After three years, the Texas Health and Human Services Commission (HHSC) is set to resume redeterminations for Medicaid clients’ eligibility in the coming months. The official end date of the continuous coverage requirement is March 31,2023. However, the process of renewing the entire Medicaid caseload will be a huge undertaking that will span many months.
As this enormous undertaking begins, we wanted to share resources to help you understand what this means for your Medicaid patients, what the process will look like, and key messages you can share.
Resources on this page include:
- Medicaid Unwinding 101: Preparing Your Patients and Your Practice
- Key Messages to Share with Patients Right Now
- Resources for Patients
- Texas' Plan for the Unwinding Process
- Timeline for Unwinding & Month-to-Month
We will closely monitor this process, regularly meet with HHSC, and coordinate with external partners. In addition, we will share updates with you via email and on the TPS website. If you have any questions about this process, need additional resources, or have requests for additional outreach materials, please contact Allison McHorse at Allison.McHorse@txpeds.org or (512) 370 -1512.
Medicaid Unwinding 101: Preparing Your Patients and Your Practice
TPS, TMA, and several organizations hosted a webinar to share information about the unwinding process, share resources, and explain best practices for preparing your patients and your clinic.
- Watch the recording of the webinar here.
- The passcode to access the recording is: d8KSV.3*
- Access slides here.
Key Messages to Share with Patients Right Now
- Be on the lookout for notices from HHSC like the one below. These notices will be in YELLOW envelopes with "ACTION REQUIRED" in RED lettering. Notices will come in the mail or via the YourTexasBenefits portal, depending on the clients' set preferences. Medicaid recipients should respond ASAP.
- Sign up for a YourTexasBenefits account! This is the easiest way for patients to check the status of their Medicaid case, update their contact information, and submit documents. You can share the documents below to help walk through how to create an account.
- Report any contact changes or other updated information through their YourTexasBenefits account or by calling 2-1-1. In addition, you can share the documents below, which walk through how to report changes.
- Parents can enroll/reenroll their citizen children regardless of their own immigration status. Learn more on Seguro Texas.
Resources to Use and Share
Stay Covered Texas Website - StayCoveredTX.org
This website is a resource hub created for both Medicaid members and partners interacting with families who may be impacted. The site is available in English, Spanish, and Vietnamese. Resources include:
- Information for families at every point in the process - right now, when they receive a notice, or even if they were denied.
- How to help members contact enrollment assisters and other health coverage options.
- Resources explaining how to report an issue.
Flyers, Handouts, and Other Communication Materials
Several organizations and the state have put together resources for communicating with patients. Below is a compilation of resources that may be useful.
- Sample Practice Communications:
- Pediatric Practice Template Letter (AAP Resource) - A template letter practices can customize with state-specific information and send to families on the unwinding.
- Social Media Toolkit (HHSC Resource) - English, Spanish
- Social Media Graphics (HHSC Resource) - English, Spanish
- Information on End of Coverage & Steps to Take:
- End of Medicaid Continuous Coverage Flyer (HHSC Resource) - English, Spanish
- Flyer on Steps to Keep Coverage (AAP Resource) - Flyer highlighting the three steps families can take to keep coverage
- Customizable Posters & Pushcards (SeguroTexas Resource) - English, Spanish, Vietnamese
- FAQ for Medicaid Members (HHSC Resource) - English, Spanish
- Report Changes Handout (HHSC Resources) - English, Spanish
- Your Texas Benefits Help:
- Create a Your Texas Benefits Account Handout (HHSC Resource) - English, Spanish
- Video Instructions on Using YourTexasBenefits (Feeding Texas Resource) - English, Spanish Captions, Vietnamese Captions
- Reset Your Password on YourTexasBenefits (HHSC Resource) - English, Spanish
- Avoiding Scams:
- Graphics on Avoiding Scams (CMS Resource) - Graphic 1, Graphic 2, Graphic 3, Graphic 4
- Sample Social Media Language (CMS Resource)
- Information on End of Coverage & Steps to Take:
Information to Resolve Issues or Barriers
Below are resources to share if patients experience problems, including incorrect denials, delayed notices, long hold times on 2-1-1, or incorrect information.
- Email HHSC's Unwinding Email: email@example.com
- Reach out to organizations participating in the Community Partner Program
- Submit a complaint to the Office of the Ombudsman online with this form, or call 866-566-8989 between 8 am and 5 pm CT Monday - Friday.
If you have ideas for additional materials that would be helpful for your practice to use, please reach out to Allison McHorse, and we may be able to help create them.
Texas' Plan for the Unwinding Process
Note: Texas HHSC will likely update these plans and timelines throughout the unwinding process. TPS will add updates as soon as they are announced.
Texas will have 12 months to initiate fresh renewals for the entire Medicaid caseload. All members must receive a full and fresh redetermination during this timeframe. HHSC estimates that there are more than 5.9 million Medicaid members.
There are two main channels for renewals. Medicaid clients who have successfully renewed their coverage in the past 12 months should most likely remain on a regular renewal cycle. Texas Medicaid members who have been flagged as having maintained coverage due to the pandemic-related provisions will have redeterminations initiated in 3 cohorts.
The three cohorts of members who have been flagged as having maintained coverage will have redeterminations staggered over several months. Below are the cohorts:
- Cohort 1: Individuals most likely to be ineligible or transitioned to CHIP (women who were pregnant and members who have aged out).
- Cohort 2: Individuals likely to transition to a different Medicaid eligibility group.
- Cohort 3: Everyone remaining from the previous groups, including those most likely to remain eligible.
However, if an entire family has benefited from continuous coverage, the entire family will most likely be pulled into the cohort that the first family member is in. For example, if there is a family of four with a child who is likely no longer eligible due to age, the whole family group may receive notices during Cohort 1.
If an individual is found ineligible for Texas Medicaid, HHSC will automatically check their eligibility for CHIP, Healthy Texas Women, or other programs.
Slides from HHSC explaining the process are available in this slide deck.
Timeline for Unwinding and Communications
HHSC currently plans to send renewal packets to Texans in each cohort on the dates included below. When members receive a renewal notice, they have 30 days to respond. If families are found ineligible, they will have 30 days to respond to additional requests for information before their coverage ends. This means that the earliest effective disenrollments will be 60 days after the initial notices are sent.
|Cohort||Renewal Packets Sent||Earliest Disenrollment|
|1||April 8, 2023||June 8, 2023|
|2||July 15, 2023||September 13, 2023|
|3||September 9, 2023||November 8, 2023|
|DFPS/SSI||September 3, 2023||
*NOTE: For the first cohort, HHSC has extended the deadline to return renewal packets from May 8 to May 15. More information about the extension is available here.
As the state starts checking eligibility, some Members will receive month-to-month extensions because of delays in processing paperwork. Depending on the backlog, the state might extend coverage to the member once or several times. Each time the Medicaid member will get a notice in the mail.
This may make it difficult for physician practices - staff should verify patient eligibility and end dates with every visit. Below is a screenshot of the image you will see when you log into the Medicaid Eligibility Service Authorization System (MESAV). The location of the redetermination date is highlighted in yellow below. More information about how to verify eligibility can be found on the TMHP YouTube page.
More information about the timeline and slides on month-to-month extensions are included in this slide deck.