Texas Leads U.S. in Uninsured Children Amid Medicaid and ACA Changes
Texas recorded the highest rate of uninsured children in 2024, at 13.6%, which is more than double the national average and significantly higher than neighboring states Florida and Oklahoma. Between 2022 and 2024, Texas saw a 29% increase in uninsured children, the largest rise in the U.S., largely attributed to the state's Medicaid policies and management.
The termination of the COVID-19 public health emergency in 2023 ended the continuous Medicaid coverage period, necessitating states to reassess eligibility, which led to significant disenrollments nationally. Texas reportedly made minimal use of procedural Medicaid renewals (ex parte renewals) that could have helped retain coverage among eligible children during this redetermination process. National data reflects a rise in the uninsured rate for children from about 5% to 6%, with a nearly 20% increase in the total number of uninsured children, indicating substantial coverage losses. Changes in the federal budget bill, including the expiration of enhanced Advanced Premium Tax Credits under the Affordable Care Act (ACA), threaten middle-income families in Texas who rely on marketplace subsidies, potentially increasing premium costs. Enrollment in ACA plans among children has more than doubled nationally since 2020, with Texas seeing the most significant growth in adult ACA enrollment.
Experts warn that cuts and changes in Medicaid and Medicare programs from recent legislation may result in 480,000 Texans losing coverage, raising concerns about broader implications for public health insurance access. Advocates recommend proactive measures such as regularly checking health coverage status, re-enrolling in marketplace plans, and engaging with community organizations or state agencies to mitigate coverage loss. A chilling effect due to fears associated with immigration enforcement and data sharing between CMS and immigration authorities may also be contributing to reduced Medicaid enrollment among immigrant families and their children. Emerging Medicaid cuts are also expected to impact provider reimbursement rates, potentially reducing provider participation in Medicaid networks. These combined factors suggest increasing challenges for publicly insured populations in Texas, with children already experiencing the consequences of rising uninsured rates and potential access issues. Ongoing monitoring of policy impacts and enhanced support for enrollment and retention are critical to addressing these coverage disruptions.