Despite Rick Perry’s commitment to preventing low-income people in the state from getting health insurance, over 250,000 Texas kids have been enrolled in Medicaid in the past year because of a little-known provision in the Affordable Care Act (ACA). That brings the total up to 2.9 million low-income kids in Texas who have affordable health care coverage through Medicaid.
According to a report by Kaiser Health News, the increased enrollment is the result of an ACA requirement that states expand Medicaid for children between the ages of 6 and 18 who live in households whose incomes put them between 100 and 138 percent of the poverty line. While the Supreme Court made it optional for states to expand Medicaid coverage to adults in this income group – thus creating the 1 million person Medicaid coverage gap when Rick Perry opted out – Texas didn’t have a choice on expanding it to kids. This requirement affected less than half of the states in the U.S, because the rest had already raised eligibility levels for kids before the ACA passed. But better late than never.
Many of the children who are newly enrolled in Medicaid were already enrolled in the Children’s Health Insurance Program (CHIP), but were able to transfer to Medicaid because of the expanded eligibility rules. (CHIP is intended for kids whose families’ incomes are too high to qualify for Medicaid.) Medicaid is generally considered to provide more choices at lower costs, so for the 160,000 or so kids who transferred, the change was an upgrade in coverage.
But many of the children – close to 100,000 – did not have any health insurance before, and are now insured because of the ACA and the accompanying outreach efforts. According to Stephanie Goodman, spokeswoman for the Texas Health & Human Services, the increase in enrollment that is not attributed to CHIP transfers is largely the result of low-income families applying for health care coverage through the federal health insurance exchanges, who were then referred to the state to see if they qualify for Medicaid or CHIP.
“There is no doubt we are seeing a ‘welcome mat effect’ involving children who were previously eligible but not enrolled, and who were signed up because of the publicity about the ACA’s open enrollment,” said Anne Dunkelberg, Associate Director of the Center for Public Policy Priorities.
But even though the ACA is helping to cover Texas kids, their parents are still left behind. “It’s a lost opportunity for Texas to cover the kids and teens, but not their parents,” said Dunkelberg. Not enrolling the parents makes it less likely that kids get enrolled – even when the kids are eligible. “They say more children would be enrolled had more states expanded the program for adults,” the Kaiser report said. “That’s because parents who sign up themselves are more likely to sign up their kids.”
The fact that these kids were able to enroll in Medicaid is no substitute for an actual Medicaid expansion in the state, which would provide health insurance coverage to potentially 1 million more people with the federal government footing over 90 percent of the bill. But it’s still a major step forward for some of the kids who need health care coverage most.
Rick Perry and the Republican legislature are still dug in on resisting a Medicaid expansion, even in the face of a vast and growing body of evidence to support it. We recently reported that hospitals in states that have expanded Medicaid will save over $4 billion in uncompensated care costs, meaning there will be $4 billion less in unpaid bills from people who are admitted to hospitals but can’t afford to pay for their care. Meanwhile, states that have not expanded Medicaid will save only $1.5 billion. This is on top of all of the other economic and moral reasons to support a Medicaid expansion that have gone ignored by Texas’s leaders.
At least the latest news about low-income kids enrolling in Medicaid is a glimmer of hope in a state where there’s not much good news about Medicaid.