As membership falls, more than 200, 000 Texans are awaiting Medicaid acceptance.

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When the Houston mother learned she was female with her second child, Vanessa Melendez had been arguing with the express over her mother’s Medicaid and food aid requests for months. She submitted a new program for Medicaid for Pregnant Women, which covers care during pregnancy and for 12 weeks after giving birth, last December.

And so she waited.

She didn’t get any release until she was more than four months pregnant— also into her second month — as stress over how her baby was doing became overwhelming.

It’s important for expectant women to be seen during the first 13 weeks of pregnancy, or during the first week. It allows the doctor to confirm the conception, find a fetal heartbeat and do some earlier testing. The majority of abortions occur there as well.

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” It was a bit and I felt like everything was going wrong and I wasn’t going to get the help that I needed”, said Melendez, who delivered her son in July. ” I’m going to have this girl, but I don’t have insurance.”

The Texas Health and Human Services Commission has long struggled to practice Medicaid programs in a timely manner — within 30 to 45 days, under the federal description, according to a Congressional Budget Board report released this month. Texas ‘ timeliness issues were examined by the Centers for Medicare and Medicaid Services, and the feds put Texas on a corrective action plan to process Medicaid and the Supplemental Nutrition Assistance Program ( SNAP ) more quickly. By the end of 2025, the position was improving its timeliness.

That was before the One Big Beautiful Bill Act, which was passed in July 2025, began mandating that Medicaid recipients must renew every six months rather than yearly and show they are employed, trying to work, or volunteering in an effort to combat fraud. Even though information from the Texas HHSC has not shown scam is common in Texas, the country’s queue is climbing back up.

According to most recent data from the Texas Health and Human Services Commission, which administers Medicaid on the state level, 65 % of Medicaid applications were processed in a timely manner in July, compared to 81 % a year ago. The federal government wants 95 % of them processed in a timely manner. 211, 000 programs were still awaiting express approval in August.

This has come as Medicaid enrollment globally has also quickly declined. According to preliminary condition burden data as of June, there have been 252, 000 fewer Texans enrolled in Medicaid in the 11 times since OBBBA was passed. This is a 6 % decrease. SNAP enrollment dropped 17 % — 597, 000 fewer Texans. Nearly two-thirds of the drops were caused by kids.

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There were more than 3.7 million Texans enrolled in Medicaid in June, according to latest Medicaid data from the condition, and 1.3 million homes on SNAP in July.

OBBBA even economically defrays the state for having a higher rate of SNAP and Medicaid recipients receiving under or overpaid, making Texas more careful about its application processing. In April, Texas HHSC officials told lawmakers that they will have to pay$ 700 million a year to participate in SNAP if they do not bring their error rate down starting in 2027. Similar changes to Medicaid will begin in 2029.

Together, these new requirements create more administrative burden on HHSC, which has had to offer new training to the 6, 000 or but staff members who review both SNAP and Medicaid applications, according to Diane Forester, the director of health coverage at Texans Care for Children, a nonprofit child advocacy group. And those modifications added new requirements to a technological system that was already struggling to keep up.

” Those demands are landing on a system that was already under strain”, she said. The system is obviously falling further behind, but not just one cause, according to the statement.

The state health agency did not explain to The Texas Tribune the cause of the backlog or how the agency is addressing it. The Texas Integrated Eligibility and Renewal System, the agency claimed, is in good shape.

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” HHSC routinely updates the system to meet federal and state requirements and protect data”, Jennifer Ruffcorn, an agency spokesperson, said. There were a number of provisions in the BBBBA that altered SNAP and Medicaid eligibility. HHSC provided training in these areas to ensure accuracy. TIERS continues to be a fully operational eligibility system that facilitates application processing.

State Sen. Lois Kolkhorst, who chairs the Senate health committee, said the agency is doing what it is supposed to do to root out and prevent fraud.

” We will naturally begin processing these applications more efficiently and address backlogs in the program to ensure Texas complies with all federal laws on welfare programs while providing for those who are truly eligible for aid,” Kolkhorst said.

The impact

Jessica Ballek immediately applied for Medicaid and SNAP after losing her job in December. Those benefits for her and for her two kids were approved within two days.

Ballek reapplied for SNAP in April, about a month before her deadline, and she waited. The benefits didn’t arrive in May. She relocated to Chandler, a small town in East Texas near Tyler, to begin her new job of working nights as a private home nurse. Losing SNAP made that transition exceptionally difficult and she relied on food banks when possible. However, she claimed that the food banks occasionally didn’t have enough food.

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She called for an update on her application in June and in July. She finally learned that her family had lost its SNAP benefits and that her new job had disqualified her after almost five months of untiring her.

The timeliness rate of SNAP redeterminations dropped from 83 % in January to 28 % in July, the lowest rate in four years.

She worries that her employer-sponsored insurance will be reduced as she navigates the reappearance process for both of her children’s Medicaid coverage, which she claimed she needed because hers is so limited. She won’t be informed about it for months.

” My kids have been with the same pediatrician since they were born and I don’t plan on changing that anytime soon, but that self-pay is going to eat my lunch”, Ballek said.

According to those who oversee those operations, the delays in Medicaid are causing more hospital visits and those that are federally qualified. To cope with the loss of Medicaid, many patients have turned to federally qualified health centers, which can provide healthcare at little to no cost, and emergency rooms.

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The Texas Hospital Association believes that more people are now entering the state’s emergency rooms as a result of this trend. And an increasing number of those patients have no insurance whatsoever.

According to the Texas Hospital Association, Texas nonprofit hospitals provided$ 14. 9 billion worth of medical care to uninsured Texans in 2024. More than 5 million Texans are uninsured, which is more than any other state in the country, according to the latest census data available.

Carrie Williams, the chief communications officer for the Texas Hospital Association, said,” It’s an expensive situation and not good for anyone.”

Rural hospitals, especially, rely on Medicaid funding and are always at risk of closure across the country, but changes to Medicaid will exacerbate that.

Keith Kirbow, a nurse practitioner, is concerned about rural health in East Texas as people lose access to Medicaid.

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” I was the chief nursing officer when we closed the critical access hospital in Linden because of lack of funding”, Kirbow said. I’ve witnessed this all the way from acute care to outpatient care. Health care access has been so badly impacted by people not having the ability to pay”.

He’s appreciative of working for a health care system that allows patients to see patients regardless of their ability to pay, in large part because of grants from organizations like the T. L. L. Temple Foundation and the Episcopal Health Foundation. But not all health clinics have this kind of support or access, Kirbow said.

outdated technology and OBBBA

There has been a longstanding fear that individuals are receiving benefits they don’t deserve from the U. S. entitlement programs, such as SNAP, CHIP and Medicaid— which largely serve poor families and disabled or elderly people.

Kolkhorst claimed in a recent Senate health committee hearing that HHSC had permitted some people to receive Medicaid benefits for more than 90 days without proving their eligibility, including their citizenship status. She said there were more than 1, 800 who received it that were ineligible. This is only a small portion of the Medicaid enrollment numbers.

” Those are real dollars lost and diverted from those who truly need them”, Kolkhorst said. ” So of course, we need to be more cautious when processing and screening these applications,” she said.

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Texas has been proactive about detecting fraud as early as possible, Forester said.

The benefits program integrity unit found that the state had recovered more than$ 37.5 million in improper payments made between March 1 and May 31 in a recent Office of Inspector General report. Of the more than 3, 800 cases opened against individuals, 30 were referred for prosecution and 300 were referred for disqualification from the program.

According to the most recent data available, 9 % of Texas ‘ SNAP payments had errors, which was higher than the 11 % rate at the national level. Fraud isn’t the only — or even largest — reason for errors. Not always intentional lies, but mistakes frequently caused errors.

However, fears of fraudulent activity, like lying on application forms, have escalated in late 2025 and early 2026 thanks to scandals in Minnesota and California as well as information released from the now shuttered U. S. Department of Government Efficiency. Numerous states, including Texas, began conducting extensive program administration investigations.

Texas has one of the leanest Medicaid programs in the country, Forester said. She finds it incredibly difficult to accept that the system is fraught with widespread fraud because of this.

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” We don’t have anybody that’s capable of holding down a job that is eligible for Medicaid”, Forester said. It’s mostly poor kids and sick kids, our pregnant mothers, and some of our elderly, I like to remind people.

However, the system is backlogged, she said.

Every six months, every Medicaid and SNAP recipient must submit their applications to Texas ‘ review staff. This means millions of applications are hitting the desks of Texas ‘ 6, 000 or so review staff, Forester said.

According to Forester, they are currently completing those applications using the state’s already fully operational TIERS by 2012. And the new requirements are like trying to make 2026 technology work well in a 1980 Honda Accord.

” We didn’t even know that technology could exist back then, so it’s not going to work well.” The system is not set up for that”, Forester said.

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According to Forester, Texas lawmakers will agree to spend more money on technological upgrades in 2025 to address these issues, but it will require years to complete the project. For example, the HHSC asked to replace its payment system — which is different from the TEIRS system — because the current system would require staff to track more than$ 3.5 billion manually. According to the Legislative Budget Board report, that system is anticipated to be replaced by the end of 2027.

More problems on the horizon

In the interim legislative session, Texas lawmakers would have had to work together to improve the state’s technology and address the backlog, according to Forester. But with the end of 2026 quickly approaching with a hotly contested midterm election on the wings, she has no faith they will do anything.

” We would like to see lawmakers prioritize reducing these delays in the interim and before the upcoming legislative session,” said Forester. ” But there just hasn’t been any urgency around this, which is mind-boggling to me. That’s important, and it’s great that we’re supporting the new eligibility system. But in the meantime, families cannot wait years for that system to come online”.

There are provisions of the One Big Beautiful Bill Act that haven’t yet been fully implemented, though no new federal legislation is anticipated to have an impact on Medicaid.

Eligibility for non U. S. citizens will narrow in October, cutting humanitarian immigrants such as asylum seekers and human trafficking survivors from the list of people who are eligible. Additionally, funding will continue to decline over the course of the next ten years.

And these entitlement programs are just the beginning of major changes to the country’s social safety net.

One of the biggest changes to Head Start, which provides preschoolers with low-income education, has occurred since it was founded in 1965. The changes could tighten eligibility requirements as well as change quality standards.

Ballek, the night nurse and mother of two who lost SNAP coverage, is facing a triple whammy.

She hopes to finish the Medicaid applications for her children soon. The procedure is challenging. She’s grateful her husband, who is disabled and on his own Medicaid plan, is taken care of.

If she doesn’t learn quickly whether her son’s 10-year-old well-child visit is approved, his 10-year-old well-child visit may be delayed.

And she doesn’t know how she’ll pay for the specialist her 4-year-old daughter was seeing without help from Medicaid.

She is appreciative of the teachers and nurses who work in the Head Start program for the daughter she supports. They have been able to manage her care and resolve some regression issues she’s had. However, the government wants to make a significant change to the program by increasing the ratio of students to teachers.

Ballek said there are 19 kids for two teachers in their program. She opposed having all teachers reduced to one.

” I fear, depending on how they overhaul the program, it is going to impact the students that are looking at coming into Head Start next school year and possibly change the way it is this year”, Ballek said.

Disclosure: The Texas Tribune has significant financial backing from Texas Hospital Association and Episcopal Health Foundation. T. L. L. Temple Foundation and Texans Care for Children have been financial supporters within the past five years. The Texas Tribune is a non-partisan, nonprofit news organization that receives contributions from members, foundations, and corporate sponsors. Financial supporters play no role in our journalism. Find a complete list of them and more details about our financial and disclosure procedures here.

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Sep 10, 2026Hill Country Post

As membership falls, more than 200, 000 Texans are awaiting Medicaid acceptance.

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