Juliette Vasquez gave birth to her daughter in June with the help of Medicaid, which she said covered prenatal check-ups and medications that kept her pregnancy on track.
But as she cuddled her daughter, Imani, in southwest Houston one afternoon this month, she described her fear of not having health insurance that helped her deliver her baby.
This month, Ms. Vasquez, 27, joined the growing ranks of Americans whose lives have been disrupted by the repeal of a policy that barred states from taking people off Medicaid during the coronavirus pandemic in exchange for additional federal funding.
Since the policy was lifted at the beginning of April, more than half a million people in Texas have been dropped from the program, more than any other state reported removal to date, According to KFFA health policy research organization. State health experts and advocacy groups say many of those losing coverage in Texas are young mothers like Ms. Vasquez or children with few, if any, alternatives to obtaining affordable insurance.
Ms. Vasquez said she needs to stay healthy while breastfeeding and be able to see a doctor if she gets sick. “When you’re taking care of someone else, it’s completely different,” she said of needing health insurance as a new parent.
Enrollment in Medicaid, the federal statewide combined health insurance program for low-income people, rose to record highs while a pandemic-era policy was in place, and the nation’s uninsured rate dropped to a record low early this year. But since the so-called unbundling began, states have reported dropping more than 4.5 million people from Medicaid, according to the KFF.
This number will rise in the coming months. Congressional Budget Office Saucepan that more than 15 million people will be dropped from Medicaid in a year and a half and that more than six million of them will end up without insurance.
While some people like Ms. Vasquez lose their coverage because they no longer meet the eligibility criteria, many others are dropped for procedural reasons, suggesting that some people may lose their insurance even though they still qualify for it.
The upheaval has been particularly acute in Texas and nine other states that have not adopted the Affordable Care Act expanding Medicaid, all of which have state governments that are either partly or wholly controlled by Republicans. Under the health law, states can expand their Medicaid programs to adults who earn up to 138 percent of the federal poverty level, or about $41,000 for a family of four.
But in Texas, which had the highest uninsured rate of any state in 2021, Medicaid is far more restrictive. Many of the people covered are children, pregnant women, or people with disabilities.
The ongoing unbundling has renewed concerns about the so-called coverage gap, in which some people in states that haven’t expanded Medicaid have incomes that are too high for the program but too low for coverage subsidized through the Affordable Care Act markets.
said Joan Alkire, executive director of the Georgetown University Center for Children and Families.
Medicaid in Texas grew exponentially during the pandemic when the state was prohibited from taking people out of it. At the start of dismantling, nearly six million Texans were enrolled in the program, or roughly one in five people in the state, up from nearly four million before the pandemic.
Now the program is greatly reduced. Adrian Buentello, a Legacy employee who helps patients with illness Legacy Community Health, a network of clinics in and around Houston that provides low-cost health care to the uninsured, said it has been overwhelmed in recent weeks by panicked parents whose children have suddenly lost coverage. Medicaid. their health insurance eligibility forms.
“Moms are crazy,” he said. “They are in distress. They want their child to have these required vaccinations, these yearly exams that schools require.”
Texans are missing out on Medicaid for several reasons. Some people now have too much income for their children to qualify for, or they now earn too much to maintain their own coverage. Some young people have dropped out of the programme.
Some new moms like Ms. Vasquez lose coverage because they’re two months after giving birth, which is a stricter cutoff than in most states. Gov. Greg Abbott, a Republican, recently signed legislation extending postpartum coverage to a year, which would make Texas In line with most of the country. But the new rule is not expected to go into effect until next year.
Kayla Montano, who was born in March, said she suffered an umbilical hernia and pelvic pain due to her pregnancy and is due to lose coverage at the end of this month and will likely fall into the coverage gap. Ms. Montano, a mother of three in Mission, Texas, said she was only working part-time so she could take care of her young children, a schedule that left her ineligible for insurance from her employer.
“My health is going to stop until I start working full time again,” she said.
Health experts are particularly concerned about the many Texans who lose Medicaid coverage for procedural reasons, such as not returning paperwork to confirm their eligibility, even if they still qualify for the program.
Of the 560,000 people Texas reported being dropped from Medicaid during the first months of eligibility checks, about 450,000, or roughly 80 percent, were dropped for procedural reasons. Nationally, in states where data is available, three-quarters of those who lost Medicaid during the disengagement process have been removed from the program for procedural reasons, according to the KFF.
In a statement, Tiffany Young, a spokeswoman for the Texas Health and Human Services Commission, which is overseeing the state’s cannibalization process, said Texas has prioritized conducting eligibility checks for those most likely not to qualify for the program. She said the agency was using a range of tactics to try to reach people, including text messages, robocalls and community events.
Ms. Young said the first few months of the eligibility checks generally went as expected, though she said the state has been aware of some cases where people have been mistakenly excluded from the program. “We are working to restore coverage for these individuals as soon as possible,” she said.
Because of its size and rural expanse, Texas has been particularly difficult to reach people whose coverage may be at risk, said Adrienne Lloyd, director of health policy for the Texas chapter of the Child Protection Trust, an advocacy group.
Ms. Lloyd said many rural residents lack consistent access to the Internet or nearby Department of Health offices where they can seek help re-enrolling in Medicaid in person, while the state hotline can have long wait times. Others, she said, may not feel comfortable using technology to renew their coverage or may have difficulty filling out paper forms.
The work required for those who haven’t signed up online or over the phone can be a challenge. Early this month, Luz Amaya drove nearly 30 minutes to a food bank branch in Houston to help fill out an application to re-enroll her children in Medicaid. She said her arthritis affected her hands, which made driving difficult.
Ms. Amaya was among dozens of parents who visited the food bank for an event sponsored in part by the state that provided registration assistance.
Mrs. Amaya becomes emotional at the event when she learns that her eldest daughter will soon be off Medicaid and may no longer be able to get the treatment she needs. Ms Amaya said she was there in part to confirm coverage for another daughter who needed treatment.
An attendee, Mario Delgado, said he came to re-enroll in Medicaid after he and his wife suddenly lost coverage at the start of the state breakup. He said that both of them are disabled and cannot work. With money tight, they collected drug payments.
He said his wife needs back surgery, and he needs medication to keep up with his diabetes, which is making his hands swollen. “If I cry, the pain stays the same,” he said, describing the resignation they felt as they struggled to afford health care.
Soon he received good news. He and his wife are back on Medicaid. “I’m going to sleep better,” he said, emerging from the building in the scorching Texas summer heat.
Health experts have warned that many of those who have lost coverage in a relaxed state may not realize their fate until they are informed by a healthcare provider or pay a bill for a medical service.
Perla Brown, the mother of an autistic child, said she attended the food bank event after her son’s therapist told her her child had lost Medicaid. She soon discovered messages in the email she had missed that warned her of the imminent loss of his coverage. She said she was worried about paying the medical appointment bill.
Having a baby, said Ms. Vasquez, a new mom, “opens up your heart in a whole different way.” She’s learned to enjoy closing her daughter’s blankets once too much spit has accumulated. She added that the way her daughter learned to play on her stomach made her happy.
But she said the joy of parenting has been dampened by obsessive thoughts about the consequences of losing her Medicaid. Health care is “always about cost,” she said.