Hundreds of Thousands Denied Medicaid and Food Assistance in Texas

It's a department of dysfunction, and it isn’t getting better


Most Texans in poverty benefiting from SNAP are children (image via Getty Images)

Impoverished Texans, the vast majority of them children, could go hungry this Christmas because of dysfunction at the Texas Health and Human Services Commission, whistleblowers at the state agency warned in an anonymous letter released Nov. 21.

"Thousands of Texans are still waiting to receive the much-needed food assistance they applied for over six months ago," the whistleblowers wrote, referring to the federal Supplemental Nutrition Assistance Program, SNAP. "Governor [Greg] Abbott and Commissioner [Cecile Erwin] Young, how can you reasonably expect anyone in the situation we have placed our citizens in to have a happy Thanksgiving or a merry Christmas while they are contemplating how they will feed their families?"

This is the fourth letter in a series from the whistleblowers detailing a catastrophic failure of safety net services in Texas. While the latest focuses on food assistance, others have documented widespread and erroneous denials of Medicaid coverage for the state's poorest citizens. The November letter asks Abbott to step in and fix a backlog that's causing people who need SNAP to wait 180 days to begin receiving food.

SNAP and Medicaid are huge in this state. Last year, SNAP provided food to 3.5 million Texas residents, approximately 90% of them kids. During the same period, close to 6 million Texans – 1 out of every 5 – were enrolled in Medicaid, which provides affordable health care. Three out of four Medicaid recipients are kids. The program is also meant to provide care to pregnant mothers, new moms, people with disabilities, former foster care children, and elders. To be eligible, applicants must show they live far below the federal poverty line. They are disproportionately Hispanic and Black.

“How can you reasonably expect anyone in the situation we have placed our citizens in to have a happy Thanksgiving or a merry Christmas while they are contemplating how they will feed their families?”   – Whistleblower letter

The Texas HHSC plays a central role in providing services for these communities by administering SNAP and Medicaid in the state. However, as documented in the whistleblower letters, this year the agency's reapplication process for Medicaid has resulted in hundreds of thousands of citizens losing health care coverage – estimates range as high as 900,000 – and they often aren't aware of the coverage loss until they make an appointment to see a doctor. As the problem has intensified, the whistleblowers – an unknown number of tenured employees who have maintained anonymity out of fear of retaliation by their bosses – have detailed the agency's descent into chaos.

"Within a tight eight-month timeframe, we were tasked with processing close to 6 million Medicaid recipients," the whistleblowers wrote in July, as the dimensions of the crisis became apparent. "Approximately two weeks after the process began, we started receiving numerous emails from agency leadership indicating that thousands of individuals had been erroneously denied coverage. Consequently, we were burdened with the manual correction of these coverage issues. Despite multiple inquiries, the reasons for these denials were not adequately explained by agency leadership."

They Knew This Was Coming

It's now believed that information technology glitches caused many of the coverage cancellations. Some of the IT glitches have reportedly been fixed. Other cancellations were the result of HHSC's late delivery of letters warning recipients to reapply for coverage. The errors caused HHSC employees, who were already working mandatory overtime shifts of 50 to 60 hours a week, to review the denied applications one by one, bogging down the approval process. Since the same workers also oversee SNAP applications, waiting times to receive SNAP assistance rose from 75 days in September to 180 days today. Waiting times are expected to rise to 200 days by the end of December.

Stacey Pogue of Every Texan told us the backlogs are the inevitable result of Texas leaders refusing to adapt. The federal government stopped allowing automatic reenrollment for people on SNAP and Medicaid this year following the pandemic's end, and the state didn't hire new people or form an action plan, Pogue said. The feds gave the states one year to handle the reenrollment, from April 2023 to April 2024. Texas officials decided to do the work in eight months, by the end of December.

"They knew this was coming for a long time and their plan, though it wasn't in writing, was to do this unprecedented amount of work with a system that was riddled with errors and a short staff," Pogue said. "It was going to result in errors and delays, unquestionably. And there's no doubt that leadership from the governor could have prevented it. The governor had the option to say, 'Not one eligible kid loses coverage on my watch. Not one eligible person with a disability loses coverage on my watch. Nobody in need of food is going to wait.' He never said that."

Every Texan is proposing that the state ask the feds to allow it to automatically reenroll recipients of SNAP and Medicare for six and 12 months, respectively, as other states have successfully requested. That would take the manual paperwork of thousands of renewals off the desks of the HHSC workers, allowing them to focus on the smaller numbers of new applicants. "All that renewal paperwork would go away," Pogue said. "We did this so many times during the public health emergency. We do it after hurricanes. It's not an unusual thing for Texas to do."

Somebody Call the Feds

The Texas Democratic delegation to Congress has been aware of the HHSC meltdown since July and has been working to get the federal government involved. U.S. Rep. Lloyd Doggett, D-Austin, has met regularly with officials from the Department of Agriculture, which has authority over SNAP, and the agency has met with HHSC officials and warned them that they are breaking state law. Doggett has also tried to get intervention from the Centers for Medicare & Medicaid Services, the agency with authority over Medicaid, but has been less successful.

HHSC leaders have not held regular press conferences to explain the meltdown and have not yet responded to questions from the Chronicle. Instead, the whistleblowers say agency leaders are dismissing the urgency of the problem and trying to identify the whistleblowers. The whistleblowers describe HHSC as a hostile work environment and say that their two main supervisors – Chief Program & Services Officer Michelle Alletto and interim Deputy Executive Commissioner Molly Lester-Regan – are either unconcerned about the meltdown or simply incompetent. They worry about burnout and the possibility of mass resignations. They believe that more vulnerable Texans will lose SNAP and Medicaid coverage in December.

"With every passing day, the situation continues to decline," the letter said. "While we are still experiencing major morale [and] communication issues and a gross lack of leadership, our communication today is less about us the 'forgotten workforce' but more about those we have dedicated our careers and sacrificed our time and lives to serve."

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