Along with the 21,000 children dropped from the rolls of the Children's Health Insurance Program in three months, another 79,000 have lost their Medicaid coverage, according to new figures from the Texas Health and Human Services Commission.

Medicaid insures about 1.76 million of the poorest children, down from 1.84 million in November, according to estimates from the Center for Public Policy Priorities, a Texas advocacy group.

State health officials use slightly more current numbers that show almost 1.9 million children are covered by Medicaid, but with a similar decline in enrollment.
The three-month drop contrasts with children's Medicaid trends over five years, during which enrollment went up almost every month, and short-term declines were quickly made up.

CPPP blames a perfect storm of factors for declines in Medicaid and CHIP: The state's shaky new privatized eligibility system, an exodus of state workers leaving the agency before being laid off and a lack of training among temporary workers hired to replace them.

Health and Human Services spokeswoman Stephanie Goodman agreed that staffing shortages contributed to the drop, but she said the private company processing the applications, Bermuda-based Accenture, couldn't be blamed.

The sharpest decline began in November, and Accenture didn't begin handling Medicaid applications until the beginning of January.

But Accenture took over the CHIP enrollment process in November, and advocates say the declines are related, since those applying for the first time complete just one application. CHIP covers children whose families make too much to get Medicaid but not enough to purchase private insurance.

Anne Dunkelberg with CPPP noted that Travis County, which is included in a pilot program already using call centers staffed by Accenture, saw a 10.6 percent drop in children's Medicaid coverage, while only 2.2 percent of Cameron County's eligible children lost coverage. In Bexar County, enrollment dropped 4.6 percent, or 6,412 children, comparable to drops in Dallas and Tarrant counties.

Goodman said a deeper look into the numbers also reveals that, like CHIP, much of the decline has come from a lack of renewals. But unlike CHIP, which reinstated fees and made the twice-a-year renewal process more complex, there were no policy changes that could account for the steep decline.

Goodman also noted that the drop happened at the same time the agency was swamped with hurricane applicants.

"We processed 450,000 clients in 10 days," she said. It is unclear whether those displaced clients were reflected in the numbers provided by the state and CPPP.

HHSC officials held a conference call Thursday afternoon with organizations around the state that do outreach for CHIP and children's Medicaid. A coalition of 250 of those organizations sent a petition to state officials last week, requesting it suspend the CHIP policy changes and figure out how to bolster enrollment figures.

Texas leads the nation in the number of uninsured children, according to the Children's Defense Fund of Texas, which leads the coalition. Almost 22 percent of children, or 1.4 million, lack coverage.

The problem "seems to be going back to the call centers," said Toni Van Buren, public policy director for United Way of San Antonio, after the conference call. "But we were told that Accenture would be hiring more workers, and (state officials) asked us to accumulate evidence of the problems we're hearing about from families so they could investigate."

Van Buren is one of many outreach coordinators from around the state hearing from families who believe they have been wrongly dropped, or didn't receive proper notification before they were dropped.

Responding to that criticism, the state reinstated CHIP for 6,000 children last week.
HHSC is in the early stages of overhauling the way it handles eligibility for all welfare programs, including cash assistance and food stamps.

Accenture won an $899 million contract to run the four call centers that will process applications for all the programs. A reduced number of state workers will still decide actual eligibility, as required by law.

The push to privatize came from state lawmakers, who directed in 2003 that HHSC explore privatization as a way to save money.

Some savings comes from laying off 2,900 state workers, to be replaced by lower-paid private workers under Accenture.