WASHINGTON — The Medicaid caseload in Texas ballooned by millions throughout the COVID-19 pandemic, but soon the state will have to reevaluate Texans’ eligibility because federal emergency declarations are expiring this spring. It means millions of Texans could be at risk of losing continuous Medicaid coverage.

Tiayana Hardy, who lives in Garland, Texas, told Spectrum News becoming a mother was a beautiful moment. Her daughter, Laylani, was born just last November.           

“I love it. It feels amazing. She's my best friend and doesn't even know it,” Hardy said.  

The 22-year-old, who works in retail, has relied on Medicaid, which because of Texas rules in pre-pandemic times would only cover her for up to two months after childbirth. But Hardy has been getting consistent health care coverage during the federal COVID-19 public health emergency. Hardy said continuous care gives her peace of mind knowing she can make an appointment if something comes up.

“Two months is definitely not enough time, and I wish they would extend it out. Hopefully they do, because it would definitely not only help me but help a lot of other people, as well,” she said.

In addition, Hardy said she is anemic and is trying to manage some anxiety. 

“I am still having some postpartum bleeding, along with some cramping,” she said. “Those are just a few things that I just want to get checked on, especially I'm more concerned with like, I don't want to be here today and gone tomorrow, especially because I have her now.”

Garland, Texas, resident Tiayana Hardy’s daughter, Laylani, was born last November. Hardy has relied on continuous Medicaid coverage, but could risk losing it because the COVID public health emergency is ending. (Courtesy of Tiayana Hardy)

In January, the Biden administration announced it is ending the COVID emergency declarations, which means for the first time in three years states will begin disenrolling people from Medicaid. In Texas, that could begin as early as this April.

An estimated 2. 7 million Texans are at especially risk of losing health insurance and will need to have their Medicaid eligibility redetermined. That includes kids, young adults and new mothers. State health officials will have to eventually look reevaluate all the more than 5.9 million Texans on Medicaid.

“It'll be a huge workload on the state. But there's this extra challenge of communicating to families, many of whom have moved in the last three years, to make sure that they understand what's happening and what steps they need to take to keep coverage,” said Stacey Pogue, senior policy analyst at Every Texan. “There's a lot of changes to what's happening in the system and a lot of barriers.”

As the state ramps up efforts, some local organizations will also work to ensure Texans start the renewal process and explore other options.

David Hernandez, chief financial officer for HHM Health in North Texas, said the nonprofit health care provider helps patients navigate different benefits and offers sliding fee discount program based on income levels for those uninsured or underinsured.

“It's all about improving access to health care, and really, truly making it an option for anyone, regardless of their ability to pay, and regardless of their insurance status. We will help and try to get them some type of assistance if they're eligible,” Hernandez said. “We need to expand our outreach efforts.”

Texas remains the state with highest rate of uninsured people in the nation. There has been much debate in the state legislature about narrowly expanding Medicaid to new moms. While there is bipartisan support among state lawmakers to extend postpartum Medicaid coverage to 12 months this session, Republican leaders in Texas have long resisted expanding the federal program under the Affordable Care Act. That would allow the federal government to pick up part of the cost.

“We have tons of low-wage workers who are in essential jobs who show up every day who don't get offered insurance at work and have no affordable option through healthcare.gov. The only way we can create a guaranteed affordable system for them is to pull down the federal funds on the table earmarked for Texas,” Pogue said.  

As for Hardy, she is looking for a new job with better benefits, as well as considering what courses of action she could take through state programs or nonprofit organizations. She admitted it can be frustrating and stressful but then she thinks about her daughter.

“She makes me forget about everything that I worry about,” Hardy said. “She's like my safe place.”

And extended health care coverage is something that would give a lot of new moms in Texas less to worry about.