AUSTIN — About 50,000 Texas children are losing Medicaid coverage each year because their families fail to quickly send proof to the state they are still poor enough to qualify, state data show.

Yet one in three children kicked off the program in 2017 re-enrolled within a year, according to the most recent data available, suggesting they lost coverage because their parents failed to do the paperwork on time, not because they did not qualify.

Texas, which already leads the nation in uninsured children, is one of several states that verifies income during the year to make sure children are still eligible. Experts aren’t aware of another that conducts the checks as frequently as Texas does.

Only a tiny fraction of the roughly three million children on Medicaid are flagged for follow up, which calls for parents to show proof of income to the state. Public health advocates, however, say the monthly checks create confusion for families and a hassle for the state. The families are given 10 days to respond to the state’s request for information.

“We see that families often get the letter in the mail after the due date or they have very little time,” said Adriana Kohler, a senior health policy associate with Texans Care for Children, an Austin-based nonprofit founded by a public policy leader with the Baptist General Convention of Texas. “Busy, working families are dealing with redundant paperwork month after month only to learn their child has been dropped from coverage.”

The state’s health department says it has an obligation to make sure recipients qualify.

“Nothing is more important than the health of Texas children, and we have to protect the program and taxpayer resources by making sure families are actually eligible for the benefits,” said Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission.

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The income checks, which begin after six months of coverage, are on top of an annual renewal process families must go through to keep their children on Medicaid.

For those children who are swept out and then re-admitted later, the back-and-forth means a gap in coverage during which they may miss doctor’s visits, or their parents may be forced to seek costly services in the emergency room, public health experts said.

“If we keep them healthy they are in school, they will get an education, they will grow up healthy,” said Dr. Ben Raimer, President of the Texas Pediatric Society. “If we fail to keep them healthy, particularly those with chronic disease like diabetes and asthma, we are going to be in a real pickle in the future.”

An estimated 835,000 Texas kids didn’t have health insurance in 2017, an increase over the year before.

Rocio Castillo, a mother of four who lives in San Antonio, said her children have lost Medicaid coverage due to paperwork issues. She is constantly sending documentation to the state, she said, even though nothing is changing with her family income.

“It's a lot of paperwork, and I get confused,” she said. “If you don't send one paper, they cancel your Medicaid.”

Periodic income checks for Medicaid children aren’t required by law. But officials at the Health and Human Services Commission put them in place in 2014, said Anne Dunkelberg with the Austin-based Center for Public Policy Priorities.

A bill up for debate this session by Rep. Philip Cortez, D-San Antonio, would change the policy and offer children on Medicaid one year of continuous coverage. That’s already the policy for Texas children on the Children’s Health Insurance Program, which covers families with slightly higher incomes than those in Medicaid, Dunkelberg said.

At a recent hearing on the bill, which already has some Republican backers, medical professionals and child welfare groups advocated for the policy change. It would cost the state an estimated $5.7 million in 2021, according to the bill’s fiscal note.

If families fail to provide the requested income information in 10 days, Williams said, the state then sends notice giving families 15 more days before any action is taken. Income qualifications depend on a family’s size. A single mother with two kids, for example, must earn less than roughly $28,500 a year for her children to receive Medicaid coverage.

Over the past two years, the income checks flagged anywhere from 3,000 to 14,000 families each month, according to state data shared by the Children’s Health Coverage Coalition. Roughly 30 percent of families responded to the state, showing proof their children were still eligible. More than 90 percent of those who lost Medicaid coverage had it taken away for failing to respond.

The state looks for changes in family income using data from the the Texas Workforce Commission, Social Security Administration and a federal new hire report.

Public health advocates, however, said the data can be wrong, showing a mother has two jobs and extra income, when in fact she left on recently for another.

“A lot of very low-income families do end up having overtime or seasonal work that might put them above the limit for a single month, and then the next they are back down below,” said Tricia Brooks, with the Georgetown University Center for Children and Families. “Does it make sense to kick those kids off coverage and then have them reapply?”

Allie Morris covers politics and policy in Austin. Read her on our free site, mySA.com, and on our subscriber site, ExpressNews.com. | amorris@express-news.net | Twitter: @MorrisReports