Children’s health insurance eligibility is broken. Here’s how to fix it.

The following testimony was provided to the Texas House Committee on Human Services on March 30, 2021.

Texas 2036 submits these written comments in support of HB 290.  Texas 2036 is a non-partisan public policy organization designed to bring together the sensible center on data-driven policies.  Texas 2036 views the health care policy space as a three-legged stool consisting of Coverage, Affordability, and Access.

Texas 2036 recognizes that the current Medicaid eligibility checking structure for children is flawed and is resulting in children being improperly removed from coverage.  Because we are supportive of ensuring that Texans (but especially children) have affordable coverage options, we are supportive of the legislation to extend Medicaid coverage for children to 12 months from enrollment to address this problem in the short term.  However, we also are cognizant that doing so is merely masking underlying issues with the reliability and useability of state data systems, as well as problems with the interoperability of state programs.

The case against the current eligibility system is that it relies on inaccurate data, and compounds that inaccuracy by not providing families with sufficient time or notice to correct the inaccurate information, and then creates an ever-greater hassle for families by not automatically moving the child to an appropriate program.

These problems can be solved by: (1) improving our state data systems used to verify income; (2) increasing the amount of time families have to appeal a determination of ineligibility; and (3) automatically transferring (if appropriate) a child’s eligibility from Medicaid to CHIP if the child is determined to be ineligible for Medicaid (children who become ineligible for Medicaid tend to remain eligible for CHIP because of the higher income eligibility thresholds).  Unfortunately, solutions 1 and 3 will take time to implement, so it is appropriate to apply a quick fix now to alleviate the burden to affected families while the state improves its systems.  However, if the legislature does choose to provide relief to these families in the form of HB 290, it should still pursue these additional fixes.

Not only would the improved systems allow the state to more accurately and frequently conduct eligibility checks for state benefit programs, but they would also provide a slew of additional benefits.  Having more accurate income information would allow the state to track the efficiency and effectiveness of its education and workforce training programs, empowering the legislature and state agencies to reward efficient programs, while phasing out those less efficient ones.

To sum up, we write in support of passing HB 290 to provide immediate relief to children who are improperly losing eligibility for health insurance, but also encourage the legislature to address the underlying problems and upgrade the state’s digital infrastructure, which will solve not only this issue, but also improve the state’s long-term ability to help create an aligned and well-educated workforce prepared for the jobs employers are offering.