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In Texas, health advocates are playing a defensive role, trying to maintain the state’s relatively modest public services while encouraging leaders to push for more services. It often happens.
That’s why the state’s nonprofit policy community is excited that the Texas Health and Human Services Commission, the state’s human services agency, will ask lawmakers for $300 million next year to improve the agency’s complex Medicaid application process. I’m letting you do it.
If realized, it would bring more than 1,000 new workers and upgrades to decades-old computer systems to make it easier for Texans to apply for Medicaid health insurance, food stamps and other programs for adults and children. You could end up spending millions of dollars.
This move could allow vulnerable Texans to enroll in these critical programs in a matter of weeks rather than the current months.
“This is very remarkable to us,” said Peter Clark, a spokesperson for Texans Care for Children, who represents the children and families of Texas. He has made improving Texas’ Medicaid eligibility system a top priority on the list of state legislators. Congress will convene in January.
The agency-initiated request is in response to a large backlog of Medicaid and food stamp applications after the federal government lifted a pandemic-era policy that suspended the requirement for periodic renewal of benefits. . Hundreds of thousands of Texans have lost Medicaid coverage because their renewal applications were not submitted early enough or because they were procedurally removed from the program due to administrative issues.
The agency notes in its legislative spending request that federal regulations require it to review food stamp applications within 30 days and Medicaid applications within 45 days. This is no longer the case after 2019.
As of Nov. 22, the waiting time for an adult or child’s Medicaid application to be processed was 71 days, with 131,869 applications awaiting completion. As of December 5, the waiting time had improved slightly to 59 days.
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“The TIERS eligibility system has been severely neglected due to the extraordinary demands of the COVID-19 pandemic,” the agency urges Congress. “Fully funding this request will provide the level of resources needed to respond to routine requests and provide (state technical staff with) remedial requests targeting timeliness obligations and client experience.” will be able to address the backlog.”
Each year, staff members submit up to 50,000 service requests for registration system maintenance.
The legislative request document calls for at least 1,772 new positions, but officials have been specific about what else the remaining $300 million will be used for. If the state approves the $300 million, it could receive an additional $100 million in funding from the federal government and other sources.
Last year, the health department hired more than 2,100 eligible workers to reduce the backlog and reported that more than 96% of eligible workers were filled.
As a result of these efforts, HHSC spokeswoman Jennifer Ruffkorn said the agency cleared the backlog of food stamp applications last month.
Why does it take so long to apply for Medicaid?
If Texans want to apply for Medicaid health insurance or food stamps, they can do so through the agency’s Texas Benefits website or the agency’s Your Texas Benefits app.
But miles away, state officials are taking that applicant’s information and dumping it all into a relentless, 20-year-old computer system with the most bureaucratic name: the Texas Integrated Eligibility Redesign System (TIERS). must be entered manually.
It is no exaggeration to say that it is a time-consuming process.
“You remember The Oregon Trail,” said Diana Forrester, director of health policy at Texans Care for Children, referring to the 1985 static video game played via keyboard prompts. That’s what it feels like,” he said.
When piloted in 2003, TIERS was hailed as a cost-saving system. But there was uproar from the start, and in 2006 the state changed contractors and shelled out an additional $56 million to fix some problems. An audit the following year found TIERS to be “difficult to use.”
Last year, Texas abruptly removed more Medicaid recipients from the program earlier than any other state, even though it remained in place throughout the pandemic, underscoring the system’s flaws. It became even clearer for income Texans: children, the disabled, and the elderly.
Forrester, who worked at the state health department for six years before becoming a health care policy advocate in 2022, said using TIERS is extremely cumbersome, with staff repeating the same information in different places on the 30-page Medicaid application. He said he had to enter it. It will be sent successfully.
Ann Dunkelberg, who retired as health policy director for the progressive policy group Every Texan earlier this year, said the process is slow by design.
“Texas has had difficulty registering and renewing for decades,” she says.
This system requires administrators to pause their work for hours, if not days, to push applications into the system after gathering the necessary documents.
“Eternal vigilance is required,” Dunkelberg said. “We have some pretty bad statistics coming out of COVID-19, and the time is ripe for some feature upgrades to prevent so many eligible people, primarily children, from missing out on the program. Masu.”
What does it look like to ask for help in the field?
As deputy coordinator of the Mercedes-based Texas Rio Grande Legal Aid Group, Bernadette Segura and her team help Spanish-speaking Texans apply for Medicaid and food stamps.
“The delays are shorter, but there are still delays,” Segura said last week. “(State health department officials) take forever to make a decision.”
Applicants for either benefit must verify that they are a U.S. citizen or legally eligible by submitting a birth certificate and proof of income, rent, utilities, and school-age children. You must prove residency.
Segura often hears from clients who have to resubmit documents multiple times because the state claims they never received them.
She said one customer, a single father, waited more than a year to receive food stamps and had to appeal to the government to receive them.
Applying for benefits requires a lot of patience, Segura said.
“You need enough time to fully charge your phone and put it on hold,” she said. It also requires some technical knowledge. If you are a Texas resident applying online from your cell phone, you need to know how to enlarge small text and how to scan documents into your application.
While waiting, many people rely on local food banks, many of which also help customers apply for food stamps.
Another hurdle, Segura noted, is the fact that applications for Medicaid and food stamps are only done in Spanish and English. Language barriers can be a powerful deterrent for eligible non-English speakers who need assistance from the Middle East, Asia and Africa, she said.
“There will be confusion depending on the applicant’s English level,” Segura said, adding that he would like to be able to apply in Arabic, Chinese and Vietnamese as well. “Language translation is always needed.”
Forrester, of Texans Care for Children, said the system can also give applicants a constant stream of confusing notices. “It’s not applicant-friendly,” she said. If you go to a community center that helps applicants, you’ll “see lines of families with stacks of notices.” Some of them contradict each other,” she said.
Applicants are overwhelmed and can’t log in to see the status of their applications, she said.
“We don’t need more people,” Forrester said. “We need better technology.”
Disclosure: All Texans and Texans Care for Children are financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization funded in part by contributions from members, foundations, and corporate sponsors. is. Financial supporters play no role in the Tribune’s journalism. See the complete list of them here.
