TDMR took a look at the most recent enrollment figures for Texas Medicaid on the HHSC website. HHSC used to keep this up pretty well, but for some reason, the latest data is from July 2025.
What we discovered was revelatory.
Enrollment numbers lower than 2015 despite population explosion
According to the most recent numbers for July 2025, children’s Medicaid enrollment, and therefore eligibility for EPSDT dental services, stood at 2,970,551.
That number may look large until you realize it is lower than the 2,988,710 children enrolled in January 2015, and 1.3 million fewer than the 4,326,209 children enrolled at the end of the Public Health Emergency (PHE) in May 2023. In fact, at the start of the PHE in 2023, the numbers were a lot less than in 2015, at 2,823,779.
The population of Texas in 2015 was around 27.5 million. Today, in 2025, it is north of 31.9 million. That’s a 16% increase in population!
In other words, after a decade of population growth, rising costs, and unprecedented growth during the pandemic, Texas now insures fewer children through Medicaid than it did ten years ago.
2024/2025 state budget forecasts lower numbers
While this may seem surprising, it really shouldn’t be. HHSC and the legislature knew it was going in this direction.
The 2024–2025 General Appropriations Act, signed in May 2023 at the start of the unwinding, presents the situation in black and white. Under line item A.1.7. Strategy: Health Steps (EPSDT) Dental, the state projected an average of 2,877,158 recipient months per month (page II-43). In plain language, the number of Medicaid-eligible children expected to receive dental services each month.
Providers left hanging
Imagine the investments providers made in equipment, facilities and staff to service 4.3 million Texas children. Then two years later, these providers find that 25 to 30 percent of those patients are gone and the numbers are expected to go lower. Add in all the inflation, staff problems, and low fees. Oh my.