Texans who receive health insurance through Medicaid will have to requalify and renew to maintain their coverage for the first time in three years.
The public health emergency order that allowed for continuous Medicaid coverage during the pandemic is set to expire in May, and federal funding legislation ends the continuous coverage by April.
Therefore, the state of Texas will begin removing people who no longer qualify from the Medicaid rolls in April. That includes people using Medicaid programs like Healthy Texas Women, which provides free women’s health and family planning services. Enrollment in Medicaid, which provides health care to people with low incomes, has grown by about 2 million in Texas since February 2020, according to state data.
Who is affected?
This review process will most immediately affect the nearly 3 million Texans who had their Medicaid coverage extended because of the pandemic. But all Texans under Medicaid plans — almost 6 million — will eventually have to go through the redetermination and renewal process as the Texas Health and Human Services Commission returns to pre-pandemic operations.
Only some Medicaid recipients may have to reapply for coverage, according to the agency. Others may just have to renew or provide HHSC with information to verify their eligibility.
For kids already on the state’s Children’s Health Insurance Program, or CHIP, renewals will continue as usual, according to state health officials.
When will my eligibility be checked?
The Health and Human Services Commission will contact you when it’s your turn to renew or reapply. The agency will send you a notice through the mail or via email or text if you opted for paperless correspondence.
HHSC will carry out the reviews over the course of multiple months and will focus first on reviewing and removing Medicaid recipients who are likely to no longer qualify.
The agency will begin sending renewal packets in April, and all other households will be sent renewal packets no later than September, according to an agency spokesperson.
What do I need to do?
Be on the lookout for a letter mailed to your address detailing your benefits and case. To avoid losing coverage while HHSC determines your eligibility, promptly respond to any agency requests for information.
Notices and renewal packets will be mailed in a yellow envelope with red letters that say “action required.”
If you have an online account at YourTexasBenefits.com or use the Your Texas Benefits mobile app and opted for paperless correspondence, you will receive an electronic notice that there is a new letter in your account.
You can also check whether it’s time for you to renew by logging in to your Your Texas Benefits account and clicking the “select details” option for your case. Once there, either through the web address or the mobile app, you can also change your address or other details, like the number of people in your household or whether you are pregnant.
Even if your case isn’t up for renewal yet, it’s important to make sure your contact information is up to date to ensure you receive notices, said Alicia Pierce, a spokesperson for the Texas Association of Health Plans.
Another way to contact the state about your Medicaid benefits is to call 211 and select option 2 after picking a language.
Here’s more information from HHSC:
How long do I have to renew or reapply?
You have 30 days from when your renewal packet or request for information is sent before action is taken on your case, according to HHSC.
But if you are denied a renewal because you didn’t provide the requested information within that time, you can still send the information without having to start a new application if you send it within 90 days of your last day of eligibility.
Can I get help to renew or reapply?
You can get help from community clinics and centers and nonprofit organizations to access your online benefits account and renew. You can find HHSC community partners that offer computers and people to help you complete the Medicaid renewal or application process through this regional directory.
It’s helpful to contact a community partner program near you to get assistance in person, said Lynn Cowles, a health coverage senior program coordinator for Foundation Communities, a nonprofit and community partner in Austin. Other community partner programs in the state include EnrollSA in San Antonio, United Way of Metropolitan Dallas and Change Happens in Houston, Cowles said.
If you live in another part of the state, you can use the regional directory to view community partners near you, but it may take a few calls to find an active program, she said.
You can also contact the health plan provider listed on your Medicaid card to walk you through the process of renewing or providing more information, Pierce said.
If you’ve previously provided your phone number on your Medicaid application, your health plan may also text you about your Medicaid renewal, Pierce said.
If you have trouble logging in to your benefits account, your health plan may be able to help you reset your password, Pierce said. If you can’t answer the security questions required to reset your password and are locked out of your account, you can also call 211 or (877)541-7905 or go to a local HHSC benefits office.
You can find a local office here and more information on accessing your account benefits here.
If I don’t qualify for Medicaid, what other programs can I get help from?
If you no longer qualify for Medicaid, HHSC will review whether you qualify for other HHSC programs, including Healthy Texas Women and the children’s program CHIP, during the review process.
If you no longer qualify for Medicaid or these other programs, you will be referred to the federal health care marketplace, where you can enroll in a private health insurance program.
Like employer-sponsored health insurance, these plans come with monthly charges (called premiums), deductibles (which are the costs an individual has to pay before an insurer pays for costs), as well as copays and coinsurance (the amount or percentage of the health care costs you have to pay). But depending on your income, you may be able to get a tax credit that lowers your premiums and reductions that lower how much you have to pay for care.
You can go to healthcare.gov or call (800)318-2596 to learn more about marketplace plans and get help applying. The health plan provider listed on your Medicaid card may also be able to help you look into marketplace plans, Pierce said.
There are also health navigators that can help you fill out a marketplace application and pick and use a health insurance plan. Unlike insurance agents or brokers, health navigators are not paid by health insurance companies and must provide impartial information on all options and follow strict information security standards, Cowles said. You can find navigators and local assistance by selecting the “assister” option in this lookup tool.
There are also other health care programs through which you could get care and financial assistance:
Primary Health Care Services Program: Low-income Texas residents who don’t qualify for other programs can get care at clinics across Texas that work with HHSC. The current income requirement is earnings of or below 200% of the federal poverty guidelines, or $29,160 for a household of one. You can calculate your income level here. You must apply at a clinic site. Find clinics by calling 211 or searching on 211texas.org.
Family Planning Program: Through this state program, people can access most contraceptives, health screenings, family planning and some prenatal services. It is open to men and women in Texas who are 64 or younger and who earn an income of up to 250% of the federal poverty guidelines for their household’s size. This year, the maximum for a household of one person is $36,450. You can apply in person at a clinic. Find one here.
Mental health services: The state contracts with 37 local mental health authorities and two local behavioral health authorities to provide mental health services to all counties. The cost of services is based on your ability to pay, according to HHSC. Call 211 or go to the websites 211texas.org or mentalhealthtx.org to find your local authority.
HIV medication programs: If you’re uninsured or underinsured, you may be eligible for help covering the costs of HIV medication through the Texas HIV Medication Program or Patient Assistance Programs. For the Texas HIV Medication Program, a person must make 200% or below of the federal poverty guidelines. For a household of one, that is $29,160 this year. You can apply online here and call (800)255-1090 for questions.
Are other benefits changing?
Due to changes in federal legislation, all Supplemental Nutrition Assistance Program recipients have stopped receiving at least $95 in COVID-19 emergency allotments. Learn more here. Texans who receive funding under the Temporary Assistance for Needy Families, or TANF, program are not affected by this change. But renewals for both of these programs will continue, so you must respond to HHSC’s notices to continue receiving benefits. You can also manage these benefits through Your Texas Benefits.