All Texas moms, no matter our race, income, or hometown, deserve the healthiest pregnancy and birth possible so that we can thrive and help our families do the same. Underlying inequities rooted in racism drive devastating disparities in maternal and infant health, pregnancy-related deaths, and health insurance coverage.
The Governor signed House Bill 12 by Representative Toni Rose into law this summer, a crucial step forward in extending a mom’s Medicaid health coverage from 2 to 12 months following pregnancy. This is great news. It means new moms will be able to continue seeing their doctors, taking their medications, and have access to comprehensive health care services for challenges that come up during the postpartum period. House Speaker Dade Phelan made the bill a priority in the House for the last two legislative sessions. We are enormously grateful to our partners at Texans Care for Children, The Aifya Center, and many others for their sustained advocacy for maternal coverage over the years.
What’s in HB 12?
HB 12 reflects the top recommendation of the Texas Maternal Mortality and Morbidity Review Committee to address the higher rate of maternal mortality among Black women and prevent maternal deaths. Data on outcomes and inequities are crucial to understanding the problem in Texas and in crafting solutions.
- Black women in Texas are twice as likely as white women, and four times as likely as Latinas, to die from pregnancy-related causes.
- Black women in Texas are twice as likely as white women to experience severe pregnancy-related complications including hemorrhage, preeclampsia and sepsis.
An abortion-related amendment added to HB 12 on the Senate floor threatened to derail the coverage extension, but the conference committee carefully worked out a way where Texas will benefit from the fast-track Medicaid “State Plan Amendment” to get federal approval and follow standard Medicaid postpartum policy, which entails 12 full months of coverage and protections for anyone enrolled in ‘Medicaid for Pregnant Women’ no matter the pregnancy outcome.
HB 12 helps the Lonestar State catch up on postpartum coverage: 36 states (including Washington, DC) have already implemented a Medicaid extension to 12-months postpartum, and ten others are working on it (Texas included). Texas’ postpartum coverage extension can’t take effect until the state submits its State Plan Amendment request to the federal Medicaid agency (which had not been done as of this writing) and wins federal approval. Texas plans to have extended postpartum coverage effective in early 2024.
Unfortunately, this timeline doesn’t make sense with Texas’ self-imposed Medicaid unwinding timeline. Texas Health & Human Services Commision (HHSC) sent unwinding Medicaid renewals to moms who are 2-12 months postpartum in July and August 2023, and most will lose coverage by October. Once HB 12 coverage takes effect, HHSC will have to reinstate coverage for moms recently removed from the program who are still less than 12 months postpartum. This adds an unnecessary workload to an eligibility system already under tremendous strain.
The Bottom Line
One year of postpartum Medicaid health coverage is a big step forward, but even after HB 12 coverage goes into place, there will still be a long way to go to make sure women have coverage in line with the Maternal Mortality and Morbidity Review Committee’s top recommendation before, during, and after pregnancy. Most Texas women with wages below the poverty line don’t qualify for coverage before they are pregnant and may start prenatal care later than recommended while waiting for applications to go through. Expanding Medicaid to cover low-wage moms, dads, and other adults is supported by 73% of voters, and would expand eligibility to 1.4 million uninsured Texans. It is the single most powerful policy tool Texas can leverage to reduce the number of uninsured Texans.