Children’s Defense Fund – Texas Written Testimony for House Appropriations Committee Article II on HB1

Dear Chairman and Members of the Committee:

I am Dr. Laura Guerra-Cardus with the Children’s Defense Fund – Texas. We are a child advocacy and outreach organization that works within communities to help Texas children and families thrive.

Texas families are not ok. Job loss, reduced work hours, added child care burdens and now the nightmare resulting from this month’s winter storm, has wreaked havoc on people’s lives. The circumstances of the last year have led to greater child poverty, more food and housing insecurity, growing levels of physical and mental illness, and millions of Texans left financially vulnerable or at a breaking point. Our staff who work directly with families in East, South and Southeast Texas see children and families struggling with heartbreaking circumstances on a daily basis.

At a time like this, we need to double down to make sure that available supports are there for our communities. This is not a time to cut back on services and leave critical needs unaddressed.

We are here today to make three requests from this committee.

Restore cuts made to HHSC eligibility staff in 2020.

The idea that HHSC has less work to do because of the Public Health Emergency (PHE) is inaccurate. It is true that children and other Medicaid clients are not able to be dropped from coverage during a PHE, but enrollees are still being asked to submit renewals, like usual; the level of confusion for families is at an all-time high because of changing messages throughout the PHE; and, need has increased across HHSC’s eligibility systems. Many more families are applying for SNAP, and even Medicaid and CHIP as hundreds of thousands of Texans have lost their jobs.

If you call 211 today, you will wait on the phone nearly an hour and half to get your question answered, assuming you don’t accidentally get disconnected when it’s your turn. If you go to an HHSC office today eligibility staff are often too stretched to help answer questions. These are not signs of a system that has too little work to do.

HHSC’s eligibility staff are often the linchpin to ensuring our state is able to respond to the needs of Texas families. From our experience with the agency, eligibility staff have been under-resourced and overworked even before the pandemic; frequently asked to work mandatory overtime. Maintaining the 5% cuts implemented in 2020 will further burden an already stretched system. We ask that you support the agency’s eligibility staff – essential frontline workers who are often going through r difficulties similar to those being experienced by the clients they serve. Please restore those cuts, we cannot ask them to do more with less.

Support 12 months of continuous eligibility for kids on Medicaid.

Between Dec 2017 and February 2020, 237,000 children lost Medicaid and CHIP health coverage at the same time we saw our child uninsured rate sky-rocket to 12.7%. If it were not for the PHE this trend would be continuing and the loss of coverage for children would be astronomical – averaging about 9,000 children a month. Because the PHE is likely to end in 2021, it is imperative that we take action this session to address children’s health coverage. Not only should the rising child uninsured rate be of grave concern for anyone who cares about the wellbeing of children and our future workforce but it is also a matter of public health. Last September the American Academy of Pediatrics (AAP) sounded the alarm and a call-to-action due to a 44-69% drop in dental and healthcare visits and 22% drop in immunizations between March and May 2020. We have already had several dangerous measles outbreaks and must take steps to ensure children are getting their needed check-ups in order to keep communities safe.

Some in the legislature have also stated that our first job in addressing our high uninsured rate is to ensure the 660,000 Texans who are eligible for coverage today, get enrolled. Eighty five percent of these Texans are children. The best thing the legislature could do to decrease the number of eligible uninsured Texans is to provide 12 months of continuous eligibility for children in Medicaid. Fixing our Medicaid eligibility system is also a matter of equity. It is time to finally allow children on Medicaid who are lower income and more likely to be in communities of color, to receive 12 months of uninterrupted coverage just like children on CHIP. We must stop the practice of allowing our lowest income children to be erroneously kicked off of coverage up to four times a year.

Expand Medicaid to Texas’ essential workforce.

We have all been in emergency mode at some point over the last year – going to the grocery store hoping to find essential items like milk and toilet paper. Like these essential items our state has learned how much we also need essential workers to ensure that our basic needs are met. We owe a great debt to people in the food industry up and down the line, custodial, home, construction staff and low-wage healthcare workers who have enabled our societal and healthcare systems to continue to function as we work to get the pandemic under control. The pandemic has brought to light that as a society we need our essential workforce to be healthy. As Texas’ essential workers do their best to take care of their children and families, it is our turn to show meaningful appreciation for the role they play by ensuring they have the health and financial protections that only healthcare coverage can afford. And the answer is simple. Numerous reports just this year have shown that we can ensure our essential workforce across the state has access to life saving, financially necessary healthcare coverage through Medicaid expansion at no cost to the state.

The Impact of Medicaid expansion in Texas on the state budget (Episcopal Health Foundation) – “…one million enrollees produces an annual cost of $6.3 billion. The total non-federal cost would be $650 million ($630 million match plus $20 million for administrative, technology, and state employee costs)… Compared to the $650 million cost of expanding coverage, [cost savings show] a positive difference of $54 million per year or almost $110 million for the biennial budget.”

Texas 2036 Health Coverage Policy Explorer – “By accessing the Enhanced Federal Matching Funds, Texas can make dramatic increases to coverage at virtually no cost to the state.”

House Bill Gives States Incentive to Quickly Expand Medicaid, Cover Millions of Uninsured – The report describes how the House provision would provide a financial windfall to states that newly expand, including $5.97 billion for Texas.

We hope the energy crisis this month serves as a wake-up call to the Texas legislature that we cannot lead by continuing to ignore the big problems facing our state. Healthcare is one of them. We are 50th out of 50 in the nation for the number and rate of uninsured people. As our rural hospitals have closed Texas’ healthcare community has been screaming for over a decade that we must do something to stabilize our healthcare system.

This year, more than ever, we ask the legislature to be the leaders that Texans need right now and to tackle our state’s problems head on.


Laura Guerra-Cardus, MD
Texas Deputy Director

Children’s Defense FundTexas 
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