Child Health

Cover-Alls: Dr. Laura Guerra-Cardus testifies to the value of 12-month coverage for children on Medicaid

March 13, 2019 | Texas

CDF – Texas and a coalition of children’s advocacy groups in Texas testified Tuesday in support of HB 342, which would increase continuous coverage for children on Medicaid from 6 months to 12 months. Implementing 12 months of continuous coverage would be an important step in reducing Texas’ troublingly high uninsured rate for children, especially given that Texas has the highest rate of uninsured children in the nation. Here’s what she had to say.


Children’s Defense Fund – Texas

Testimony to the House Human Services Committee

March 12, 2019

Dr. Laura Guerra-Cardus, M.D., Deputy Director, Children’s Defense Fund – Texas

Hello, my name is Laura Guerra-Cardus.  I’m with the Children’s Defense Fund testifying in support of HB 342.

We are here today to express our strong support for children’s healthcare coverage and ask that the legislature take action this year to reverse the troubling trend we are seeing in our child uninsured rate.  Texas has the highest rate of uninsured children in the country and it’s getting worse.

The single most effective thing that we can do to reverse this trend and get children connected to care is to implement 12 months of continuous coverage for children in Medicaid – just like we do in CHIP.

CDF-Texas helps families enroll in Medicaid and CHIP in Houston, the Rio Grande Valley and E. Texas, and since the implementation of monthly income checks, we have seen significant confusion among families and providers who don’t understand why children are cycling on and off coverage so regularly.  

Some of the top issues we have seen in the field include:

  • Confusion about renewals vs. periodic income checks
  • Delayed receipt of letters and inadequate time to provide verifying information.
  • Eligibility system errors
  • Issues for families with fluctuating incomes, like those working seasonal and contract jobs.

The implementation of these monthly income checks has increased the number of times eligible children can fall through these kind of cracks from one time a year to up to five times a year – per child.

Recent HHSC data shows that 92% of children who lose coverage during these checks are losing it for procedural reasons and not because they are over the income limit. It confirmed what families, outreach workers, health plans and providers have been experiencing – eligible children have been churning on and off coverage.

Rising child uninsured rates should worry us all for a number of reasons:

  1. Children thrive and do better in school and in life when they have coverage. – studies have shown that adults who were on Medicaid as children were more likely to graduate high school, go to college, be higher income earners, pay more taxes and be healthier as adults.
  2. Rural hospitals have thin budget margins and particularly suffer with any rise in the uninsured. Texas has the highest rate of rural hospital closures by far and uncompensated care is a major contributing factor. Since 2013 Texas has seen 19 rural hospitals close, endangering communities across the state.

Included with this testimony is a list of child uninsured rates by congressional district.  Uninsured rates in rural Texas communities range from 11% to 15.3%. This is higher than the Texas average and in some places triple the national average of 5%.   

National trends show that uninsured rates in Texas are expected to continue to rise and it will take action to curb this trend.

In 2007 the Texas legislature passed 12 months of continuous coverage for CHIP with a near unanimous vote in both chambers.  

We hope we can count on your support this year to make government work better for Texas families and to bring equity to the way we treat children on Medicaid, something that has been long overdue.