Vanessa Melendez applied for Medicaid for Pregnant Women last December. Then she waited. She didn't hear anything back until she was more than four months pregnant, the Texas Tribune reported — well past the first trimester, when doctors confirm a pregnancy, check for a heartbeat and run early tests.

"I'm going to have this baby, and I have no insurance," she remembered thinking.

She is one of hundreds of thousands. Texas's backlog of Medicaid applications grew from about 1,600 in January to more than 210,000 in August, according to state data released by the nonprofit Texans Care for Children. The Tribune counts 211,000 applications still waiting in August.

The agency responsible is the Texas Health and Human Services Commission — part of Governor Greg Abbott's administration.

San Antonio's mayor asked Abbott for help

On Monday, September 21, San Antonio Mayor Gina Ortiz Jones wrote to Abbott asking him to "immediately dedicate resources" to clearing the backlog, and offered her office's help, Fox San Antonio reported. The station's report included no response from Abbott's office.

That silence runs all the way down. When the Tribune asked the state health agency what was causing the backlog and how it planned to fix it, the agency did not explain either one. It only insisted that its application system "remains a fully functioning eligibility system."

How fast it fell apart

The federal government wants 95% of Medicaid applications handled on time — within 30 to 45 days. Texas had long struggled with this; federal officials put the state on a corrective action plan to speed up Medicaid and SNAP processing, and by the end of 2025 it was improving, the Tribune reported.

Then the numbers collapsed:

• Medicaid: 65% of applications processed on time in July, down from 81% a year earlier (Texas Tribune). By late August, it was 62%, down from more than 90% (TPR, using the state's data).
• Food assistance: the SNAP backlog went from about 3,700 to more than 150,000. On-time SNAP renewals fell from 83% in January to 28% in July — the lowest in four years.
• Enrollment: in the 11 months after the budget bill passed, 252,000 fewer Texans were on Medicaid and 597,000 fewer on SNAP. Children were almost two-thirds of the drop.

What changed

Trump's budget bill, passed in July 2025, rewrote SNAP: new work-reporting requirements the state is still putting in place, and a bill of about $700 million a year in benefit costs starting in 2027 if Texas doesn't bring its error rate down. The state health agency told KERA the new SNAP mandates "require a thorough review of each case." Texas uses one application for Medicaid and SNAP, so every one of those changes lands on the same 6,000 or so eligibility workers — and slows Medicaid down with it — using a computer system that's been running since 2012.

The state's own health committee chair, Republican Sen. Lois Kolkhorst, pointed to fraud, citing more than 1,800 ineligible people who got benefits. That's a tiny fraction of the more than 3.7 million Texans on Medicaid. Texas's SNAP error rate last year was 9% — better than the national rate of 11%, and the Tribune notes most errors are mistakes, not lies.

Diana Forester of Texans Care for Children put it bluntly: "We don't have anybody that's capable of holding down a job that is eligible for Medicaid. … it is mostly poor kids and sick kids, our pregnant moms and some of our elderly."

Nobody in charge is in a hurry

Abbott's health agency has asked the Legislature for money to make 642 temporary workers permanent — a request for the next legislative session.

Forester told the Tribune she doesn't expect lawmakers to act before then. "There just hasn't been any urgency around this, which is mind-boggling to me," she said. "Families cannot wait years for that system to come online."

Meanwhile, hospitals are absorbing it. The Texas Hospital Association says more uninsured patients are walking into emergency rooms. Texas already has more uninsured people than any other state — more than 5 million.

The bottom line

Texas's Medicaid backlog went from about 1,600 applications in January to 211,000 in August, and on-time SNAP renewals fell to 28%, as state workers took on the new SNAP rules in Trump's budget bill. Greg Abbott's health agency won't say what's causing it or how it will fix it, and Fox San Antonio's report on the mayor's request for help carried no response from Abbott's office.

Source

More than 200,000 Texans are waiting for Medicaid approval — Jess Huff and Dan Keemahill, The Texas Tribune, September 10, 2026. Photo: Maria Crane for The Texas Tribune.