Texas children are dropping off Medicaid and the Children’s Health Insurance Program at a pace that puts the state among the largest losses in the country — and the bill does not disappear when the coverage does.
Texas had 190,956 fewer children enrolled in Medicaid or CHIP in February 2026 than in January 2025, a decline of about 6%, according to an analysis of state enrollment data by Georgetown University’s Center for Children and Families reported by Axios San Antonio. Georgetown’s more recent state data indicates the decline has continued.
The center’s June 10 analysis found that Texas is one of 10 states — with California, Indiana, Florida, Georgia, Illinois, Ohio, Arizona, Virginia and Kentucky — that together account for 67% of the national decline in child Medicaid and CHIP enrollment. Nationally, Georgetown reported in May, roughly two million fewer children are enrolled than at the start of 2025.
Texas started from the worst position in the country. An estimated 1.1 million Texas children, about 14%, were uninsured in 2024 — the highest rate of any state — according to census figures cited in a February 2026 UnidosUS report. Texas has removed more than a million children from Medicaid since eligibility redeterminations resumed in 2023 after the pandemic pause.
The critical detail for anyone arguing about cost is that a large share of these children still qualify. Texas 2036 estimated in a 2023 report that roughly 400,000 uninsured Texas children were eligible for Medicaid or CHIP but not enrolled. Children’s hospitals report seeing more uninsured patients who remain eligible, according to the Axios account.
Researchers cited in that reporting attribute the falloff to paperwork and renewal requirements, confusion over new Medicaid work rules, and immigration-enforcement fears discouraging families from applying — administrative friction rather than a change in who qualifies.
A child who is eligible but unenrolled does not stop getting sick; the visit moves from a managed primary-care setting to an emergency department, where the encounter costs more and is far more likely to go unpaid. Uncompensated care is one of the costs Texas hospitals cite most often when defending their pricing, and the Texas Hospital Association has consistently pointed to charity care and government underpayment as drivers of what commercial payers are charged.
Every dollar of avoidable uncompensated pediatric care is a dollar that reappears in hospital chargemasters, in employer premiums and in the deductibles Texas families pay — the same cost chain the House Select Committee on Health Care Affordability, chaired by Rep. James Frank, R-Wichita Falls, is examining ahead of the January 2027 session.
Enrollment friction is also the cheapest problem on that committee’s list to fix. It requires no new eligibility category and no new appropriation of benefits — only faster renewal processing, functional ex parte redetermination and accurate address data. Every Texan, an Austin-based policy organization, tracks Texas Medicaid and SNAP application delays against federal processing standards and has documented backlogs at the Health and Human Services Commission as a persistent contributor to coverage loss among eligible applicants.
HHSC publishes monthly Medicaid and CHIP enrollment statistics through its healthcare statistics portal, the state’s own measure of whether the trend has turned. The next monthly release will show whether the decline Georgetown flagged in February has stabilized — and whether Texas is heading into the 2027 session with more uninsured children than it had when lawmakers last adjourned.