After a multi-session advocacy effort by the Texas Medical Association, specialty societies, and women’s health advocates, Texans who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) and who are pregnant or become pregnant will see their postpartum coverage automatically extended starting March 1.
During the 2023 regular state legislative session, TMA and its allies successfully championed House Bill 12 by Rep. Toni Rose (D-Dallas), which extends Medicaid and CHIP postpartum coverage from two months to one year. The Centers for Medicare & Medicaid Services recently approved Texas’ state plan amendment to implement the law.
“When we heard that [HB 12] passed, I think there was a collective ‘Hallelujah!’ from OB physicians and midwives in our state,” Rakhi Dimino, MD, an obstetrician-gynecologist in Houston and chair of TMA’s Committee on Reproductive, Women’s, and Perinatal Health, told Texas Medicine Today. “I also think some of us are holding our breath a little, hoping it does take effect. This was such a long, long, drawn-out battle.”
Texas Medicaid pays for more than half of the state’s births, and a projected 137,000 women will benefit from this extension in fiscal year 2025, according to a Jan. 17 press release issued by Gov. Greg Abbott.
Texas residents who are not currently enrolled in Medicaid or CHIP but who were while pregnant and who are still within their 12-month postpartum period will see their coverage reinstated for the remainder of that period. Such coverage will not be retroactive, meaning Medicaid will not pay for any services obtained during the gap.
Similarly, women who are enrolled in Healthy Texas Women – a free women’s health service available to eligible low-income women – and who are still within their 12-month postpartum period will be transitioned back to Medicaid for the remainder of that period.
However, the extension does not apply to those enrolled in CHIP Perinatal, which covers the unborn children of eligible pregnant women. Such women are eligible for the state’s Family Planning Program, which provides basic health care services, including contraception and screening for chronic conditions.
Dr. Dimino hopes to see her patients take advantage of the extended postpartum coverage when the law takes effect, but how smooth the implementation process goes remains to be seen.
She also worries whether postpartum women will be informed of their extended coverage and if Texas physicians will be able to meet the increased need, given longstanding workforce shortages.
“Is it possible for them to have true access, and not just on paper?” she asked.
Helen Kent Davis, TMA’s associate vice president of governmental affairs, says HHSC is working with TMA, Medicaid and CHIP managed care organizations, and others to streamline implementation, including identifying a process for reinstating postpartum coverage if a woman has moved into a new Medicaid managed care service area.
Dr. Dimino expects the law will help many of her patients have continuous access to care during the 12-month postpartum period, when many women struggle with complications and pregnancy-related issues, like hypertensive and mental health disorders; increased risk of domestic violence; and chronic conditions that predate their pregnancy. All can impact their future health and pregnancies.
“It’s still a fairly dangerous time period for women,” she said, adding that most of her Medicaid and CHIP patients currently stop accessing care when their coverage ends two months postpartum.
In 2019, 36% of pregnancy-associated deaths in Texas occurred 43 days to one year postpartum, making a full year of continuous postpartum care one of the top recommendations of the Texas Department of State Health Services’ Maternal Mortality and Morbidity Review Committee since the group began issuing reports in 2018.
That same year, TMA mobilized a Maternal Health Congress, during which maternal access-to-care concerns topped the association’s own list of resultant recommendations, including providing 12 months of continuous coverage for preventive, primary, and specialty care coverage for women before, during, and after pregnancy.
Still, it took several sessions for a legislative fix to gain bipartisan support, which Representative Rose found last year in the wake of the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization regarding abortion. With its passage, HB 12 cemented a top win among TMA’s legislative priorities in 2023, followed by a slate of other maternal health wins.
TMA continues to advocate that the Texas Legislature build on HB 12 by implementing other reforms, including to address systemic workforce, payment, and eligibility issues that can undermine women’s health.
For more information on physician-led efforts to shape legislation, check out TMA’s state advocacy page