St. David's Foundation offers $21 million in response to Medicaid unwinding crises

Nicole Villalpando, Austin American-Statesman
Updated ·7 min read
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Editor's note: the story has been updated to correct that HHSC does not plan to increase staff hours at its 2-1-1 information center. HHSC also now says that SNAP benefits are being processed in 32 days as of Dec. 15.

St. David's Foundation is giving $21 million to four local federally qualified health centers to help provide health care to Central Texans most at risk for not having health care.

Federally qualified health centers receive federal funding to serve medically underserved areas and populations. They can often get reimbursement via Medicaid, Medicare or other programs for people with lower incomes, but for people without insurance, the centers offer sliding scales or care at reduced prices.

That risk of lacking health care coverage has increased this year because of Medicaid dropping many families from its rolls in the wake of the pandemic, said Dr. Edward Burger, St. David's Foundation president and CEO.

That Medicaid unwinding process has meant that as of November, 1,482,635 people have lost Medicaid coverage in Texas, according to the state Health and Human Services Commission's latest unwinding dashboard. Two-thirds of those people lost coverage for procedural reasons, such as not returning their renewal form fast enough, not receiving the form at all or missing some needed paperwork.

Arlett Mireles, middle, does crafts with her children, from left, Dylan, 10, Dustin, 8, Casey ,7, Dave, 6, and Lindsey, 3, at their home in October. Mireles and her children learned through People's Community Clinic that they had lost Medicaid coverage in August. The clinic has become an even more important health care partner to the family now that they are uninsured.

Texas has led the country in the number of people disenrolled, according to KFF, a health policy researcher. Its numbers show Texas disenrolled 1.7 million people as of Dec. 13. The next highest was Florida with 1.1 million people disenrolled.

Understanding the need for more funding

Texas is going through a "health crisis," Burger said. "That weighed very, very heavily in the urgency of getting these dollars to these individuals who are losing their health care for technical reasons, not because they have eligibility problems."

People hit by the unwinding are "already vulnerable and marginalized," Burger said. "It's increasing health disparities. Our mission is to increase health equity."

Another letter to Gov. Greg Abbott

St. David's Foundation is not the only system aware of the impact the Medicaid unwinding is having in Texas.

On Monday, Xavier Becerra, the secretary of the U.S. Health and Human Services, sent Gov. Greg Abbott and eight other governors a warning letter. These were governors of the nine states that had the highest percentage or highest number of children who lost coverage in Medicaid or Children's Health Insurance Program during this re-enrollment period.

"There are several strategies that I strongly encourage your state to adopt to help eligible children maintain access to the health coverage they need to thrive," Becerra wrote. "My Department stands ready to do all that we can to help your state advance this goal, including by providing Texas with the flexibility to pause procedural disenrollments for children while it adopts other strategies to ensure eligible children remain enrolled."

Abbott has not responded to questions the American-Statesman sent to his office about the letter and other inquiries about Medicaid unwinding. The Statesman could not find any evidence that Abbott has responded publicly to Becerra or to the Texas delegation of Democratic U.S. representatives or to a whistleblower group at the Texas Health and Human Services Commission.

The federal department, the congressional delegation, the whistleblowers and advocacy groups have called for Abbott to pause the renewal process to allow the state time to fix technical problems and to hire more support and technical staff, especially those processing the Medicaid, CHIP and Supplemental Nutrition Assistance Program food benefits forms and those answering the 211 calls.

Currently there are no plans to increase staffed hours at 211, wrote Tiffany Young, a spokesperson with Health and Human Services Commission, in an email to the Statesman: "A limiting factor of extending operating hours is the eligibility determination system requiring down time to refresh and receive necessary security updates overnight."

That eligibility determination system is what agents use to answer case-specific questions.

The state has increased program staffing at the commission by 40%, according to whistleblowers.

Texas has not been in compliance with federal requirements to process new applications within 45 days of receiving them. SNAP benefits were taking more than 100 days as of September and expected to reach 200 days this month, according to the whistleblowers. U.S. Rep. Lloyd Doggett, D-Austin, said that SNAP benefits have not been timely since July 2021. Young says that as of Dec. 15, the time staff are taking to process SNAP benefits is 32 days.

A March 2023 state report showed that even before unwinding began, only 53.99% of Medicaid applications were processed within 45 days. In the state's December report, 48,464 people still have pending renewal Medicaid applications. That report does not give the number of days those applications have been lingering.

Renewal forms are handled differently, Young said.

"States are required to process renewal applications before the last day of the person’s current certification period to be considered timely," she wrote. "Medicaid recipients are being automatically extended if a person has provided their renewal application and is not renewed by the end of the certification period."

Young wrote that the state has now initiated contact with all the families who were part of the Medicaid unwinding renewal process.

In its December report, of the 1,080,037 renewals set to be initiated in August, September and October, 511,696 have not been completed; 23.8% were renewed, including 4% were renewed using ex parte process (that's the process that uses data from SNAP or Temporary Assistance for Needy Families to automatically determine eligibility); 10.8% were determined ineligible; and 17.9% were terminated for procedural reason.

Advocacy groups, the congressional delegation and whistleblowers have called on Texas to increase its use of the ex parte system. Ex parte has only been used in 2.7% of Medicaid renewals in Texas during this renewal process, the least of any state, according to KFF. Oregon has been able to renew 82% of its renewals this way, according to KFF.

The importance of federally qualified health centers

St. David's Foundation automatically renewed grants for the federally qualified health programs and gave an 18-month grant instead of a one-year grant. The centers also didn't have to apply for these grants, which is unusual. The foundation uses money earned from St. David's HealthCare hospital system to provided community funding.

The $21 million went to:

  • CommuniCare Health Centers (Hays County), $1,866,572

  • Community Health Centers of South Central Texas (Bastrop and Caldwell counties), $3,969,000

  • Lone Star Circle of Care (Travis, Bastrop and Williamson counties), $9,234,000

  • People’s Community Clinic (Travis County), $6,668,344

Regina Rogoff, chief executive officer at People's, said her center has been trying to get its patients requalified through Medicaid and CHIP. Often, that has meant having its financial counselors calling the 211 system with a patient trying to get requalified. "It's very hard to expect the patient to do it themselves," Rogoff said. "You have to sit on hold for a long time."

While People's will see a patient regardless of insurance, "the more we can do for the patient helps them and helps us," Rogoff said.

Medicaid unwinding: Austin families talk about being stuck in Medicaid red tape and living without coverage

She sees St. David's Foundation's grant as an acknowledgement of the "uncertainty" with Medicaid and CHIP and that centers like People's are bearing the brunt of care when people can't get Medicaid renewed.

Of St. David's Foundation, she said, "they are trying to be a good partner."

People's Community Clinic's tips on Medicaid renewal

This article originally appeared on Austin American-Statesman: St. David's Foundation offers $21M in aid in Medicaid unwinding crisis