For years, the state's health care policies have been pretty dismal for many people in Texas, including moms and kids. At this point in the legislative session, unfortunately, it’s clear that isn’t going to change this year. However, there are still a few bills moving at the Legislature that would represent small, meaningful progress on maternal health and Medicaid managed care.
The Legislature's efforts on education this session are critically important, but children need to be healthy if they are going to succeed in school. Maternal mortality and pregnancy complications remain a significant concern in Texas, resulting in tragedy and long-term health issues for many mothers and children. Further, the Dallas Morning News investigative series showed that funding and meaningful reforms to Medicaid managed care are needed so that kids, pregnant women, and people with disabilities can get medications, physical therapies, and other health care to stay healthy. Meanwhile, Texas has the nation’s worst uninsured rate for kids and for adults, a fact that state leaders appear unwilling to address or even publicly acknowledge.
While these challenges will continue after the session, the following bills still have a chance to pass and make some improvements in maternal and child health:
Passed the Senate, Waiting for a Hearing and a Vote in the House
Maternal and Child Health
SB 748 by Sen. Kolkhorst would create a newborn screening preservation account to establish a consistent and long-term funding stream to repair, upgrade, and expand screenings conducted by the DSHS public health lab.
SB 436 by Sen. Nelson seeks to prevent and address substance use disorders affecting moms by directing Department of State Health Services (DSHS) and the Texas Maternal Mortality & Morbidity Task Force to implement initiatives that: improve screening to better identify and care for women with opioid use disorder; improve referrals to treatment and continuity of care; increase medication-assisted treatment options; and optimize health care provided to pregnant women with opioid use disorder and to newborns.
SB 750 by Sen. Kolkhorst includes many provisions on maternal health, including directing the Health and Human Services Commission (HHSC) to evaluate and develop a limited postpartum care package for women enrolled in Healthy Texas Women program; and directing HHSC to develop strategies to ensure continuity of care for new mothers who transition from Medicaid for Pregnant Women into Healthy Texas Women.
Medicaid Managed Care
SB 1140 by Sen. Watson would direct HHSC to contract with at least three independent, “third party arbiters” to review and resolve a Medicaid client’s appeal after HHSC or a Medicaid health plan denies or reduces health care services. HHSC would establish a common procedure for appeals and the third party arbiter would provide objective, unbiased medical necessity determinations done by clinical staff with training and experience in the health care service at issue.
SB 1105 by Sen. Kolkhorst would direct HHSC to implement a no-wrong-door system for Medicaid grievances reported to the agency; establish a procedure for expedited resolution of a Medicaid-related grievance; and publish quality and health outcome data for each Medicaid health plan in an easy-to-read format. The bill also requires health plan notices to clients about denial of services to include a clear, easy-to-understand explanation of the reason for the denial.
Passed the House, Waiting for a Hearing or a Vote in the Senate
HB 253 by Rep. Farrar would require HHSC to develop and implement a five-year strategic plan to improve access to screening, referral, treatment, and support services for postpartum depression. (Hearing held in Senate)
HB 25 by Rep. Gonzalez would create a pilot program that removes obstacles in the current medical transportation program and ensures more Texas mothers can attend prenatal and postpartum care appointments. Prenatal and postpartum care are vital for the health of Texas mothers and babies, but transportation is a barrier for many mothers to get this critical care. The current medical transportation program does not account for the fact that many pregnant women and new mothers are taking care of young children when they have doctor’s appointments. This pilot program would ensure moms and their children can travel together through the medical transportation program and moms can request rides quickly. (Hearing held in Senate)
HB 1589 by Rep. Ortega would improve awareness about the Healthy Texas Women program by directing HHSC and the Maternal Mortality Task Force to develop effective ways to notify pregnant women enrolled in Medicaid that they will be auto-enrolled into Healthy Texas Women two months after the birth of their baby. This could include sending the notice to women while they are pregnant and through other means, like text or email.
HB 800 by Rep. Howard would include contraception as a covered benefit under the Children’s Health Insurance Plan (CHIP) when teens have parental consent. A baby is born to a teen mother once every 18 minutes in Texas. Access to contraceptive coverage can help teens avoid early pregnancy and graduate from school at higher rates.
HB 1111 by Rep. Sarah Davis seeks to improve maternal and newborn health through a multi-faceted approach: a pregnancy medical home pilot program that uses a maternity management team to effectively coordinate maternity care; a pilot program to improve care coordination services for women at higher risk for poor pregnancy, birth, or postpartum outcomes; and by directing HHSC to develop a program to delivery prenatal and postpartum care through telehealth services to pregnant women with a low risk of pregnancy-related complications, among other provisions.
HB 3721 by Rep. Deshotel would require HHSC to contract with an independent review organization to review and resolve a Medicaid client’s appeal made after a Medicaid health plan denies or reduces health services because of medical necessity. The IRO must assign a physician or other health care provider with experience as a reviewer to make a review determination. Amendments added on the House floor clarified that the IRO process would occur automatically and clients could opt-out; and that the health plan bears the burden of proof to show the service is not medically necessary.
Voted out of a House Committee, Need the Calendars Committee to Take Action Immediately to Schedule them for Vote of the Full House if They Are to Have Any Chance of Passing
Maternal and Child Health
HB 342 by Rep. Philip Cortez would reduce red tape and keep kids connected to health care by ensuring kids in Medicaid get six uninterrupted months of coverage at a time. Texas has the nation's highest uninsured rate for kids and it is getting worse. The current process in Medicaid of month-to-month checks for half the year asks parents to submit paperwork up to 5 times a year (per child) and is causing thousands of eligible children to lose coverage every month.
HB 1110 by Rep. Sarah Davis and HB 744 by Rep. Rose would improve the health of moms and babies by extending the length of time eligible women are covered by Medicaid from 60 days post-delivery to 12 months. Extension of coverage for a year would help Texas mothers access primary, specialty, and behavioral health care during a critical window of time following the birth of their baby.
HB 2618 by Rep. Walle would create a pilot program to place peer support specialists — trained individuals with lived experience recovering from a mental health condition — in safety-net health centers to serve women at risk of or who have developed postpartum depression. One in seven women develop postpartum depression, but many do not receive treatment, which can have a devastating impact on the entire family and contributes to maternal mortality. This pilot would place mental health peer specialists at safety-net health centers where new moms already go for prenatal and postpartum care.
Medicaid Managed Care
HB 2453 by Rep. Sarah Davis would strengthen Medicaid managed care by improving key areas such as contract oversight, network adequacy enforcement, prior authorizations, appeals and fair hearings, utilization review, care coordination, transparency, and accountability.
HB 4178 by Rep. Frank would reform the fair hearings process after a Medicaid client appeals a denial of services; streamline enrollment and coordination of benefits; and simplify the prior authorization process for Medicaid managed care.
Bills in the House Local & Consent Calendar Committee, Waiting to be Scheduled for Vote of the Full House
SB 2132 by Senator Powell and HB 1641 by Rep. Button would improve awareness of the Healthy Texas Women program by adding information to the notice sent to new mothers enrolled in HTW after having a baby. The notice would add a list of HTW-participating health providers in their local area and information about services covered in HTW. SB 2132 also requires HHSS to examine different times to send the notice and different ways to send the notice such as text or email.
HB 2091 by Rep. Ortega would promote the use of community health workers, also known as promotoras, as an important resource for improving access to and quality of care in Medicaid. Community Health Workers provide cultural mediation between a patient and health care and social services, and are particularly impactful in the area of maternal health. This bill would address a funding barrier to hiring additional Community Health Workers by allowing Medicaid health plans to report associated expenses as a quality improvement cost rather than an administrative expense.