In Texas, nearly 1.8 million individuals have lost Medicaid health insurance coverage over the last two years, as reported by KFF, a nonprofit organization focused on health policy research.
This loss in insurance is part of a broader national trend following the rollback of Medicaid coverage that was initially expanded during the COVID pandemic.
A representative from the Texas Health and Human Services Committee (HHSC) mentioned their commitment to ensuring those eligible can access benefits, mentioning ongoing collaboration with the Centers for Medicare and Medicaid Services (CMS) amidst the public health emergency and altered Medicaid procedures.
They noted that federal directives mandated HHSC to reassess the eligibility of around six million Medicaid recipients over 12 months.
The spokesperson emphasized that adhering to federal eligibility guidelines has been a significant focus. Throughout this process, HHSC plans to engage regularly with federal partners to ensure compliance and continue support for eligible Texans.
Why does this matter?
The rollback has led to a notable decrease in Medicaid enrollment across the country. While some individuals might find alternative insurance through their jobs, many others could be left uninsured, which raises serious concerns about health outcomes and costs for vulnerable populations in Texas.
What’s happening?
During the pandemic, several states enhanced Medicaid coverage under the Affordable Care Act (ACA). As a result, many Americans were encouraged to enroll in health insurance, which led to increased participation. However, with changes in federal rules that took effect in March 2023, states could begin excluding individuals from Medicaid, though they were required to keep most enrollees covered.
Consequently, Medicaid enrollment has been steadily falling in Texas, led by both eligibility loss and procedural removals. From about 5,922,450 people on Medicaid in March 2023, projections indicate a drop to roughly 4,164,694 by March 2025, per KFF data.
That’s a decline of nearly 1.8 million—faster than in states like Florida, California, and New York. Interestingly, this number is just slightly below the figures seen in February 2020—only a 1% difference.
This drastic reduction in Medicaid participants from Texas, along with similar declines in other major states, represents a significant portion of the national Medicaid population, according to Timothy McBride, a public health professor at Washington University in St. Louis.
Combined, Texas, Florida, New York, and California accounted for 36% of Medicaid enrollment, and during the retraction phase, this group represented 31% of the overall decline from 2020 to 2025.
Factors contributing to this situation include Texas’s large population and comparatively lower rates of employer-sponsored health insurance. High poverty levels and the lack of quality job opportunities that offer health insurance—especially in Texas and Florida—worsen the landscape, particularly impacting non-white communities in those states, McBride noted.
There is, perhaps, less alarm for individuals who have secured private health insurance after leaving Medicaid. However, McBride expressed concern about those who may remain uninsured due to this rollback.
He pointed out that negative outcomes from the loss of coverage could lead to delays in seeking medical care, worsening health conditions, and increased financial strain from medical debt.
What are experts saying?
Timothy D. McBride added that while some citizens might have retained Medicaid coverage on paper during the pandemic’s public health emergency, others genuinely transitioned out for various reasons, such as obtaining new insurance. Nevertheless, the most worrying group consists of individuals left uninsured due to procedural factors, with estimates indicating that about 30% of those losing coverage may not have any health insurance now. Some even lost coverage for their dependents.
Laura Dague, a health policy professor at Texas A&M University, commented that the significance of this drop in enrollment largely hinges on people’s awareness of their ongoing coverage and its frequency of use, although empirical evidence on this remains limited.
Looking ahead
As this unwinding process continues, we can expect further decreases in Medicaid registration both in Texas and nationwide. With millions already losing coverage, accessibility to care for low-income individuals and families remains a pressing concern.
