Texas families currently experience higher birth rates, preterm births, and maternal mortality as compared to the rest of the US. The weight of these experiences are disproportionately felt by the state’s underserved communities - including low-income families and families of color - and it is anticipated that disparities will only worsen in the context of Texas’ deepening maternity care “deserts” and mounting restrictions on reproductive healthcare. Indeed, as stressors on Texas’ maternity care services continue to stack up, ensuring high-quality maternity care for the state’s underserved communities is absolutely essential.
Medicaid is Texas’ primary vehicle for providing maternity care for underserved communities – providing coverage for half of all Texas mothers. Moreover, Texas is unique in that nearly 100% of Medicaid beneficiaries are enrolled in Medicaid managed care. Medicaid managed care therefore emerges as an extremely powerful tool in Texas for improving maternal and infant health.
In this context, The Geiger Gibson Program (GGP) in Community Health at George Washington University and the Episcopal Health Foundation (EHF) partnered to explore the extent to which Texas’ Medicaid managed care program addresses key aspects of maternity care. Building on a study conducted with The Commonwealth Fund, the GGP team conducted an extensive review of Texas’ standard managed care contracts, analyzing the contractual requirements Medicaid health plans are held to by the state across 35 key maternity topics. The team compared Texas’ contractual language to the contractual requirements in the 38 other states and DC using Medicaid managed care as of 2022.
In discussion with the Texas Association of Community Health Centers, and in light of more recent policy developments (identified below), the GGP conducted focus group with key health center representatives to assess their concerns, knowledge of maternity payment modalities, and thoughts about opportunities for strengthening maternity care. The following highlight key opportunities and challenges from the contract reviews and focus group discussions.
