Texas Medicaid: A Waiting Game That’s Killing Families

View the Texas Watchdog article Texas Medicaid: A Waiting Game That’s Killing Families here. 

For families with special needs children in Texas, hope comes with an expiration date. Caught in the convoluted web of the Texas Medicaid Waiver system, thousands of families are left waiting — not just for services, but for relief from a state-run program that seems designed to fail them. With more than 158,000 individuals trapped on waitlists, some waiting over a decade for basic support, the Texas Medicaid Waiver system is less a safety net and more a bureaucratic hell. Promises of home and community-based services (HCBS) remain just that: promises that rarely come to fruition. What should be a compassionate system has instead turned into a slow, suffocating disaster for the most vulnerable.

The Texas Medicaid Waiting List: A Decade of Limbo A System Designed to Delay

Texas’s Medicaid Waiver system operates like a dystopian lottery. More than 158,000 people are on various interest lists for Medicaid Waiver programs, including Home and Community-Based Services (HCBS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), and the Deaf Blind with Multiple Disabilities (DBMD) program. While these programs are designed to help families avoid institutionalization, the reality is far more grim. Some families have been waiting for services for over 16 years — long enough that their children may never receive the assistance they need during their most formative years.

Slots That Never Open

The Texas Health and Human Services Commission (HHSC) has recently approved the release of a meager 1,549 slots across various waiver programs for the 2022–2023 biennium. That number — 1,549 — is absurdly small when compared to the 158,000 still waiting. It’s an insult to families who are desperately hanging on, hoping their child will get one of those golden tickets. But the math is unforgiving: the chances of receiving assistance before it’s too late are slim to none. Families who don’t secure these slots are left to fend for themselves, forced into making impossible decisions — like whether to give up full-time work to care for their child, or, in the worst cases, institutionalize them.

Delayed Funding: When Bureaucracy Becomes a Death Sentence A State That Can’t Keep Up

Texas doesn’t just have a waitlist problem; it has a funding problem. The federal government mandates that Medicaid applications be processed within 45 days, but Texas has blown past that timeline for years. As of January 2024, nearly 40% of Medicaid applications in the state were taking longer than the required timeframe. These delays leave families without access to healthcare and force them to make desperate choices, like delaying critical medical treatments or paying out of pocket for care they can’t afford. For many, this backlog isn’t just an inconvenience — it’s a life-threatening crisis.

Healthcare Providers Strangled by Delays

Delayed funding doesn’t just affect the families; it strangles healthcare providers too. Texas Children’s Hospital, the largest pediatric hospital in the country, has been forced to lay off employees and cut services due to delayed Medicaid reimbursements. Safety net clinics across Texas, already operating on razor-thin margins, have reported a 30% decrease in Medicaid revenue as families lose coverage or wait indefinitely for approvals. The result? Service cuts, layoffs, and an increasing number of families left without care. Clinics that serve low-income and rural communities — already some of the most vulnerable populations — are teetering on the edge of financial collapse.

Legislative Paralysis: The Ideological Stalemate on Medicaid Expansion Refusal to Expand Medicaid

At the heart of Texas’s Medicaid crisis is its stubborn refusal to expand Medicaid under the Affordable Care Act (ACA). Texas remains one of only ten states that have yet to adopt Medicaid expansion, leaving an estimated 1.4 million low-income adults without coverage. This refusal is a political choice, not a fiscal necessity. Expansion would bring billions in federal funding into the state, easing the pressure on both hospitals and families, but Texas’s Republican leadership has turned it into a political hill to die on — even if that means millions are left without healthcare.

Abbott and Paxton: Playing Politics with People’s Lives

Governor Greg Abbott and Attorney General Ken Paxton have been instrumental in fighting federal pressure to expand Medicaid. When the Biden administration rescinded a Trump-era extension of Texas’s Medicaid waiver, Paxton didn’t look for solutions — he filed a lawsuit. It’s all part of a long-standing ideological war against federal intervention, but the victims of this war aren’t bureaucrats or politicians. They’re families with disabled children who can’t get the care they need because Texas refuses to admit that Medicaid expansion is the right thing to do.

The Real Victims: Families Devastated by Inaction Stories of Struggle and Survival

For the families waiting on the Medicaid Waiver system, life is a constant struggle against a ticking clock. Micaela Hoops, a North Texas mother, found herself buried under a $3,000 hospital bill after losing her son’s Medicaid coverage due to a procedural error. This isn’t an isolated case — it’s the everyday reality for thousands of families across Texas. Many are forced to take on massive debt to cover medical expenses or forego treatment altogether. And it’s not just about the money. The emotional toll on these families is devastating. Parents are pushed to their limits, often having to quit their jobs to provide full-time care for their children while waiting for Medicaid services that may never come.

Economic and Emotional Devastation

For families who are already financially strained, these delays and denials are catastrophic. Many are one medical bill away from financial ruin. Families are choosing between paying rent and paying for their child’s medical equipment. The constant stress of navigating a broken system takes a toll on mental health as well. The emotional exhaustion of fighting for care — all while watching your child suffer — is more than most people can bear. In a state that prides itself on family values, these families are left abandoned.

Comparing Texas to Other States: The Model of Failure Medicaid Expansion That Works Elsewhere

Texas isn’t the only state that has struggled with Medicaid, but it’s one of the few that has refused to fix the problem. In contrast, states like Oregon, Minnesota, and Louisiana have embraced Medicaid expansion and implemented efficient systems that automatically renew coverage for eligible individuals. Louisiana, for example, uses an express lane eligibility process that pulls data from SNAP applications to automatically renew Medicaid for families. It’s a system that cuts down on paperwork, reduces wait times, and keeps families insured.

Texas’s Pathetic Performance

Meanwhile, Texas’s Medicaid renewal rate is embarrassingly low. While states like Oklahoma and Washington have ex parte renewal rates of over 75%, Texas limps along at 3.7%. The difference is stark: in states where Medicaid has been expanded and streamlined, families get the care they need without constant delays and roadblocks. In Texas, however, the system is built to fail, trapping families in a cycle of bureaucratic red tape and endless waiting.

Economic Impact: The Hidden Costs of Medicaid Failures The Economic Fallout

Texas’s refusal to fix its Medicaid Waiver system comes with a price tag that extends far beyond the healthcare industry. The Perryman Group estimates that Medicaid disenrollment in Texas could result in a staggering $58.9 billion loss in gross product annually, along with the elimination of 509,200 jobs. These are numbers that should set off alarm bells, but the state’s leadership remains unmoved. The economic ripple effect is undeniable. Families who lose Medicaid coverage are forced to spend more out of pocket on medical care, which means less disposable income for everything else. Small businesses suffer, local economies stagnate, and communities fall further into poverty.

Uncompensated Care and Collapsing Clinics

Uncompensated care costs are skyrocketing as hospitals and clinics treat patients who can’t pay for services. Many healthcare providers, especially in rural areas, are being forced to close their doors because they simply can’t survive without timely Medicaid reimbursements. For rural communities, the loss of a clinic or hospital often means losing the only accessible medical care for miles. Texas is bleeding from the inside out, and the state’s refusal to fix Medicaid is at the heart of the problem.

The Human Cost: Children Left Behind Children Paying the Ultimate Price

The long-term effects of Medicaid failures on children are the most heartbreaking aspect of this crisis. Children with severe medical needs, like those with autism, cerebral palsy, or neurodevelopmental delays, are missing out on crucial treatments because of Texas’s Medicaid disaster. Research has shown that children with continuous Medicaid coverage fare better in school, have lower mortality rates, and experience fewer health complications as adults. Texas is condemning these children to lives of struggle by denying them the services they need at critical developmental stages.

A Generation Sacrificed

As of March 2024, more than 1.35 million children had lost Medicaid coverage due to administrative issues, not because they were ineligible. This isn’t just a healthcare problem — it’s a ticking time bomb for the state’s future. Children without healthcare are more likely to suffer academically, drop out of school, and face lifelong economic hardships. Texas is sacrificing an entire generation on the altar of political ideology, and the consequences will be felt for decades.

A State That Refuses to Care

The Texas Medicaid Waiver system is a moral and economic failure. It’s a system designed to keep families waiting, suffocating them under layers of bureaucracy until they either give up or their needs become too urgent to ignore. For the 158,000 families on the waitlist, every day is a reminder that Texas values budget cuts over human lives. The state’s refusal to expand Medicaid or even streamline its processes is nothing short of a dereliction of duty. Until Texas confronts the reality that its Medicaid system is broken, families will continue to suffer — and the most vulnerable will continue to pay the ultimate price.

View our sources and citations in our research document here.