Impact: Medicaid expansion remains a nonstarter in Texas, but lawmakers are more open to targeted improvements in coverage that focus on women and children, and TMA aims to capitalize on that, says Texas Medical Association lobbyist Caitlin Flanders.
In 2021, the Texas House of Representatives approved just such a measure – House Bill 133 – which extended coverage to women from two months to 12 months after delivery. Unfortunately, the extension to 12 months in that bill was whittled down to six months in a compromise with the Senate. But it never went into effect because it required approval from the Centers for Medicare & Medicaid Services (CMS), which declined. CMS said it fell short of the agency’s own recommendation for 12 months of coverage postpartum. Currently, Texas’ coverage remains at two months postpartum.
Nevertheless, that initial House vote is significant, says Rep. Tom Oliverson, MD (R-Cypress), a member of the House Select Committee on Health Care Reform. “The House is clearly supportive of the idea of extending eligibility postpartum to a year. That was something we put our marker down on last session. The speaker supported it, I supported it, and it’s something we obviously believe in.”
As for children, the Texas Legislature in 2021 made it easier for those under age 19 to keep their Medicaid coverage by reducing from four to one the number of midyear reviews families must contend with to keep their children in the program. Lawmakers also made the review easier by granting families more time to submit paperwork. Previously, many children arbitrarily lost benefits because their families faced so many reviews.
TMA sees even more opportunities this session to push for more behavioral health care resources for both women and children, says Lubbock pediatrician Celeste Caballero, MD. She testified on the topic this past summer for TMA and several specialty societies at an interim hearing of the Senate Special Committee to Protect All Texans, which was formed in response to the Uvalde shooting.
The needs for longer postpartum care and improved mental health coverage frequently go hand in hand, and they affect more than just the woman involved, Dr. Caballero says.
“I’ve seen multiple examples of moms who have fallen through the cracks after delivery,” she said. “They didn’t have their OB-gyn follow them anymore, and they didn’t have the health coverage they needed. And I saw women who would fall into the depths of depression, and whole families suffer when that happens.”
Over the interim, Texas Speaker of the House Dade Phelan (R-Beaumont) responded to these needs by redirecting $100 million in state funding to improve mental health and school safety programs.
TMA aims to build on those gains to address the long-term mental health effects of the Uvalde shooting and the COVID-19 pandemic, says pediatrician and TMA President Gary Floyd, MD, who helped the association launch a Mental Health Response Team. (See “Ready for Recovery,” November 2022 Texas Medicine, pages 28-32, www.texmed.org/ResponseTeam.)
As for more comprehensive coverage, Texas could save a lot of money by creating a state-based exchange within the context of the Affordable Care Act, says Representative Oliverson, who plans to file a bill to that effect.
So far, 18 other states have done so, and he says the savings generated can be ploughed back into other parts of the health care system. They also provide coverage to patients who can neither afford an Affordable Care Act health plan nor qualify for a federal subsidy.
“I’m particularly looking at ways that we could get credits or premium reductions for employees working for small employers because it seems like that’s the portion of the marketplace that’s struggling the most right now – the small employers,” Representative Oliverson said.