Findings from the 2026 Survey of Texas Medicaid Managed Care Organizations (MCOs) indicate continued progress in how health plans identify and respond to non-medical drivers of health (NMDOH), alongside persistent operational and policy barriers that limit scale and sustainability.
- Food insecurity remains the most frequently identified NMDOH need, followed by
childcare, transportation, and difficulty paying utilities. The elevated ranking of childcare reflects the impact of HB 1575’s standardized screening requirements for pregnant members. - Implementation of HB 1575 has significantly expanded NMDOH screening and formally integrated community health workers (CHWs) and doulas into Medicaid case management. However, MCOs report ongoing challenges related to provider enrollment, billing, limited provider capacity, and concerns about duplication with existing service coordination functions.
- Administrative burden and data-sharing limitations persist across survey years,
particularly for provider-based screening and referrals to community-based organizations (CBOs). MCOs continue to cite lack of interoperability, inconsistent data standards, and limited CBO infrastructure as major constraints. - MCOs continue to invest in NMDOH interventions through value-added services (VAS), performance improvement programs (PIPs), and quality improvement (QI) activities, but report uncertainty about how to classify NMDOH investments as allowable Medicaid costs— especially when working with non-traditional providers.
- Interest in nutrition-related in-lieu of services (ILOS) authorized under HB 26 is high, but MCOs emphasized that participation will depend on timely, clear guidance from HHSC regarding eligible provider types, billing codes, reporting requirements, and
cost-effectiveness expectations.
While recent legislation has created important new opportunities to address NMDOH in Texas Medicaid, survey findings suggest that policy authorization alone is insufficient. Clear guidance, operational flexibility, and targeted technical assistance will be necessary to translate these policy changes into sustainable, scalable practice.
As the Texas MCO NMDOH Learning Collaborative enters its seventh year, these findings will inform targeted convenings, implementation support, and policy recommendations aimed at strengthening NMDOH infrastructure and improving outcomes for Medicaid members.