By Episcopal Health Foundation CEO Elena Marks and St. David's Foundation Earl Maxwell via Austin-American Statesman

Texas has the highest rate in the nation of uninsured children and is home to one in five of our nation’s uninsured kids. Even more concerning is that this rate has started to rise.

As foundation and nonprofit leaders, we are focused on the specific solutions we can advance today to make a positive difference for kids and families. We should be doing all we can to sign up the estimated 350,000 uninsured kids who are eligible but not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). The state, funding organizations like us, community organizations, school systems and health care providers are all working on this and can double down on our efforts together.

And once we have kids enrolled, isn’t it our obligation to keep them covered? Contrary to what people who are privately insured might assume, Medicaid enrollment for children is not a “one and done” annual process. Parents are required to do initial applications and annual renewals and submit documentation to prove eligibility. But they can also be subject to multiple random income checks requiring a response. Imagine having to renew any of your insurance policies to keep your children covered — health, home, auto, and so on — not just once but potentially several times a year.

Because of this paperwork burden, more than 4,000 Texas kids lose coverage each month. Not because they are no longer eligible, but because of the confusion and extra work these requirements cause families and our state agency. And when children, who have no control over this process, have a gap in coverage, we see costly emergency room care, missed chances for early diagnosis, untreated chronic conditions such as asthma and diabetes, and school absenteeism. All with lingering effects on the life trajectory of children and on our state budget and economy.

One possible solution that 24 other states already implement is continuous coverage in Children’s Medicaid. Continuous coverage ensures children are enrolled for a full year at a time. Not only does it make life easier and healthier for families, but it saves administrative costs at the state level and improves efficiencies for doctors, health care centers and health plans. Leaders must understand that requesting paperwork from thousands of families every month requires the labor of considerable state personnel. Texas already employs continuous coverage for CHIP and it is the norm for those of us with commercial coverage. Families would still have the responsibility of proving eligibility and renewing coverage annually.

Texas has significant work to do to cover more children. We and our colleagues at the Simmons Foundation and Methodist Healthcare Ministries spend millions of dollars each year supporting community organizations in assisting families with enrollment. It is frustrating to know that some of these activities are necessary because of a complicated and burdensome eligibility process. As we do our part, we hope Texas will closely consider continuous coverage for children, which is practical to administer and a family-centered step toward improving our child coverage rates.

And, as a recent survey conducted by the Episcopal Health Foundation shows, the vast majority of Texans want the state to play a major role in improving health care. It’s time to step up, Texas. If we want to truly improve the health of our communities, we need to start with our children.