This commentary originally appeared in the San Antonio Express-News.
Too many Texas mothers have to wait months for prenatal care. Lawmakers can change that.
When a woman finds out she’s pregnant, one of the first things she should be able to do is schedule a prenatal appointment. Too often in Texas, that simple step turns into weeks — or even months — of waiting.
I recently spoke with a Texas mom who learned she was pregnant in December. Since she didn’t have health insurance, she applied for Medicaid for Pregnant Women.
Then she waited for the state to process her application. After that, she waited for the next available appointment with a provider in her area. By the time she finally saw a doctor, it was March, and she was already in her second trimester.
Her story isn’t unusual.
Parents want to start prenatal care early. They know it matters. And this is one of the rare issues that draws broad agreement at the Texas Capitol.
Lawmakers across the political spectrum understand that early prenatal care helps identify health risks, helps manage chronic conditions like hypertension and diabetes, and helps connect women to critical supports, such as nutrition assistance and behavioral healthcare.
When prenatal care is delayed — or doesn’t happen — the risks increase. Late or no prenatal care is associated with higher rates of preterm birth and low birth weight.
Improving access to prenatal care is also an important strategy for reducing infant mortality, an issue the Texas House Committee on Public Health is studying.
Unfortunately, after years of improvement, the share of women receiving prenatal care in the first trimester started to decline. Nationwide, first-trimester prenatal care fell from 78.3% in 2021 to 75.5% in 2024.
The challenge is even greater in Texas. In 2024, 11.3% of Texas mothers began prenatal care in the third trimester or did not receive prenatal care at all, compared to 7.3% nationally.
There is no single reason for these delays.
Women often encounter multiple barriers between confirming a pregnancy and walking through the door of a prenatal care appointment. For women who rely on Medicaid, the process can be especially challenging. Data from the Texas Health and Human Services Commission shows that last year, approximately 40,000 pregnant Texans waited more than a month for a decision on their application and 24,000 waited more than two months.
Pregnancy doesn’t pause while paperwork moves through the system.
Even after coverage is approved, many women face another obstacle: finding a provider who can see them. The low Medicaid reimbursement rates set by state leaders make it difficult to maintain strong provider networks in some communities.
In many parts of Texas, there are not enough obstetric providers accepting new patients and appointment wait times can stretch for weeks. Some rural communities have no obstetric providers at all.
A recent state review tested what happens when someone with Texas Medicaid insurance tries to schedule a prenatal appointment. The results were troubling. Barely half of women with low-risk pregnancies could get appointments within the state’s required time frame. For women with high-risk pregnancies, only 19% were able to secure appointments within five days as required by state standards.
Texas women are doing what they’re supposed to do. They are confirming pregnancies, applying for coverage, calling providers and trying to access care. Too often, they encounter delays at every step between a positive pregnancy test and their first prenatal visit.
State leaders can streamline Medicaid enrollment, strengthen provider networks, work with Medicaid managed care organizations to reduce scheduling barriers and improve access to care for uninsured women.
Every week of delay matters.
If Texas is serious about improving outcomes for mothers and babies, making prenatal care easier to access should be a priority during the 2027 legislative session.
Diana Forester is Director of Health Policy for Texans Care for Children.
