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Changes in Emergency Department Payer Mix Among Children Following Medicaid Unwinding in Texas

Theodoros V Giannouchos1,2, Nima Khodakarami3, Daniel Marthey4

  • 1Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama, USA.

Health Services Research
|January 30, 2026
PubMed

Insights

Texas Medicaid unwinding led to fewer children

Area of Science:

  • Pediatric Emergency Medicine
  • Health Services Research
  • Public Health Policy

Background:

  • Medicaid unwinding in Texas aimed to re-verify eligibility for beneficiaries.
  • Changes in insurance coverage can impact healthcare access and utilization patterns.

Purpose of the Study:

  • To analyze shifts in the payer mix of children's emergency department (ED) visits.
  • To assess the impact of Texas's Medicaid unwinding on ED utilization by payer.

Main Methods:

  • Retrospective analysis of Texas children's ED visits (Q2 2021-Q2 2024).
  • Utilized Texas Emergency Department Public Use Data Files (7.6 million visits).
  • Interrupted time series design to evaluate unwinding's association with payer mix changes.

Main Results:

  • Overall quarterly ED visits per facility increased slightly post-unwinding.
  • Medicaid payer share for children's ED visits decreased by 7.2 percentage points (64.3% to 57.1%).
  • Commercial and uninsured payer shares increased by 3.4 and 3.8 percentage points, respectively.

Conclusions:

  • Medicaid unwinding correlated with a reduced proportion of children's ED visits covered by Medicaid.
  • The proportion of visits by commercially insured and uninsured children rose following unwinding.
Abstract

Keywords:
accesschildrencoveragehospitalsmedicaid unwindingrevenue

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