Anonymous employees with Texas HHS have filed a whistleblower complaint against the agency over "numerous and growing system issues" they say are leading to incorrectly terminated health coverage during the Medicaid redeterminations process, according to an Aug. 24 Nexstar report.
"The persistence of numerous and growing system issues remains evident, causing erroneous denials of coverage, particularly impacting newborns and pregnant women—creating a situation that could further agitate our noncompliance with CMS guidelines," the employees wrote to Texas HHS Commissioner Cecile Young in the complaint obtained by Nexstar.
According to the report, system coding errors in Texas have placed individuals under 18 in incorrect coverage groups, and 5,800 pregnant or postpartum women have had coverage incorrectly denied. The employees urged CMS to intervene to ensure the state is complying with federal regulations around the redeterminations process.
In response to the complaint, Texas HHS told Nexstar that about 95,000 people have been incorrectly removed from the Medicaid program during redeterminations, and just under 2,000 of those have not regained coverage. Before Aug. 31, another 744 will have coverage reinstated.
"We are working closely with Centers for Medicare & Medicaid Services and our partners to ensure that the redetermination process operates as smoothly as possible," a spokesperson for the agency told the outlet. "We are aware of some Medicaid cases that were denied improperly, and we've reinstated coverage for those individuals."
On Aug. 9, CMS warned Medicaid directors in 27 states and Washington, D.C. that their rates of procedural terminations — Medicaid beneficiaries removed from the program because of missing paperwork or other red tape, rather than being determined ineligible for the program — were too high. In July, the agency said it had required around a half-dozen states to pause redeterminations to correct errors through the process.
At least 5.4 million people have been disenrolled from Medicaid as of Aug. 23, and 74 percent of those disenrollments have been for procedural reasons. In Texas, 80 percent of terminations have been for procedural reasons, according to data from KFF.
Other groups are speaking out against Medicaid redetermination issues across the country.
A proposed class-action lawsuit was filed Aug. 22 on behalf of two families accusing Florida of terminating their Medicaid coverage without proper notice or a chance to contest the decision. The lawsuit alleges that the families' due process rights were violated and are asking a Florida federal court to stop the state from disenrolling people from the program "until timely and legally adequate notice of termination has been provided to them."
Arkansas Community Organizations has held several protests this year highlighting Medicaid recipients' challenges, including difficulties ensuring that the state's Department of Human Services has accurately recorded income and contact information, the Arkansas Advocate reported Aug. 22. The group is now asking state and federal officials to intervene in the state's administration of Medicaid.