By Elena Marks
EHF’s president and CEO
At the beginning of each legislative session, EHF identifies issues relating to our strategic plan that may be impacted during the session. This year, we were following bills relating to health insurance including Medicaid; mental health; women’s health/maternal mortality; and early childhood brain development. We knew the session would be devoted to school finance and there wasn’t likely to be funding or bandwidth to deal with health, and that held true. While many opportunities to advance health for low income and vulnerable populations were missed, there were some improvements.
Health Insurance and Medicaid
This is the area we watch the closest because of Texas’ distinction of being the state with the highest percentage and number of uninsured people. The legislature refused to make a relatively modest adjustment to Medicaid coverage to reduce maternal mortality rates. It also failed to address an administrative problem that has resulted in thousands of eligible children being dropped from Medicaid each month and having to delay care while they are re-enrolled. You can learn more about the problem here in an opinion column written by me and Earl Maxwell, CEO of St. David’s Foundation in Austin.
On the positive side, the legislature did pass a bill to address the problem of “surprise medical bills.” Surprise medical bills happen when out-of-network providers and insurance companies can’t agree on the price of a service, leaving patients to resolve the dispute or pay out of pocket. The new legislation takes patients out of the middle of the battle. Similar legislation is likely to pass the U.S. Congress, which means that virtually all health insurance plans will be subject to these rules.
There were also bills passed to require Medicaid to reimburse for telehealth services, make improvements to the Medicaid program for disabled children, and enhance the consumer experience in Medicaid.
Over the last several sessions, the state has increased its investment in mental and behavioral health services. Forward progress continued this session. Below are highlights:
– SB 10: Establishes a Texas Child Mental Health Care Consortium among health science and medical schools to increase children’s access to mental healthcare
– HB 18: Increased resources for school-based mental health services including counseling program and training for school employees
– SB 633: Increase the capacity of local mental health authorities
– SB 1177: Allows Medicaid the flexibility to cover home- or community-based mental health services.
Women’s Health – Maternal Mortality
Texas has one of the nation’s highest maternal mortality rates, particularly among lower-income and African American women. Many of these deaths are attributable to underlying medical conditions that are exacerbated by pregnancy or arise during or shortly after delivery—and they are preventable. A statewide task force led by Dr. Lisa Hollier (Texas Children’s Hospital and president of the American Council of Obstetrics and Gynecologists) examined the issue and concluded that a primary cause was that the women were out of care due to lack of insurance before and after their pregnancies. Texas Medicaid covers low-income women only during their pregnancies and for 60 days after delivery, but not before or after. Most of these women are uninsured outside of the time of their pregnancies, so they may enter pregnancy in suboptimal health and shortly after delivery they are unable to access care because their Medicaid coverage expires. The task force recommended that Medicaid coverage for low-income pregnant women be extended to 12 months, rather than 60 days post-partum. This would not require a wholesale expansion of Medicaid to new populations, only an extension of 10 months of coverage for these already eligible and enrolled women. Unfortunately, the bills that would have accomplished this were not passed. Instead, the legislature passed “small bills” that may bring about small improvements including the following:
– HB 25: Creates a pilot program to improve medical transportation for prenatal and postpartum care
– HB 253: Improves screening, referral, and treatment for postpartum depression
– HB 1111: Establishes a pregnancy medical home pilot program to coordinate maternity care, improve care coordination for high-risk pregnancies, and directs HHSC to develop a prenatal/postpartum telehealth program
– SB 750: Directs the Health and Human Services Commission (HHSC) to make several changes to the Healthy Texas Women (HTW) program to improve maternal health including:
- Developing strategies to ensure continuity of care for postpartum transition from Medicaid into HTW
- Assessing the feasibility and cost-effectiveness of contracting with Medicaid Managed Care organizations to provide HTW through managed care (if the HTW 1115 Waiver is approved)
- Developing a postpartum depression treatment network for women in HTW
- Developing initiatives that require managed care organizations to address social determinants of health, maternal health disparities, or prenatal/postpartum care rates
- Renaming Maternal Mortality and Morbidity “Task Force” to “review committee”
- Applying to the federal government for any federal money available to improve care for opioid addicted mothers and their children
Early Childhood Brain Development
Most of the attention given by the legislature to early childhood brain development is focused on maternal health or child abuse prevention efforts. This session, there were gains in support for new mothers with post-partum depression, as well as bills to address avoidance of adverse childhood experiences which impede healthy brain development. We are working with our partners (experts and grantees) to prepare an educational program for legislators to make them more receptive to additional investment in home visiting and other programs that build healthy brains.
While EHF does not work in the school/childcare space, we were happy that there was additional investment in pre-K that will enable more children to attend publicly funded pre-K programs.