HHSC whistleblowers on Medicaid, SNAP delays: 'We need resources' | 100K dropped from Medicaid improperly

Days after a local congressman asked the Centers for Medicare and Medicaid Services to investigate months-long delays in Texas, potentially impacting millions of low-income and vulnerable people in the state, the agency is responding.

AUSTIN (KXAN) -- Days after a local congressman asked the Centers for Medicare and Medicaid Services to investigate months-long delays in Texas, potentially impacting millions of low-income and vulnerable people in the state, the agency is responding.

CMS said in August it required Texas to reinstate Medicaid coverage for around 100,000 people who were improperly disenrolled due to 'systems issues,' which it required the state to fix.

"Any person being improperly disenrolled from health care coverage is unacceptable to this administration," a U.S. Health and Human Services spokesperson said. "HHS' top priority is people maintaining coverage, whether that is through Medicaid, Medicare, the Marketplace, or employer-sponsored insurance."

CMS, which is part of HHS, said it will respond directly to U.S. Rep. Lloyd Doggett, D-Austin. Doggett sent the agency a letter on Monday calling for it to put the Texas Health and Human Services Commission on a corrective action plan following lengthy delays processing Medicaid applications. This week, HHSC acknowledged it's taking up to 120 days to process combined applications for Medicaid and federal food benefits through the Supplemental Nutrition Assistance Program (SNAP).

So far this year, 1.4 million Texans were disenrolled from Medicaid -- the highest in the country - since pandemic-era coverage protections ended in April, the health policy research nonprofit KFF found.

"Many states have stepped up -- and we're seeing large numbers of Medicaid beneficiaries successfully renew their coverage," a HHS spokesperson said. "But other states need to do more to protect coverage. We have put all states on notice and will not be afraid to take enforcement action."

"HHSC continues to work with our federal partners as we redetermine Medicaid eligibility," said HHSC spokesperson Jennifer Ruffcorn. "Through our own quality assurance process, HHSC identified individuals who were ... denied improperly. We worked quickly to reinstate coverage for impacted individuals."

Texas has not been asked to pause disenrollments, Ruffcorn added.

CMS is continuing to closely monitor Texas renewals for Medicaid and the Children's Health Insurance Plan (CHIP) to ensure the state is in compliance with federal requirements.

Texas has the lowest number of auto-renewals in the country, according to CMS, which noted the state has adopted some recommendations to make renewing Medicaid coverage easier. Auto-renewals are when a state checks available data to verify eligibility, before requesting someone fill out a renewal form, to make it easier for people to not lose coverage.

'Instead of a competition, we need resources'

Doggett has also called for the US Dept. of Agriculture to investigate HHSC over months-long delays with SNAP food benefits. Last month, USDA officials came to Texas for what HHSC described as a "technical assistance visit" to brainstorm ideas about cutting down the backlog.

This week, KXAN reported HHSC is incentivizing staff with prizes to work 15 or more hours of overtime this week calling it the "6 Days of Merry Service Challenge," according to an internal email obtained by Doggett's office.

The goal is to drop the time it takes for an application to be reviewed to between 50-70 days. Even if that goal is met, the agency would still be out-of-compliance with federal rules which requires 30 days for SNAP applications to be finalized and 45 days for Medicaid.

"They have set for themselves a best case, aspirational goal to remain out-of-compliance with federal law in the future," Doggett previously told KXAN. "And that's just not acceptable."

The group of anonymous HHSC employees who blew the whistle on long wait times responded to the overtime "blitz" to bring down the wait times.

"The last thing we need is a artificial push for us to work more overtime above the 20 hours of mandatory overtime," they told KXAN. "Instead of a competition, we need resources to do our jobs."