About 1 in 5 Texas newborns, roughly 22,000 babies in 2023, were not automatically enrolled in Medicaid, Diana Forrester of Texans Care for Children told the House Subcommittee on Maternal Health, Menopause and Access to Evidence-Based Medicine on Nov. 6. She asked the panel to press the Health and Human Services Commission to audit the process. The topic took about 56 minutes of the hearing.
Federal rules give a child of a Medicaid mother coverage from birth to age 1 without an application. Forrester said the system is not always delivering. The automatic process takes about six days, she said, while the manual one averages 45. A family that falls through must apply into a system with “over 200,000 Medicaid applications in a backlog.” Her ask: “We’re asking HHS to audit the newborn enrollment process from the point the baby is born. Through the creation and activation of Medicaid record.”
Dr. Anne Blake, a neonatologist speaking for the Texas Pediatric Society and the Texas Medical Association, said the cost is clinical. “When a newborn is not automatically enrolled in Medicaid, parents can panic,” she said. Families without an active card skip early visits, and doctors lose the window to catch dehydration, heart defects and dangerous jaundice. Blake said the Legislature took a step with House Bill 3940, which she said lets providers bill with the mother’s Medicaid number. “This workaround should only be viewed as a Band-Aid,” she said. She also said her groups will back upcoming legislation by Rep. Toni Rose to raise allowable postpartum depression screenings from one to four.
Rep. Joanne Shofner, R-Nacogdoches, asked Forrester who at HHSC handles infants and mothers. Forrester said it is all in the eligibility division. Shofner observed that “there’s no carve out for just babies, mamas, etc.” Asked what is at stake in a coverage gap, Blake said, “Infants don’t have the ability to tell us or show us what’s wrong with them until something has declared itself to the point of catastrophe.”
Hillary Davis, a senior advisor in HHSC’s Family Resources and Eligibility Services division, described the pipeline. At the request of Rep. Johnson, she said, the agency reviewed 2024 cases that fell out of automatic enrollment and found the exceptions were mostly data entry errors or mothers not on Medicaid at the time of birth. A data integrity unit works those cases, she said. Davis said fixing the process would take policy direction. “We would need direction as far as how to change our process,” she said, because the work is tied to the birth registration form from the Department of State Health Services. She said she had no suggestion from the agency on how to change it, and that any new approach would need quality control and program integrity safeguards.
Rachel Bowden of the Texas Department of Insurance said Senate Bill 896 extended commercial plans’ automatic newborn coverage from 31 to 60 days. Jamie Duensing of the Texas Association of Health Plans said confusion persists. “There’s still confusion, right? Because that provider, that baby doesn’t have an ID, they don’t have an insurance card,” she said. She said Florida runs a system that avoids the gap. “So what we looked at is Florida is able to do this with their eligibility system and technology system,” she said, adding that Texas would likely need to invest in its system. She also urged standardized newborn naming conventions across computer systems.
No vote was taken. The audit request, a Medicaid system redesign modeled on Florida and Blake’s screening bill are all candidates for the 90th Legislature in January 2027. The Dispatch previewed the hearing and earlier covered the panel’s work on Healthy Texas Women.
- Nov. 6: The House Subcommittee on Maternal Health, Menopause and Access to Evidence-Based Medicine heard testimony on automatic newborn insurance enrollment; no vote was taken (hearing notice).
- Nov. 6: Texans Care for Children’s Diana Forrester said about 22,000 newborns, 1 in 5, were not auto-enrolled in 2023 (her testimony).
- Nov. 6: Forrester said automatic enrollment takes about 6 days and manual enrollment about 45, with more than 200,000 applications backlogged (her testimony).
- Nov. 6: HHSC’s Hillary Davis said the agency’s 2024 review found mostly data entry errors or mothers not on Medicaid at birth (her testimony).
Fact box
- Issue: Automatic insurance enrollment of newborns, chiefly Medicaid (approx. 56 minutes, about 33 percent of the hearing)
- When: Friday, Nov. 6, 2026 · run time 2:51:04
- Where: Room E2.030, Capitol Extension, Austin
- Chair: Rep. Katrina Pierson, R–Rockwall (HD-33)
- Key witnesses: Diana Forrester, Texans Care for Children; Dr. Anne Blake, Texas Pediatric Society and Texas Medical Association; Hillary Davis, HHSC; Rachel Bowden, Texas Department of Insurance; Jamie Duensing, Texas Association of Health Plans
- Archived video: house.texas.gov video 22888