Texas lawmakers have filed a number of good bills for kids to consider during this legislative session, and we expect more to come before the March 12th bill filing deadline. For today, we’ve picked out 10 to tell you about. We could have easily included more, but we’ll save them for our next blog post about good bills. And remember, many of the Legislature’s key decisions for children and families will take place as they work on the state budget bill, which we’ve addressed in a separate blog post about the first drafts of the budget. The next few weeks and months will be a critical time for Texans to encourage legislators to approve the following bills and other good proposals.
HB 607 by Rep. Donna Howard would support children in foster care — and help Community Based Care — by conducting a foster care needs assessment. For example, the bill would help Texas leaders know if and where the state needs more maternity homes for pregnant and parenting youth in foster care or more foster care placements that are prepared to serve human trafficking survivors. Even before COVID, Texas already faced a shortage of safe, nurturing placement options for children in foster care with higher needs, as underscored by testimony in the federal lawsuit on Texas foster care. Now, the pandemic has further reduced the supply of adequate foster care placements, contributing to a spike in the number of children sleeping in CPS offices. The bill will also help Texas prepare for the 2018 Family First Act — the federal rewrite of foster care funding — to take effect in Texas this year. The 2018 law will cut off federal funding for sub-standard foster care facilities, among other provisions.
HB 725 by Rep. Jared Patterson would make Texas children eligible for public school pre-k if they were in foster care in other states. Last session, the Governor and Legislature did a great job on education funding, providing state funding for full-day pre-k and other early childhood investments to help kids become strong readers by third grade. Research from Texas and across the country shows that effective pre-k programs help students start kindergarten with the skills they need to succeed, boost early literacy and academic achievement, and reduce both grade retention and provision of special education services. Under state law, Texas school districts are required to offer voluntary, full-day pre-k to four-year-olds who meet the state’s pre-k eligibility requirements (and districts may offer pre-k to eligible three-year-olds). Students are eligible for pre-k if they qualify for free or reduced-price lunch, are designated as English Learners, have ever been in Texas foster care, or have a parent who is on active duty with the military or was killed or injured on active duty. HB 725 would make a small but important addition to that list.
HB 41 by Rep. James Talarico would improve the quality of pre-k by limiting pre-k class size to 22 students and requiring a teacher or aide for every 11 students. For pre-k programs to be effective and lead to significantly greater school success, full-day programs and low student-teacher ratios are two of the essential ingredients. Despite efforts to improve the quality of early childhood education in recent years, there is still no statewide standard for pre-k class sizes or student-teacher ratios. State law establishes a limit of 22 students per class for kindergarten through fourth grade. With a class size over 22 or big groups per teacher, it's challenging even for the most experienced teacher to address each child's needs, manage behavioral challenges, and get young students ready for kindergarten. HB 41 would implement the recommendations of a 2016 report commissioned by the Texas Education Agency. Although this change would help all children, it would be particularly impactful to children with disabilities and developmental delays and young English Learners who can become bilingual with the proper individualized support.
HB 168 by Rep. Mary González would improve partnerships between child care providers and Early Childhood Intervention (ECI) programs to better serve children with developmental delays and disabilities. ECI is an effective federal-state program that contracts with community organizations, such as Easterseals and Any Baby Can, to provide life-changing therapies and services to children under age three with autism, speech delays, Down syndrome, and other disabilities and developmental delays. Unfortunately, a recent federal investigation and our recent report showed that the state has fallen short of its obligation under federal law to ensure that eligible children have access to ECI services. The Legislature should fully fund ECI and can strengthen Child Find efforts to reach more children who are eligible for ECI by passing this bill to increase child care providers knowledge and skills related to developmental delays and disabilities and increase referrals from child care providers to critical early intervention services for babies and toddlers. The bill also prohibits discrimination by licensed child-care facilities and registered family homes on the basis of a disability and requires providers to report to HHSC on any suspensions or expulsions of children.
HB 1237 by Rep. James White would address racial disproportionality in the CPS system. For years, the Department of Family and Protective Services (DFPS) has tracked racial disproportionality and disparities. We know that Black children and families face the greatest risks under the current CPS system in Texas. For example, Black children account for 11 percent of the state’s child population but 18 percent of reports to CPS, 20 percent of CPS investigations, and 20 percent of the children who are removed from their families and placed in foster care. The reasons for disproportionality are difficult to untangle, but research in Texas suggests White families receive more leeway than Black families. This bill would build on the work that DFPS has started to reduce or eliminate inequity by requiring DFPS to take specific, intentional actions to address the problems they identify and report on why the actions they have taken failed or succeeded.
HB 4 / HB 974 by Four Price would leverage telemedicine and telehealth to improve children’s access to Early Childhood Intervention (ECI), Texas Health Steps check-ups, mental health services, and more. This bill directs HHSC to adopt payment rates in Medicaid for telemedicine and telehealth services by January 2022 for a variety of medical and behavioral health services for kids, including ECI, physical therapy, occupational therapy, speech therapy, nutritional counseling, targeted case management, and well-child check-ups, among others. The bill leverages telehealth successes during the COVID-19 pandemic, promotes consistency in reimbursement for health providers, and implements payment for audio-only behavioral health services, where appropriate.
HB 515 by Rep. Tom Oliverson, HB 522 by Rep. Julie Johnson, HB 980 by Rep. Art Fierro, and SB 228 by Sen. César Blanco would increase access to telemedicine and telehealth services — including Early Childhood Intervention services and mental health services — for children with private insurance regulated by the Texas Department of Insurance (TDI). During the pandemic, access to these services via telehealth has been a critical lifeline to families. For health benefit plans regulated by TDI, only certain health and mental health professionals are allowed to provide services via telehealth and telemedicine. This bill expands that list. For example, it would add qualified mental health professionals who hold a bachelor’s or more advanced degree in psychology, social work, special education, educational psychology, early childhood education, or early childhood intervention. The bill also requires health benefit plans regulated by the TDI to reimburse these services at least at the same rate they would use if the visit were in person.
HB 290 by Rep. Philip Cortez and SB 39 by Sen. Judith Zaffirini would keep eligible children enrolled in Medicaid health insurance for 12 uninterrupted months. When parents work in low-wage jobs that don’t offer health coverage, Medicaid insurance does a good job making sure that kids have reliable access to check-ups, support for mental health challenges, and help when they get sick. Right now Texas has an effective, robust system for checking kids’ eligibility when they enroll in Medicaid and again when they reach a year of health coverage. But, just a few months after confirming kids’ eligibility, Texas also runs inaccurate, unnecessary mid-year eligibility checks that mistakenly remove eligible children from health coverage. This legislation would keep kids enrolled in their Medicaid insurance for 12 months at a time to make sure kids don’t bounce on and off insurance, reduce the administrative burden on HHSC and doctors, and bring down the state’s high children’s uninsured rate.
SB 141 by Sen. Nathan Johnson, HB 107 by Rep. Senfronia Thompson, HB 133 by Rep. Toni Rose, HB 146 by Rep. Shawn Thierry, HB 98 by Rep. Lina Ortega, and HB 414 by Rep. Armando Walle* would extend Medicaid health insurance for new mothers from 60 days to one year after pregnancy. The legislation would implement the top recommendation of Texas’ Maternal Mortality & Morbidity Review Committee — and maternal deaths are only the tip of the iceberg. Many more Texas mothers face severe pregnancy complications that have harmful health effects on mom and baby during the critical early years of a child’s brain development and can lead to expensive hospital or NICU stays. For example, untreated postpartum depression can harm a child’s brain development, language skills, and school readiness. Access to health insurance is key for addressing these challenges, yet Texas is one of the only states where Medicaid is typically not available to women with jobs below the poverty line, except during their pregnancy and 60 days after pregnancy. When Texas women become uninsured 60 days after pregnancy, they may only have access to the state’s new Healthy Texas Women Plus (HTW Plus) program. HTW Plus is an important advancement for women’s health and could be the backbone for a comprehensive benefit program through postpartum Medicaid. However, as opposed to the proposed 12-month Medicaid coverage, HTW Plus does not cover many important services, including a broad prescription drug benefit, surgical care, hospital inpatient or outpatient care, and physical therapies, and has virtually no network of specialty or mental health providers to deliver covered services right now. In 2019, with strong bipartisan support, the Texas House passed HB 744 to implement 12-month postpartum Medicaid, although the legislative session ended before the Senate took up the bill.
*Rep. Walle’s bill would extend coverage for two years, while the other bills extend it for one year.
Numerous bills would draw down federal Medicaid expansion funding to offer a health insurance option to low-wage workers whose employers do not offer insurance. (Here are 12 examples from the first few hours of bill filing in November. The most recent is HJR 86 by Rep. Lyle Larson) Providing an affordable insurance option to cashiers, cooks, janitors, and others would improve their children’s health, in part by helping moms have healthier pregnancies and healthier babies. Today, if a single parent with two kids has a yearly income between $3,900 and $22,000, then he or she earns too much to qualify for Texas Medicaid — unless she’s pregnant or has a disability — and not enough to qualify for ACA subsidies. A growing number of Texas legislators on both sides of the aisle have talked about addressing the issue this session, whether it’s through a direct Medicaid expansion or — as recently outlined by House Speaker Dade Phelan — a Texas plan to draw down additional federal health care dollars.