Texas' backlog of Medicaid applications grew from about 1,600 in January to more than 210,000 in August.
During the same period, the backlog for the Supplemental Nutrition Assistance Program, or SNAP, grew from about 3,700 to more than 150,000, according to data from the Texas Health and Human Services Commission, or HHSC, released by Texans Care for Children – a statewide research and advocacy organization. The group worries the backlog could continue to grow.
"We're very concerned that Texans are stuck waiting longer for healthcare and food," said Diana Forester, director of health policy at Texans Care for Children. "We want to make sure pregnant women can start prenatal care quickly. We want to make sure that kids can see the doctor when they're sick or need a checkup. We want to make sure people can eat."
Federal changes to SNAP create problems
Forester's group points to recent changes to SNAP as one of the key drivers of the increasing backlog.
Last year, federal policymakers approved significant changes to SNAP as part of the massive federal tax and spending bill.
Texas will already see millions of dollars in additional administrative costs later this year when states will have to take on more of the administrative costs of running SNAP – going from an even share with the federal government to covering 75%.
In addition, Texas could be responsible for covering more than $700 million in benefits costs if it doesn't improve the accuracy of its program. In order to avoid paying for part of the program, Texas would need an accuracy rate of 94%, but in fiscal year 2025, the state's rate was 91%.
In an email to KERA, HHSC said it continues to focus on helping eligible Texans receive food and healthcare benefits as quickly as possible. The agency issued a similar statement to KERA in May after Forester's organization released data showing more than 40,000 pregnant people in Texas were waiting at least a month for their application to be processed.
HHSC said the new SNAP mandates "require a thorough review of each case" to ensure program accuracy.
Forester said the state needs to find a way to be accurate without creating significant delays.
Texas has an integrated application, meaning people only need to fill out one application to apply for both Medicaid and SNAP. But Forester said that means any change to SNAP or Medicaid can cause issues for both programs – especially because they share the same pool of eligibility workers.
Another policy introduced in the federal tax and spending bill was new SNAP work reporting requirements, which HHSC is working on implementing.
Forester said that means technology changes and additional training for the 6,000 eligibility workers across the state. The system depends on people to manually enter data and information, which Forester said creates more opportunities for errors and additional responsibilities – like disaster relief SNAP – to make the process more complicated.
"These extra demands are landing on a system that was already under strain," she said. "We just have a very old eligibility system. It's very manual heavy, so anytime there are big changes, it just has a cascading effect on timeliness."
Texans encountering longer waits
As of Aug. 21, the median number of days it takes the state to process a Medicaid application has increased from almost 50 to about 70 – adding almost a month to how long Texans are waiting.
"They've submitted the 30-page application," Forester said. "They've done everything right, and it's just sitting there on a computer for 70 days before a worker can get around to even start processing it."
HHSC shared the new application timeliness data during recent monthly stakeholder meetings. The data shows the state went from processing more than 90% of Medicaid applications within 45 days – the federal standard processing time – to 62% by late August.
For Texas families, Forester said the longer wait isn't just an administrative delay.
"That's 70 days of waiting to know if your kid has healthcare coverage and you can take [them] to the doctor," she said, "or whether you can start prenatal care and check on your baby and make sure it's okay, or if you can afford the medications that you need."
The wait for SNAP grew from about 20 days in January to more than 30 days in August – with a 20% drop in applications processed within the federal standard processing time, which is about a month.
"The families that we have talked to, all of them say SNAP is crucial to their budget," Forester said. "It does not pay for all of their food, but it pays for a substantial amount of their food…. It's crucial for kids to get the right kind of nutrients when they're growing so that they don't have more health problems later."
Advocates call for state action
Late last year, HHSC recognized the need to update the state's eligibility system for public benefit programs in its self-evaluation for the Sunset Advisory Commission.
However, Forester said even if the legislature makes a substantial investment to improve the technology, it will take several years to implement significant changes.
She said Texas families need relief quickly, which might mean the state needs to better work with community organizations, or it needs to host in-person enrollment events like it has in the past.
Forester said one of the biggest problems with the current eligibility system is that it's hard for someone to know what's happening with their case, which amplifies the issues that already exist within the process.
"People are getting more and more frustrated and so they're calling more often to try and get updates," she said. "All of that takes resources and time for staff that they could be processing applications."
In the past, Forester said the "pop-up" events hosted by HHSC would allow people to take their paperwork and wait in a line to see an eligibility worker.
"Everybody that I have talked to that has been to one of those was so relieved to just have that process, to understand what was happening, to be able to talk to a person and to know that they had done everything they could to get through that process," she said. "It helps alleviate the burden of the unknown."
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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