Patient Care Protected: Medicaid Coverage for Women and Children
By Sean Price Texas Medicine August 2023


Related content: 
2023 Legislative Wrap-Up: TMA Secured Big Wins With a New Strategy

TMA Priority: Pursue more comprehensive coverage of and secure additional funding and resources for maternal and behavioral health care for women and children.

Physician-Led Results: The culmination of multi-session efforts, the Texas Medical Association – along with its allies in protecting maternal health – achieved a key objective with the passage of House Bill 12 by Rep. Toni Rose (D-Dallas), which extends Medicaid postpartum coverage from two months to one year. It was one of several important TMA priorities that lawmakers approved to protect women’s health. 

Representative Rose thanked Texas physicians for their advocacy on the issue during TMA’s final First Tuesdays at the Capitol lobbying event of the session.

“If it wasn’t for you, we wouldn’t be able to be successful with [HB] 12,” she told the audience.

The policy embodied by HB 12 is so important that the Texas Maternal Mortality and Morbidity Review Committee has identified it as its top recommendation since the panel began issuing policy reports in 2018, says Houston obstetrician-gynecologist Carla Ortique, MD, chair of the committee. She also is a member of TMA’s Council on Science and Public Health and serves as a consultant for the Committee on Reproductive, Women’s, and Perinatal Health.

One big reason: Fifty percent of pregnancy-associated deaths in Texas occur after 60 days postpartum, she says.

“Without access to care, we really can’t expect to see any improvement in our outcomes,” Dr. Ortique said. “[This bill] recognizes that many times women got outstanding coordinated care during the course of their pregnancy. But then they’d lose their access because of loss of Medicaid at eight weeks postpartum. Their health would decline, and they’d lose access to medications and ongoing behavioral health care, [and] ongoing primary care for treating things like hypertension and diabetes was very limited.”

Both houses of the legislature voted to speed up enactment of the full-year coverage. However, rulemaking for the new policy by the Texas Health and Human Services Commission may take several months, meaning the start date could be delayed.

House Bill 1575 by Rep. Lacey Hull (R-Houston) calls for pregnant women enrolled in Medicaid managed care and other state programs to be screened for nonmedical drivers of health, such as where people live, work, and play. If those women are found to have a problem like food insecurity or lack of transportation, they will be referred to the proper service, says Helen Kent Davis, TMA’s associate vice president for governmental affairs.

Health officials are still trying to research the best ways to screen patients and “close the loop” by getting them an effective referral that physicians can confirm, she adds. But this bill codifies for the first time the need for this type of screening and intervention.

Budget gains for behavioral health include:

  • A $2.3 billion funding boost to overall mental health services, such as community mental health services and grant programs for adults and children, substance use disorder treatment, and mental health hospitals;
  • An additional $122 million for the Texas Child Mental Health Care Consortium – the umbrella organization for the Child Psychiatry Access Network and Texas Child Health Access Through Telemedicine initiatives; and
  • $28 million for loan repayment for psychiatrists and other mental health professionals, a major increase of $25.9 million.

A separate bill, House Bill 1357 by Justin Holland (R-Rockwall), gives Texas Medicaid authority to pay for medication-assisted opioid or substance use disorder treatment without prior authorization or precertification.

Last Updated On

August 04, 2023

Originally Published On

August 02, 2023

Related Content

Leadership | Medicaid | Texas legislation