Don’t panic. 

That’s the advice Stacey Thompson has been dishing out on repeat for the past several weeks amid her phone’s constant rings, pings and dings. As a health care navigator, Thompson and her colleagues at the local nonprofit Civic Heart Community Services have been fielding calls from a growing number of Texans who will be deemed ineligible for Medicaid beginning next week. 

“Honestly, we’re hearing it’s going to be more than 1 million people in Texas,” says Thompson’s co-worker, Jeness Sherrell. “We’re looking at the portion of Texas we serve — 59 counties — that could really be hundreds of thousands of folks.”

Texas already has the highest rate of uninsured residents in the nation. In 2021, 5.2 million Texans were without health insurance. That’s 18 percent of the population — 4.2 percentage points greater than the next highest state, Oklahoma, according to the nonprofit organization, Every Texan

It’s a problem that comes with high personal cost for those who find themselves without insurance, as well as the state’s population as a whole. A 2019 report by the Texas Alliance for Health Care consortium projected the state could see more than 6.1 million uninsured residents by 2040, resulting in a loss of more than $175 billion to the Texas economy that year.

The ‘unwinding’

Early in the pandemic, Congress enacted the Families First Coronavirus Response Act, which paused the requirement that Medicaid recipients re-enroll for the program each year. So if you qualified for government-funded health care in 2020, you continued to qualify throughout the public health emergency. The policy resulted in the number of Americans enrolled in Medicaid and the Children’s Health Insurance Program, or CHIP, growing by 23.3 million between February 2020 and March 2023, according to KFF, an organization that creates and disseminates health policy information. 

Thing is, not everyone who qualified in 2020 still fits the criteria. Now, Medicaid’s continuous enrollment provision is going through what’s being called an “unwinding.”

“Maybe your children aged out,” says Sherrell. “They were 18 and now they’re 20. You might have been unemployed at the time, or working part time and now you’re working full time. Or maybe you got married.”

Maybe that means you. Or your sister. Your neighbor. One thing’s for sure, according to Thompson: “This is going to affect women and children the most — and the African American and Latino community.”

But how would you — or your sister, or your neighbor — know you’re about to lose coverage in this unwinding? 

And what should you — or your sister, or your neighbor — do if you’re unwound?

Here’s your guide.

A man talks to a service orienteer
Abelardo Rodriguez, at left, talks with Margarita Romo of Civic Heart Community Services about helping his daughter apply for Medicaid during a community health event May 11 outside of a Harris County Justice of the Peace building in Houston’s East End. (Antranik Tavitian / Houston Landing)

What to do

Texas Health and Human Services has split those likely to be affected into three groups. The first includes those most likely to be ineligible now: women who were pregnant, who may transition to the Healthy Texas Women Program in their postpartum period; those who have aged out; and adults who no longer have an eligible child in their household. 

Members of that first group should have received an email or yellow envelope in April that says “Action Required” in red, containing a renewal packet with a request for information. They were given 30 days to respond, and on June 1, members of this cohort who have been deemed ineligible — or those who have not responded — will begin being disenrolled.  

In July, the state will send packets to a second cohort, including Texans who are likely to transition from one Medicaid group to another. In September, a third group — those most likely to see no changes to their eligibility — will begin the re-enrollment process. 

If you’ve received that envelope and still haven’t acted, you have some options. 

Medicaid recipients can update their information online at YourTexasBenefits.com, or call 2-1-1 and — after choosing your language option — select option 2. Or, you can call Civic Heart, one of 10 Texas agencies that received federal funds to help Texans find the best insurance options for their families.

“We can talk over the phone. We can meet you in person,” says Thompson. “You can call us and say, ‘I get off work at 5, can I call you at 8 p.m.? Or 10 a.m. on a Saturday?’ Yes, you can.”

As Civic Heart navigators, Thompson and Sherrell walk families through the process. They’ll help you upload mailed forms into the state portal, update information and answer any of your questions with the process. 

“We’re here to help you through the system to make sure you can go through the process as quick as possible,” Thompson says. 

But as busy as she and her colleagues have been since those yellow envelopes began landing in mailboxes, they wish they were busier.

Two women talk at an informational kiosk
Ana Cuellar, at left, talks with Margarita Romo of Civic Heart Community Services about Medicaid access during a community health event May 11 outside of a Harris County Justice of the Peace building in Houston’s East End. Cuellar was seeking to apply for Medicaid after breaking up with her partner and losing her dependent status. (Antranik Tavitian / Houston Landing)

Avoiding gaps

“We feel, unfortunately, that the community doesn’t really get it yet,” says Sherrell. “So that’s our main concern: that everyone sees that this is something that’s happening. It’s really about to happen, and I would hate for us to get to June 1 and 100,000 people lose their health coverage.”

Working with the navigators will not guarantee that a family keeps their current coverage. Rather, if Sherrell and Thompson learn that a family will be subject to the unwinding, they guide that client through the health care marketplace, helping to find a new plan. That requires discussing the difference between co-pays, monthly premiums and deductibles, and determining which plans best fit a family’s needs. 

“We want to ensure there’s no gaps in coverage,” says Sherrell. 

A person passes paperwork
Abelardo Rodriguez, at left, takes an informational pamphlet from Margarita Romo of Civic Heart Community Services, at right, while he asks about helping his daughter apply for Medicaid during a community health event May 11 outside of a Harris County Justice of the Peace building in Houston’s East End. (Antranik Tavitian / Houston Landing)

If you’ve reached this point in the column and your palms are sweating, it’s time to remember those first two words from Thompson: don’t panic. 

It’s not too late to log on to the state’s website, call the hotline or reach out to Civic Heart. You can still avoid a gap in coverage by beginning your process now. 

“This is happening, but it doesn’t have to happen to you,” says Thompson. “Let us help you be proactive.” 

Health care coverage is essential. One in five uninsured adults went without needed medical treatment due to cost in 2021, according to KFF. That same year, KFF found that uninsured adults are more than twice as likely to have problems paying medical bills as those who are insured. That can quickly lead to medical debt — especially in Houston, where this year’s Kinder Houston Area Survey found that more than 40 percent of respondents say they couldn’t come up with $400 in an emergency. 

“Anything can happen,” says Thompson. “Even to the healthiest people in the world. Our biggest thing is that you’d rather have insurance and not need it than need it and not have it.”

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Maggie Gordon is a columnist who has worked at newspapers across the country, including the Stamford Advocate and the Houston Chronicle. She has covered everything from the hedge fund industry and education...