst in the nation in data matching even though we have one of the largest enrollment populations ….
Millions of Texans have lost coverage, most of them have been children of color in low-income families and that’s the same population that stands to continue losing access if this continues to unfold. We’re working closely with federal agencies and with our state agency itself to try to diminish the impact, but the result has been really catastrophic.
SOR: What are Every Texan’s priorities during the interim between the 88th and 89th legislative sessions?
MB: We’re definitely focused on helping local enrollers and local community members stem the tide of Medicaid disenrollments.
We’re actively trying to provide training and education so people who are eligible are able to access and navigate the rather complex bureaucratic system to make sure that they get access and that folks who might be at risk of losing access have the information they need to navigate the system to try to prevent to that loss of access to healthcare.
So that’s a big focus for us now, in addition to working with the agency and federal entities to try to see what we can do to push the state to act.
The National Health Law Program and a number of other organizations filed a formal complaint with the Federal Trade Commission to investigate some of the inaccurate eligibility determinations in Texas, so we’re certainly not the only ones in the space trying to work on access, but we are kind of leading the charge when it comes to community efforts for training and public education, so that’s a big focus in the interim.
Public education is a big piece and training is a big piece. In other states, it’s usually the state that funds and runs those efforts but unfortunately we don’t have that infrastructure here in Texas so it kind of falls onto organizations like ours.
We have a number of different bills that are focused on access to SNAP and improving current systems to ensure that folks who are eligible actually have access to public benefits offered through federal programs.
We’re really concerned that Texas has opted out of the summer meals program and so we’ll be working with partners to identify legislative priorities ahead of the next general session to try to help lessen the impact of those negative policy decisions for our state.
SOR: As CEO of Every Texan, what is your vision for the organization going forward? How does that vision fit Every Texan’s 2022-2027 strategic plan?
MB: When it comes to our healthcare work, we’re certainly leaning in more heavily to our statewide coalitions where we have member-driven and community-driven organizations participating ….
One example of that is Seguro Texas. This is the coalition that focuses on access for immigrants to public benefits and we’re really excited that we’ve brought a lot of enrollers and community members into that space to try to understand how to translate what they’re experiencing on the ground into policy changes that need to happen in the capitol.
A lot of our analyst work has, in a lot of ways, turned into community engagement work where we’re trying to create feedback loops with people who are on the ground, folks who are experiencing the impact of how these federal programs are being administered, so as we think about what policy changes we want, we’re actually prioritizing changes they need that they’ve observed that will help create better access.
We’re only in the second year of implementation of our strategic plan, but certainly thinking about how to be more community-led with how we operate and how we establish priorities is a big change in how we do our work and something I think we’re really proud of.
SOR: The panel you are speaking on during the conference at the end of the month will pertain to social determinants of health (SDOH), like housing support, food services, and more. Can you briefly tell me about the importance of focusing on SDOH in order to improve the health of Texans overall?
MB: In our organization, we have our health and food justice team that focuses both on access to healthcare and also access to food security. In selecting that priority, we recognize that regular, consistent access to nutritious food, and programs that give people that nutritious food, goes hand in hand with the opportunity for healthy, thriving lives that we want for all Texans.
A lot of the work we do at the agency level when it comes to access to Medicaid or access to the marketplace kind of goes hand in hand with education around how to access food benefits like SNAP and TANF.
This Q&A has been edited for clarity and length.