Texan lawmakers disagreed on how long health insurance should be extended for new mothers

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Texas mothers on Medicaid could keep their health insurance for six months after giving birth, instead of just two months, according to a bill that the Senate will hear on Monday.

Maternal health advocates said the bill – originally intended as a one-year extension – could lower the state’s maternal mortality rate and provide vital help to mothers who grapple with conditions such as postpartum depression or health complications in the months after giving birth.

Medicaid covers low-income women from pregnancy to two months after delivery, although one-third of maternal deaths occurred 43 days or more after giving birth in Texas.

The six-month extension of the Senate version of House Bill 133 is stingier than a proposal that the House largely passed earlier this year with the support of the Republican House spokesman. This would give the mothers a full year after giving birth as recommended by Experts | and a State Committee is dedicated to the study of maternal mortality.

The difference must be eliminated before the bill can become law.

“I’m still a little confused about why the arbitrary six-month cut was introduced,” said a House proposal writer, Rep. Shawn Thierry, D-Houston, shortly after the change was unveiled. “If you are concerned about the cost, let me reiterate that having 12 months of postpartum health coverage for women is relieving the pressure on our Texas healthcare system because we know women get the right care early on reduces complications, reduces hospital stays, reduces other illnesses, and reduces deaths. “

The Senate version of the bill is expected to cost the state $ 49 million in 2026 once it is fully ramped up. The more expansive house measure is expected to cost less than $ 90 million this year.

The Senate sponsor of the law didn’t respond to a request for comment from her office, but said last week, “We think it’s good and right and it protects children.”

The Chairman of the Senate, Lt. Gov. Dan Patrick said in a Television interview that he supports the bill, but the extension of the benefit must be less than a year.

The proposal affects tens of thousands of women in Texas, where most of the uninsured residents in the country live. About half of babies in Texas are born to mothers on Medicaid – roughly 181,000 in 2018.

Experts and studies have found that maternal mortality in the US is higher than other high-income countries and that many maternal deaths are preventable. The risk is particularly acute for black and indigenous women two to three times more likely to die than white women. A state report Suicide, drug overdose, and heart problems are causes of pregnancy-related deaths in Texas.

Maternal health advocates also say that women who were previously uninsured may find out that they have undiagnosed health issues during pregnancy and after receiving Medicaid coverage, but cannot treat the issues before their coverage expires.

Dr. Lisa Hollier, chair of the state committee for the review of maternal mortality and morbidity, previously told The Texas Tribune that there are complications like heart disease and mental illness that are more likely to show up well after delivery.

“It’s really important that women have access to all the services … like emergency rooms, like hospitalization, that can really help them recover from their heart disease or recover from their postpartum depression,” said Hollier.

There is a Texas program, HTW Plus, which offers mothers one year of coverage for mood or substance abuse, diabetes, asthma, and cardiovascular disease. Hollier said it was an “outpatient package” that was helpful but limited. Medicaid offers the same services and additional medication, testing, and hospitalization not covered by the state program, she said.

Proponents have said that the state program has almost no network of specialty providers or mental health care providers to deliver these services.

However, the federal government is urging states to offer mothers on Medicaid two-month postpartum coverage several states tried to extend that to a year.

In the 38 states that have expanded Medicaid, mothers who make up 138% of federal poverty – about $ 3,000 per month for a family of four – can continue to qualify as parents for Medicaid after birth.

But in Texas one of a Dozen states If you’ve chosen not to expand Medicaid, parents must be well below the federal poverty line to qualify for Medicaid – about $ 200 a month for a mother with one child. Childless adults are generally ineligible regardless of their income.

HB 133 is passed after lawmakers have made broader efforts to extend Medicaid to working poor Texans. Longtime proponents say this would give people better access to prevention rather than resorting to costly trips to the emergency room. Opponents say Medicaid is a poorly managed program and financially unsustainable.

Maternal health advocates welcomed six-month health insurance for new mothers, but said it was not enough.

“Another four months is certainly better than mothers doing 60 days after birth, but it is clear that treating the physical and mental health of mothers for a full year after birth is critical to their health and baby development said Stephanie Rubin, executive director of advocacy group Texans Care for Children. A year of full follow-up is the top recommendation of a maternal mortality committee appointed by the state’s Republican governor, she said.

Cindy Zavala, 19, said six months was not long enough to address health concerns that arise after giving birth.

The El Paso resident gave birth to a son, Leonel, in November 2019, but returned to her doctor six months later with bladder pain. She decided to wait for the pain – thinking it might have been caused by carrying the baby or an intrauterine device that she inserted and removed after delivery. But the pain didn’t go away until her doctor gave her birth control pills last fall.

Zavala continued to have health coverage because the federal government temporarily banned states from throwing new mothers from Medicaid during the coronavirus pandemic.

She’s not sure what she would have done without it.

“When you are breastfeeding, you still have a lot of hormones in your body, so after six months there are still a lot of things happening to the mother’s body,” she said.

A federal discharge bill passed earlier this year encouraged states to extend postpartum Medicaid coverage to one year by avoiding a lengthy and cumbersome process that they would normally have to go through. It is unclear whether the streamlined process applies to the six-month extension.

The Senate amended bill also includes provisions from a separate measure to move Medicaid case management for children and pregnant women to a managed care model. The same applies to the state program “Healthy Texas Women”.

Disclosure: Texans Care for Children was a financial supporter of The Texas Tribune, a nonprofit, non-partisan news organization funded in part by donations from members, foundations, and corporate sponsors. Financial supporters play no role in the journalism of the Tribune. A full list can be found here.