As the public health emergency winds down, millions risk losing Medicaid coverage, not because they no longer qualify but because they get caught in the redetermination process once continuous coverage ends. However, one population faces continual risk for interrupted coverage — pregnant Texas women. When a member loses their Medicaid benefits and then re-enrolls within a short period of time, it is referred to as churn, and it is particularly common in states that have not expanded Medicaid coverage for postpartum women.
In Texas, new data suggests almost 90% of Texas women whose pregnancies were covered by Medicaid found themselves uninsured during some point in the first year after their deliveries.
In the 12 states that have not expanded Medicaid (Texas included), women remain at higher risk of losing coverage after childbirth, resulting in adverse health outcomes compounded by churn. Postpartum women report experiencing acute and ongoing conditions, undiagnosed concerns, pregnancy and reproductive health, mental health, and weight/lifestyle concerns. Financial hardships and health insurance churn make accessing care for these new moms nearly impossible. This is particularly concerning in Texas, given that disparities persist in maternal mortality among low-income women of color.
Texas moms deserve coverage that is comprehensive and includes increased access to prenatal care and education. As a result, more expectant moms receive prenatal care and education — and receive it earlier — helping Texas mothers deliver healthier babies. Prior to Medicaid managed care, Texas Medicaid operated under a fee-for-service system in which less than 15% of women received timely prenatal care. Today, because of managed care, 90% of expecting mothers in Medicaid receive timely prenatal care. Texas Medicaid also connects at-risk pregnant mothers with special doctors, support systems, and highly trained individuals in their local community who can help these moms make the healthiest choices for themselves and their babies.
Texas has taken steps to improve access to timely prenatal care and postpartum care for low-income women. SB 750 (86R) directed the improvement of data on maternal health and causes of death. It also established Healthy Texas Women Plus, which covers some health services (including screening and treatment for hypertension, postpartum depression, and substance use disorders) for postpartum women with low incomes (200% above the federal poverty level, or $36,620 for a family of 2) in the 12 months after childbirth. Most recently, HB 133 (87R) extended Medicaid coverage for women by 4 months to allow for a total of 6 months of postpartum coverage. On Thursday, the House Human Services Committee will hold a hearing on a number of Medicaid issues including the implementation of HB 133.
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