Between December 2017 and April 2019, the number of Texas children enrolled in Medicaid and CHIP dropped by more than 201,700, or about 6%. That’s according to the Center for Public Policy Priorities presentation at the State of Reform Conference in Irving last month. The trend is part of a larger trend of fewer Texas children having health insurance.
Fewer children and adults on Medicaid increases the likelihood that patients will avoid care until absolutely necessary, and much more expensive, which has an impact on uncompensated care provided by hospitals in the state. The drop has coincided with increased anti-immigrant rhetoric and harsh conditions for immigrants and asylum seekers on the southern border of Texas, in addition to the new public charge policy that goes into effect this month. While children can lose Medicaid because of an increase in income, which may be the case because of the robust economy, not filing the paperwork is the larger issue.
The rule will allow federal officials to deny visa or permanent residency to immigrants who they believe may become primarily dependent on government aid, or a “public charge.” Income and prior use of Medicaid, CHIP, public housing, or food assistance could influence the decision to make a denial. It is based on an 1882 policy saying foreign nationals must be “self sufficient” before they can enter the country.
The rule “is creating a climate of fear among the poorest immigrant families,” said Cheasty Anderson, senior policy associate for the Children’s Defense Fund-Texas told the Texas Tribune.
“If the public charge rule has an impact, and people not enrolling in Medicaid and CHIP, they will become ill and probably come to the ER,” says Steve Love, DFW Hospital Council President. “When they receive treatment, the hospital won’t get reimbursed and it could erode the margins.”