Even as the share of children in Texas without health insurance continues to decline, the state still has nearly twice the national average, according to a new study.

A Georgetown University Center for Children and Families report released Thursday found that Texas still ranks second-worst in the nation for uninsured children, even though the rate of Texas kids without insurance decreased from 16.6 percent in 2009 to 9.5 percent in 2015. The national average was 4.8 percent in 2015.

Researchers, working from U.S. Census data, found almost one in five uninsured children in the United States live in Texas — 682,000 as of 2014. Only Alaska ranked worse. 

Joan Alker, the center's executive director, said Texas lags behind other big states like California, which has tried to streamline its application process online with its state health insurance exchange, done more outreach to underrepresented communities and expanded Medicaid, the joint federal-state health insurance program for the poor and disabled. Under the federal health law, people who make up to 138 percent of the poverty line are eligible for Medicaid. Thirty-one states and the District of Columbia have taken up the offer.

The Texas Tribune thanks its sponsors. Become one.

 

“I think it speaks to this ongoing resistance and reluctance to embrace the coverage agenda,” Alker said. “We know that just because we’re talking about kids doesn’t mean that all states will do the right thing.”

Alker said California lawmakers have also made a more concerted effort to care for undocumented children, citing a law that went into effect in May making 170,000 undocumented low-income children and teenagers eligible for Medi-Cal, California’s version of the Medicaid program. The study does not account for what this change has meant for overall uninsured numbers of children.

Carrie Williams, chief press officer for the Texas Health and Human Services Commission, said in an email that the agency has been pushing to reach more potentially eligible families to apply for Medicaid and the Children’s Health Insurance Program. The department partners with 1,300 community organizations to help people apply for not only the health programs but also food stamps and Temporary Assistance for Needy Families. She noted that one of the agency’s larger initiatives includes pointing beneficiaries to YourTexasBenefits.com or the mobile app to manage their accounts.

“We also have a robust, ongoing Children's Medicaid outreach campaign to reach families with children who may be eligible,” Williams wrote. “The campaign helps people learn about the programs and their benefits, how to apply and help them learn the best ways to manage and renew eligibility for benefits.”

Anne Dunkelberg, health and wellness program director for the Center for Public Policy Priorities, a left-leaning group, said the report has a silver lining: The number of Texas children without insurance went down by 206,000 between 2013 and 2015.

While Texas has not fully embraced the 2010 health law, Dunkelberg said the state has seen success with overhauling its eligibility systems and making the recertification process for Medicaid easier. However, she said the state could improve how it does outreach and assistance advertising Medicaid and the Children’s Health Insurance Program, particularly in rural areas.

The Texas Tribune thanks its sponsors. Become one.

“Enrollment in Medicaid and CHIP has been pretty flat, and we have some concerns — that are very difficult to research and ascertain — that some of these processes may be the reason why we’re not seeing more growth,” Dunkelberg said.

Read related Tribune coverage:

Disclosure: The Center for Public Policy Priorities has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.