Texas Legislature Can Support Maternal Mental Health by Allowing Moms to Remain Enrolled in Medicaid Insurance for 12 Months after Pregnancy
We’re excited to share a new report published by Mathematica, in collaboration with St. David’s Foundation, regarding the high cost of failing to treat postpartum depression and other maternal mental health conditions in Texas.
Here are some of our key takeaways and recommendations:
Supporting maternal health doesn’t only help moms. This report shows that our whole community — kids, schools, local businesses, the health care system, and beyond — urgently needs policies that improve moms’ access to care.
The Mathematica report found that for one year of childbirths in Texas, failure to treat maternal mental health conditions (MMHCs) such as postpartum depression creates an estimated $2.2 billion in societal costs from conception through five years postpartum. The calculations are based on pre-pandemic data.
The largest costs are productivity losses ($610 million), child behavioral and developmental disorders ($556 million), maternal health expenditures ($445 million), and preterm births ($372 million).
The report notes there are human costs beyond the costs quantified in the analysis. For example, as noted in the report, untreated MMHCs increase the risk of babies being born preterm, dying of SIDS, or growing up with health, emotional, or behavioral challenges. Similarly, untreated MMHCs by definition hurt the mental well-being of moms, in addition to placing them at a higher risk of suicide and health challenges.
These costs and the prevalence of untreated MMHCs show that addressing mental health is central to supporting maternal health.
The report notes that “MMHCs are among the most common complications of pregnancy and childbirth.” The report estimates untreated MMHCs affect 13.2% of all Texas women “not accounting for the increased prevalence of MMHCs arising from the COVID-19 pandemic” and 17.2% of those enrolled in Medicaid for pregnant women.
Maternal health policy discussions in Texas often focus on the important topics of maternal mortality, access to family planning, and addressing a mother’s physical health needs before, during, and after pregnancy. Mental health — which affects all of these areas — must also be a top maternal health priority in Texas.
Untreated MMHCs are common and costly among families of all backgrounds. However, the report shows that families of color — especially Black families — are disproportionately affected.
Untreated MMHCs affect an estimated 19% of Black moms in Texas, compared to 15% of Hispanic moms and 12% of White moms.
Other research, as summarized here, has shown that factors contributing to disparities in maternal health outcomes include: implicit bias in the health care system; chronic stress, including the physical toll of stress related to structural racism; the impact of past and present discrimination on social determinants of health such as housing, food scarcity, and education; and a disproportionate lack of access to health insurance.
The report shows that allowing MMHCs to go untreated takes a toll on children, making clear that addressing maternal mental health is central to nurturing healthy and successful children.
Of the $2.2 billion in costs for untreated MMHCS, 45% is directly related to kids, such as child behavioral and developmental disorders, preterm births (which can have long-term consequences for health and development), and asthma. For example, Mathematica estimates that failing to treat maternal mental health conditions results in an additional 7,472 preterm births.
The report notes there are consequences for children’s education beyond the costs quantified in the analysis. Untreated MMHCs “can lead to reduced educational attainment in the longer term” because children are “more likely to have a behavioral or developmental disorder, such as attention deficit hyperactivity disorder, depression, anxiety, and behavioral or conduct disorders such as oppositional defiant disorder.”
These findings are consistent with the research showing that early childhood is a critical time for brain development.
The report shows the state government pays a financial price when MMHCs go untreated — highlighting the return on investment of state maternal health efforts.
Of the $2.2 billion in costs, $1 billion is a cost to Medicaid, meaning it is paid by a combination of the state and federal government.
Many of the state’s costs associated with untreated MMHCs occur in the short term, meaning that treating those MMHCs would pay immediate dividends to the state budget. The report found that “Overall, 48% of the total health system costs [of MMHCs], beyond Medicaid, for mothers enrolled in Medicaid for Pregnant Women and their children are associated with pregnancy and birth complications and occur between conception and the child’s first birthday.”
The report noted that women are often unable to receive a screening or treatment for MMHCs — and that lack of access to health insurance is often an obstacle.
The report explained, “Nationally, half of perinatal women with a diagnosis of depression do not get the treatment they need.”
The report notes that under current state policy, Texas is one of the states where women are often left with no viable insurance options 60 days after pregnancy. Texas has the highest uninsured rate in the nation.
The report addresses the costs of untreated MMHCs. To reduce those costs, the Texas Legislature and maternal health stakeholders must ensure more moms have access to treatment and screening.
While the report does not include policy recommendations, it is clear that one of the main steps the Legislature can take to address these costs is to pass legislation this session allowing Texas mothers to remain enrolled in Medicaid insurance for 12 months after pregnancy rather than removing them from insurance after 60 days. (In many cases, MMHCs must be diagnosed and treated after the 60-day window.) This step — which is the top recommendation from the Texas Maternal Mortality and Morbidity Review Committee appointed by the Governor — passed the Texas House (but not the Senate) during the last legislative session.
The report says, “Lengthening coverage to those uninsured or underinsured in the postpartum period in a child’s first five years of life could benefit the Texas Health and Human Services Commission, employers, private health insurers, and the health care system more generally by saving at least $1 billion over a six-year period.”
Other steps the Legislature should take to boost access to screening and treatment for MMHCs include:
Improving access to group-based prenatal care and pediatric care, such as CenteringPregnancy and CenteringParenting;
Leveraging the existing structure of Texas’ Child Psychiatry Access Network (CPAN) to serve moms with MMHCs. CPAN enables health providers and trained psychiatrists to connect via teleconsultation so they can better manage and serve clients with mental health conditions;
Fully funding Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, and the state staff to enroll eligible women in these programs;
Accepting federal Medicaid expansion funding at a 90 percent match to provide an insurance option to low-wage workers, and
Ensuring that health care and mental health services are developed and provided in a culturally responsive way that reflects the input and needs of Black women and other women of color who are at higher risk of experiencing untreated MMHCs.
Additional information on postpartum maternal behavioral health challenges and recommendations specifically in Central Texas is available in this 2019 report published by Texans Care for Children in collaboration with the St. David’s Foundation.
We are grateful to St. David’s Foundation for supporting this critical research and to Mathematica for conducting and publishing this important analysis!