FEATURED: New Texas mothers who are Medicaid recipients would receive better access to primary and preventative care – for up to 12 months instead of the current two months after giving birth – under a measure supported by Valley legislators and DHR Health leaders that was signed into law on Sunday, June 18, 2023 by Gov. Greg Abbott. The governor is shown here on Monday, June 12, 2023 at the Texas Capitol.
Photograph GOV. GREG ABBOTT FACEBOOK
Expansion of Medicaid health insurance for eligible mothers for a year after giving birth, which was supported by Valley legislators and DHR Health, signed into law by Gov. Abbott
New Texas mothers who are Medicaid recipients would receive better access to primary and preventative care – for up to 12 months instead of the current two months after giving birth – under a measure supported by DHR Health leaders that was signed into law on Sunday, June 18, 2023 by Gov. Greg Abbott.
Medicaid is the largest payer for maternity care in the United States. The program has an important role to play in improving maternal and perinatal health outcomes. Timely postpartum visits provide an opportunity to assess a woman’s physical recovery from pregnancy and childbirth.
Perinatal health is the health of women and babies before, during, and after birth.
Postpartum care is defined as a range of important health needs, including recovery from childbirth, follow up on pregnancy complications, management of chronic health conditions, access to family planning, and addressing mental health conditions.
All state senators and state representatives whose legislative districts include portions of the Rio Grande Valley voted for House Bill 12.
The measure, which went into effect immediately, requires the Health and Human Services Commission (HHSC) to continue Medicaid coverage to women enrolled during a pregnancy for at least 12 months, beginning the last day of the woman’s pregnancy, according to a bill analysis of the legislation.
“It has been a journey, yet incredibly worthwhile as House Bill 12 made it across the finish line today,” said Rep. Toni Rose, D-Dallas, in a posting on her Facebook. “(I am) elated House Bill 12, which expands Medicaid coverage from two to 12 months after the end of a pregnancy, has been signed by the governor.”
Governor Abbott, the Texas GOP platform, Texas Democrats’ platform, and the Texas Maternal Mortality and Morbidity Review Committee had all called for extending new moms’ health coverage to 12 months. Thirty-eight other states, including Florida, Alabama, South Carolina and Oklahoma, have all passed the 12-month extension.
Rose is the primary author of House Bill 12.
As the author ofHouse Bill 12, she is the legislator who filed the bill and is guiding it through the legislative process (also called the primary author).
Filed” is used to refer to a measure that has been introduced into the legislative process and given a number
Legislation is a proposed or enacted law or group of laws.
A bill is type of legislative measure that requires passage by the Texas Senate and the Texas House of Representatives and action by the governor in order to become effective. A bill is the primary means used to create and change the laws of the state.
A bill analysis is document prepared for all bills and joint resolutions reported out of committee. A bill analysis may include background information on the measure, a statement of purpose or intent, and an analysis of the content of the measure.
Following the passage earlier in the spring – on Friday, April 21, 2023 – of House Bill 12 by the House of Representatives, Dr. Carlos Cárdenas, MD, and Chair, Board of Managers, DHR Health, said the goal of House Bill 12 would be “fantastic” for women patients and their loved ones.
“We know that if we can extend Medicaid coverage to our most vulnerable – children after they are born – and give that ability to their new mothers, we can have a significant impact on the health of the child. That translates into higher performances as they grow,” he said.
Doctors Hospital at Renaissance, Ltd (“DHR”) and its general partner, RGV Med, Inc. (“RGV Med”) own and operate a 583 licensed beds in five hospitals across the Rio Grande Valley. DHR Health is one of the nation’s largest independent health systems and the largest physician-owned hospitals in the United States.
“It’s absolutely imperative that we do this. I am very, very supportive of moving forward to 12 months – we’d love to get 18 months if at all possible. But 12 months would be fantastic,” DHR Health’s Dr. Cárdenas continued. “It would double where we are now. It was something that was a Texas Medical Association (TMA) initiative as well, going back to when I was president of the TMA. To come to fruition is something that we are very, very supportive. I think it’s visionary and a great move for our Legislature to do the right thing for children and women.”
The Texas Medical Association is a professional nonprofit organization representing more than 55,000 physicians, residents, medical student and alliance members. It is located in Austin, has 110 component county medical societies around the state, and is the largest state medical society in the United States.
According to the House Research Organization, which is the nonpartisan research arm of the House of Representatives:
• House Bill 12 extends postpartum Medicaid coverage to 12 months after the end of a pregnancy for people who are currently eligible for Medicaid, which could lower maternal morbidity and mortality rates in the state and save lives.
• Many pregnancy related deaths are preventable, and providing comprehensive health care after delivery could improve pregnancy outcomes. The bill would give Medicaid recipients better access to primary and preventative care during and after pregnancy, which could reduce health care costs by preventing more pregnancy complications. Comprehensive postpartum coverage also could reduce racial disparities in health outcomes for pregnant people.
• Last session (in 2021), the Legislature extended postpartum Medicaid coverage from two months to six months after the end of a pregnancy. This required the state to apply for a federal Medicaid waiver, which has not yet been approved. Extending postpartum coverage to 12 months would allow the state to apply for a state plan amendment, which would require a much more expedient response from the federal government.
• Over the last several years, policymakers, researchers, and the public have focused considerable attention on the number of maternal deaths and adverse health outcomes resulting from pregnancy and delivery in Texas. For example, the Maternal Mortality and Morbidity Review Committee and the Department of State Health Services jointly submitted a report in 2022 that found that 44 percent of maternal death cases reviewed occurring within one year of pregnancy were identified as pregnancy?related and that there was a chance for preventability in 90 percent of the reviewed pregnancy-related deaths.
Additionally, the Medicaid and CHIP Payment and Access Commission has recommended that Medicaid coverage be provided for 12 months postpartum, and the U.S. Congress enacted legislation in 2021 giving states the option to provide 12 months of coverage through a state Medicaid plan amendment. HouseBill 12 now provides for this 12 months of postpartum Medicaid coverage for women in Texas.
CHIP, the Children’s Health Insurance Program, covers children in families that earn too much money to qualify for Medicaid but cannot afford to buy private insurance.
Sen. Lois Kolkhorst, R-Brenham, who is Chair, Senate Committee on Health and Human Services, was the Senate sponsor of House Bill 12. As sponsor, her role was to get Senate approval for House Bill 12.
Sen. Juan Hinojosa, D-McAllen, and Sen. Judith Zaffirini, D-Laredo/Starr County, were Senate cosponsors of House Bill 12. As cosponsors, they helped Kolkhorst secure passage of House Bill 12 in the Senate.
More about DHR Health
DHR Health is a health system that operates two general acute hospitals, the only dedicated women’s hospital south of San Antonio, a rehabilitation hospital, a behavioral hospital, and more than 70 clinics Valley-wide.
DHR Health offers the most comprehensive and advanced healthcare services in the Rio Grande Valley including – but not limited to – advanced cancer services, the only transplant program in the Rio Grande Valley, and as of September 8, 2021, the first 24/7 Designated Level One Trauma Center south of San Antonio.
On Tuesday, November 16, 2021, Driscoll Health System held a groundbreaking ceremony for Driscoll Children’s Hospital Rio Grande Valley, located at 2820 W. Michelangelo Drive in Edinburg, which is being built on the site of the DHR Health campus, next to DHR Health’s The Women’s Hospital at Renaissance. DHR Health was instrumental in working with Driscoll Children’s Hospital to bring the first true freestanding children’s hospital to the Valley.
The new, independently operated eight-level pediatric hospital will further the mission of Driscoll Children’s Hospital founder Clara Driscoll to provide medical care to all the children of South Texas. The building is expected to be completed later in 2023. The Driscoll Children’s Hospital Rio Grande Valley represents a combined investment of more than $105 million with DHR Heath. Driscoll Children’s Hospital Rio Grande Valley will operate with more than 500 employees, creating significant economic impact and new job opportunities for clinical, ancillary and support staff in the Valley.
Dr. Cárdenas Biographical Sketch
Dr. Carlos J. Cárdenas, MD, has almost 30 years of experience in medicine and health care management.
He was raised in McAllen, and earned his Bachelor of Arts degree in Biology from Austin College in Sherman, Texas. Following his undergraduate studies, he attended and graduated medical school from the University of Texas Medical Branch in Galveston, Texas.
He began his medical career as an intern and resident at Scott & White Memorial Hospital in Temple, Texas, in 1985.
In general, an intern is defined as a medial doctor in their first year of residency after graduating from medical school, while a resident is a doctor in residency at a hospital or other medical facility. Interns are in their first year of medical training post-medical school and are sometimes referred to as first-year residents.
Dr. Cárdenas became a board certified internal medicine specialist in 1988, and has served as an internal medicine physician in various medical organizations since 1991.
He co-founded South Texas Gastroenterology Associates in 1992, where he is actively practicing.
Dr. Cárdenas served as President of the Hidalgo – Starr Medical Society in 2001, and was elected to the Board of Trustees of the Texas Medical Association in 2005. He was president-elect of the Texas Medical Association in 2016 and served as president of the association in 2017-18.
Dr. Cárdenas serves as Chair, Board of Managers, Doctors Hospital at Renaissance.
He was one of seven physicians who helped found Day Surgery at Renaissance, LLC.
Legislative Budget Board analysis of House Bill 12
Another resource for the Texas Legislature and the public to obtain details about how much money it will cost the state and/or local governments and other related information to put new laws into effect is the Legislative Budget Board, also known as the LBB.
The Legislative Budget Board is a permanent joint committee of the Texas Legislature and is co-chaired by the Lieutenant Governor and the Speaker of the House. The remaining board members are specified to include the chair of the Senate Finance Committee; the chair of the House Appropriations Committee; the char of the House Ways and Means Committee; three members of the Senate appointed by the Lieutenant Governor; and two members of the House appointed by the Speaker.
Among its major duties, the Legislative Budget Board develops budget and policy recommendations for legislative appropriations, completes fiscal analyses for proposed legislation, conducts evaluations and reviews to improve the efficiency and performance of state and local operations, and adopts constitutional and statutory spending limits.
A bill analysis is a document prepared for all bills and joint resolutions reported out of committee. A bill analysis may include background information on the measure, a statement of purpose or intent, and an analysis of the content of the measure.
What follows is the fiscal note, dated Saturday, May 27, 2023, by the Legislative Budget Board about House Bill 12.
The fiscal note is an estimate prepared by the Legislative Budget Board of the probable costs or savings or the probable revenue gains or losses that will be incurred as an effect of a bill or joint resolution.
A joint resolution is a type of legislative measure that requires adoption by both the Senate and House of Representatives, but does not require action by the governor.
A joint resolution is used to propose amendments to the Texas Constitution, ratify amendments to the U.S. Constitution, or request a constitutional convention to propose amendments to the U.S. Constitution.
Before becoming effective, the provisions of joint resolutions proposing amendments to the Texas Constitution must be approved by the voters of Texas.
The bill requires the Health and Human Services Commission (HHSC) to continue Medicaid coverage to women enrolled during a pregnancy for at least 12 months, beginning the last day of the woman’s pregnancy.
The bill requires HHSC to seek a state plan amendment (SPA) to implement the bill.
It is assumed services would begin March 1, 2024. The additional average monthly caseload associated with extended coverage is estimated to be 27,147 in fiscal year 2024, increasing to an average of 121,623 in fiscal years 2025 to 2028.
The average monthly cost per recipient is estimated to be $261.20 in fiscal year 2024, increasing in each subsequent year to $277.06 in fiscal year 2028.
The total estimated cost of the extended coverage for client services is estimated to be $85.1 million in All Funds, including $33.4 million in General Revenue, in fiscal year 2024 increasing in each subsequent year to $405.4 million in All Funds, including $162.8 million in General Revenue, by fiscal year 2028.
The bill is estimated to reduce the number of clients served in Healthy Texas Women (HTW), since eligible women would not transition until 12 months after their pregnancy ends.
Postpartum services provided in HTW Plus will also decrease to only those women who are not enrolled in Medicaid for Pregnant Women.
Savings to the Healthy Texas Women program assume a mix of General Revenue and Federal Funds and is estimated to be $6.3 million in All Funds, including $2.9 million in General Revenue, in fiscal year 2024, increasing in subsequent years to $13.3 million in All Funds, including $12.1 million in General Revenue, in fiscal year 2028.
The net increases in client services payments through managed care are assumed to result in an increase to insurance premium tax revenue, estimated as 1.75 percent of the increased managed care expenditures.
Revenue is adjusted for assumed timing of payments and prepayments resulting in increased collections estimated to be $6.6 million in fiscal year 2025, $7.7 million in fiscal year 2026, $2.5 million in fiscal year 2027, and $4.0 million in fiscal year 2028. Pursuant to Section 227.001(b), Insurance Code, 25 percent of the revenue is assumed to be deposited to the credit of the Foundation School Fund.
HHSC will be required to submit Medicaid and Children’s Health Insurance Program (CHIP) state plan amendments and an 1115 waiver amendment to the Centers for Medicare and Medicaid Services. It is assumed that any costs associated with this process could be absorbed using existing resources.
HHSC estimates that there will be a onetime cost of $461,000 in All Funds, $188,552 in General Revenue, to make application and systems modifications to the Texas Integrated Eligibility Redesign System (TIERS) and the Eligibility Supported Technologies (EST) in fiscal year 2024.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.