Physician-Led Results: Big Steps Forward in Medicaid, Maternal Health
By Sean Price

One of the Texas Medical Association’s biggest wins this session came in the partial realization of medicine’s longtime advocacy to extend Medicaid coverage for postpartum maternal care.

House Bill 133, authored by Toni Rose (D-Dallas) and sponsored by Sen. Lois Kolkhorst (R-Brenham) in the Senate, provides women enrolled in pregnancy-related Medicaid with six months of postpartum coverage, an increase from the two months they currently have.

“We very much appreciate all the work that [Rep.] Toni Rose as well as Sen. Lois Kolkhorst did for us in getting those extra four months,” said New Braunfels family physician Emily Briggs, MD, who sits on TMA’s Committee on Reproductive, Women’s, and Perinatal Health.

TMA strongly supported obtaining 12 months of coverage in this session, but getting the coverage level up to six months was still a “great start,” says Kimberly Carter, MD, an Austin obstetrician-gynecologist and co-chair of TMA’s Task Force on Health Care Coverage. The task force, made up from a cross-section of Texas physicians, was created in March to provide data and feedback on legislation designed to extend Medicaid coverage and – more long-term – to guide policymakers on all efforts that expand access and care.

“We are moving in the right direction and are really excited that the legislators prioritized this issue to successfully pass an extension, but we continue to have a goal of 12 months,” she said.

Obtaining 12 months of coverage remains an important target for future Texas legislative sessions because medical evidence shows that women run into a wide variety of medical problems in the year after giving birth, Dr. Briggs says.

In March, she testified before the House Appropriations Committee on behalf of TMA and other medical groups that “too many women die during pregnancy or in the year following, though nine in 10 of these deaths were potentially preventable.”

Many women who have important problems like postpartum depression, hypertension, and other morbidities common after delivering a baby are not diagnosed until several months after the birth, says John Carlo, MD, who is the new chair of TMA’s Council on Legislation. They often have to wait weeks or months to begin care with the appropriate specialist, and by that time even a six-month Medicaid benefit will have run out.

“It’s a victory, but it’s a guarded one because I really wonder if we have the networks of [physicians], especially around psychiatry and behavioral health and cardiovascular diseases and the things we know cause the morbidities after pregnancy,” he said.

Even when women are able to obtain treatment, postpartum health problems often require lengthy treatment, Dr. Briggs says.

“When [a woman is] first being treated for, say, hypertension, it’s not like we give her medicine and she’s cured,” she said. “We need time with that medication for lifestyle management or for coping mechanisms if its depression. … It’s an ongoing life issue. It’s not like a gall bladder being removed and, blam, you’re done.”

Despite these drawbacks, extending Medicaid coverage to six months is a substantial improvement and will benefit Texas women as well as their families, Dr. Briggs says.

“When you’re providing care to mom, you’re elevating care … to the entire family,” she said. “You’re encouraging that mom to find a medical home. You’re encouraging her to have a place to go when her partner has an issue, when her child has an issue, when the rest of the family needs care. So, you’re benefiting the community by benefitting the mom’s access to care. I think that’s a big reason that this is such a big win.” 

Other legislative highlights in maternal care include: 

  • A $5.7 million increase for women’s health services – including Healthy Texas Women, the Family Planning Program, and Breast and Cervical Cancer Services – compared with the 2020-21 biennium.
  • $47 million allocated in general revenue to implement six months’ postpartum Medicaid coverage.
  • $7 million to continue TexasAIM, a statewide maternal safety initiative, and to develop and establish a high-risk maternal care coordination services pilot for women of child-bearing age. 

Extended coverage for kids

The Texas Legislature also approved House Bill 2658, which among other provisions provides children under 19 years old on Medicaid with two consecutive six-month periods of coverage. The measure, which started off as House Bill 290 by Rep. Philip Cortez (D-San Antonio), was amended onto HB 2658 to improve its chances of passage.

As filed, HB 290 would have provided children on Medicaid with 12 months of continuous coverage, a proposal called for by TMA. Instead, the compromise language directs Texas Medicaid to provide children six months of continuous coverage followed by one electronic income verification at six months. Children confirmed eligible will retain coverage for another six months. However, if the electronic income check cannot confirm eligibility, which is often the case, parents will be given 30 days to provide documentation, up from just 10 days currently.

Families with children on Medicaid have been forced to regularly prove their child is eligible for Medicaid services, and this new law eases that burden, Dr. Briggs says.

“There was a lot of bureaucracy, a lot of red tape that resulted in a lot of kiddoes losing their coverage, and this House bill essentially removes [most of] that red tape,” she said. “It makes it so that children can continue their coverage without having to jump through so many hoops.”

HB 2658 also provides payment for one preventive dental care exam for adults with disabilities who are in the Star+Plus Medicaid managed care program. That is a major step forward for public health as well because it will help prevent more serious dental problems later – problems that contribute to poorer health and higher use of emergency departments, says Helen Kent Davis, TMA’s associate vice president of governmental affairs.

Despite these successes, Texans’ access to Medicaid remains limited overall. Legislators declined to pass a plan to accept federal Medicaid funds, which would have extended health care coverage to 1 million more Texans than are currently covered, Dr. Carter says. Physicians need to push lawmakers to come up with a Texas solution to improve access to care for more people, she says.

“One of our reasons for increasing [physician Medicaid payments] is that it is linked to increased access to care,” Dr. Carter said. “There are doctors who say they don’t want to take those patients because [Medicaid] doesn’t pay enough.”

Dr. Briggs in her March testimony pointed out that Texas has not enacted a meaningful, enduring physician rate increase in more than a decade.

Last Updated On

June 23, 2021

Originally Published On

June 23, 2021

Sean Price

Reporter

(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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