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Enrollment Patterns in the Texas Medicaid Emergency Waiver Following Hurricane Katrina

Quast, Troy PhD; Mortensen, Karoline PhD

Journal of Public Health Management and Practice: September/October 2013 - Volume 19 - Issue - p S91–S92
doi: 10.1097/PHH.0b013e31828b72b3
Insights From Evaluation of Practice Experience

This article discusses enrollment patterns in the Texas Medicaid emergency waiver following Hurricane Katrina. The analysis of the TexKat waiver may provide lessons for future Medicaid emergency waivers.

Department of Economics and International Business, Sam Houston State University, Huntsville, Texas (Dr Quast); and Department of Health Services Administration, School of Public Health, University of Maryland, College Park (Dr Mortensen).

Correspondence: Troy Quast, PhD, Department of Economics and International Business, Sam Houston State University, Box 2056, Huntsville, TX 77341 (

This project has been approved by the Centers for Medicare & Medicaid Services Privacy Board (Data Use Agreement no. 20696).

Prof Mortensen gratefully acknowledges support from the Eunice Kennedy Shriver National Center for Child Health and Human Development grant R24-HD041041, Maryland Population Research Center. Prof Quast gratefully acknowledges financial assistance from a Faculty Research Grant from Sam Houston State University.

The authors thank Gerri Barosso of ResDAC (a contractor for the Centers for Medicare & Medicaid Services, contract no. HHSM-500-2005-00027I) and Dennis Roberts with Health Management Associates for expert assistance with the Medicaid MAX claims data.

The authors declare no conflicts of interest.

Hurricane Katrina was one of the most destructive natural disasters in US history. The August 2005 storm inflicted the highest economic cost of any hurricane at $108 billion and was directly responsible for 1200 deaths.1 A unique aspect of Katrina's devastation was the extent of displacement that it caused. More than 1.5 million people along the Gulf Coast were forced to leave their homes.2

To help Katrina evacuees obtain health care in their new locations, the federal government coordinated with states to implement Medicaid emergency waivers. Medicaid emergency waivers are used following disasters to quickly provide short-term Medicaid insurance coverage to low-income individuals.

The largest Hurricane Katrina waiver, “TexKat,” was implemented in Texas. The program was available to evacuees whose incomes fell below certain thresholds and who were parents, pregnant women, children, and individuals with disabilities.3 TexKat information was available through the newly launched Texas Emergency Information and Referral call center, Texas Health and Human Services field offices, and evacuation locations.3 Individuals could enroll in TexKat from August 2005 to January 2006 and receive up to 5 months of coverage. Almost 60 000 individuals were covered at a cost of roughly $56 million.4

This research brief extends the analysis of 2005 TexKat data by Quast and Mortensen,5 with individual-level Medicaid enrollment data for the duration of TexKat. These data are not publicly available and, to the authors' knowledge, have not been previously used to analyze the TexKat program.

The Figure depicts monthly enrollment patterns during TexKat. October 2005 had the largest number of new enrollees. While new enrollment in subsequent months declined, there were still a relatively large number of new enrollees as late as January 2006. Total enrollees peaked in January 2006 at slightly fewer than 50 000, as the coverage period began to expire for the earliest enrollees.



The Table compares the demographic characteristics of TexKat enrollees to all Hurricane Katrina evacuees. The data for all enrollees are based on a survey of more than 6000 individuals by the Gallup Group.6 Sizable differences exist across the demographic profiles of the 2 groups. For instance, the percentage of whites in TexKat is less than half of the percentage for all evacuees whereas the percentage of males is almost 25% greater.



Like all disasters, certain aspects of Hurricane Katrina were specific to the time and location of the event and are not generalizable to future disasters. As such, one cannot assume that the enrollment patterns observed in TexKat would necessarily be repeated elsewhere. However, our analysis of the TexKat waiver may provide lessons that apply to future Medicaid emergency waivers. For instance, the enrollment patterns that we observe may indicate that planners should not assume that all of the take-up in future waivers will be limited to the few weeks immediately following the disaster. Furthermore, the analysis of demographic characteristics suggests that the group of individuals who enroll in a waiver may differ significantly from the overall evacuee population. Planners may need to account for these potential differences in their preparations.

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1. Blake ES, Landsea CW, Gibney EJ, Asheville N. The deadliest, costliest, and most intense US tropical cyclones from 1851 to 2006 (and other frequently requested hurricane facts). NOAA Technical Memorandum NWS NHC-6. Published 2007. Accessed October 27, 2012.
2. Groen J, Polivka A. Hurricane Katrina evacuees: who they are, where they are, and how they are faring. Mon Labor Rev. 2007;131(3):32–51.
3. Center for Public Priorities. How Texas is helping Hurricane Katrina victims with health care services. Accessed January 31, 2013.
4. Texas Health and Human Services Commission. Final Report on the Katrina Medicaid Demonstration. Austin, TX: Texas Health and Human Services Commission; 2006.
5. Quast T, Mortensen K. Emergency department utilization in the Texas Medicaid emergency waiver following Hurricane Katrina. Medicare Medicaid Res Rev. 2012;2(1):E1–E16. doi:10.5600/002.01.a01.
6. Texas Health and Human Services Commission. Hurricane Katrina evacuees in Texas. Published August 2006. Accessed May 2, 2011.
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