At least 812,000 Texas children have lost health care coverage in the last seven months following the end of pandemic-era continuous Medicaid renewals, according to the latest data from KFF.

Children are 58% of the 1.4 million Texans who have been dropped from the federal health insurance program. The state has both the highest number of people booted off Medicaid or the Children’s Health Insurance Program and the largest percentage of those disenrolled who are children among states that differentiate enrollment data by age.

Texas’ disenrollment numbers have already surpassed the 1.3 million-person total researchers originally estimated could lose coverage as eligibility for the insurance program was recalibrated. The state already has the highest uninsurance rate in the country.

“We knew we were going to have problems, to be candid. I’m sorry we’re seeing the kind of numbers that we’re seeing,” said Steve Love, president and CEO of the Dallas-Fort Worth Hospital Council. “This is going to really exacerbate the problems we already have with the uninsured in Texas.”

Nearly 70% of people kicked off Medicaid in Texas lost coverage for procedural reasons like failing to return renewal packet requests from the Texas Health and Human Services Commission. Texas falls closer to the middle of the pack for procedural disenrollments, which ranges from 96% of people removed from Medicaid rolls in New Mexico to only 7% of those kicked off the insurance in Oregon.

States are required to first try to renew Medicaid recipients through what’s known as an “ex parte” process, or using already available data sources, like state wage databases, to access ongoing eligibility. Only 8% of Texans who retained coverage did so through the ex parte process, the lowest rate of any state. By comparison, 99% of people who were renewed for Medicaid in North Carolina were deemed eligible through the ex parte process.

Someone can be deemed ineligible for Medicaid for a number of reasons, including surpassing the program’s income limits. Many women who received Medicaid for Pregnant Women have since timed out of the program, while some children have turned 19 since the start of the pandemic, disqualifying them from coverage.

In June, the state did expand Medicaid for new moms to a whole year after birth.

Nearly one-quarter of Texas Medicaid renewals are still pending a decision from the state as of Nov. 14, according to KFF.

Almost 760,000 Texans had their Medicaid or CHIP coverage renewed as part of the continuous renewal unwinding. State and federal official started readying an off-ramp from continuous enrollment around a year ago.

The process has been arduous, requiring Texas’ health agency to hire staff to get updated contact information for people who moved during the pandemic. The state agency and local governments began a public awareness campaign warning people on Medicaid that they would have to apply for renewal sometime after March 31. Once the state requests information from an enrollee, they have 30 days to return their renewal packet.

Losing health coverage can have ripple effects that extend beyond individual access to care, Love said.

“From the adult side, it’s going to affect the health of the workforce. You’re going to have workers that don’t have the medical coverage they need, and as a result, they’re going to miss more work,” Love said. “Children are going to miss more school. Children aren’t going to get the care they need, even some of the well care that they need in their early check-ups because they don’t have the coverage.”

The latest numbers reflect a worrying trend in children’s access to programs that are meant to support North Texas’ most vulnerable families. A recent report from Children’s Health and the University of Texas at Dallas showed that pediatric health coverage has been on the decline since long before the start of the pandemic, with nearly one in six children in Dallas County living without health insurance in 2021.

“Pediatric health is a prime indicator of a healthy adult life,” said Christopher Durovich, president and CEO of Children’s Health. “Too many children are starting at a disadvantage.”

Other children’s support programs have seen similar declines. enrollment in the Supplemental Nutrition Assistance Program, also known as food stamps, increased from 2021 to 2022. Those rates have yet to return to 2018 levels in Dallas and Tarrant counties.