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Texas House OKs Medicaid coverage expansion for mothers until one year postpartum

Madlin Mekelburg
Austin American-Statesman
The Texas House gave initial approval to a bill that would extend Medicaid coverage to mothers for up to a year postpartum. Currently, mothers lose coverage after two months in Texas.

The Texas House on Thursday approved a bill to extend Medicaid coverage to eligible women for at least one year after giving birth or experiencing a miscarriage, a move advocates say could reduce the state’s maternal mortality rate.

Currently, eligible low-income women in Texas lose Medicaid coverage 60 days after pregnancy.

“For the past few years, I’ve heard from families across the state who have lost loved ones due to complications of childbirth,” said Rep. Toni Rose, D-Dallas, author of House Bill 133. “Believe me when I say that this issue knows no political or geographical boundaries.”

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Health experts and advocates have pushed for years for lawmakers to expand coverage, citing state health data that shows one third of maternal deaths in Texas occur between 43 days and one year after pregnancy.

A similar bill was unsuccessful in 2019.

Lawmakers voted 121-24 to approve House Bill 133, sending the bill to the Senate for consideration. An identical bill filed by Sen. Nathan Johnson, D-Dallas, has not received a committee hearing in the Senate.

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Qualifying for coverage

Texas has narrow eligibility criteria to determine whether an individual qualifies for coverage under Medicaid, the joint state-federal program that provides health care to some low-income and disabled people.

To qualify for benefits through the program in Texas, an individual must have an annual income below a certain threshold and also must be either pregnant, a parent or caretaker of children, have a disability or a family member with a disability, or be 65 years old or older.

Pregnant women can qualify for free health coverage through Medicaid for Pregnant Women, which makes coverage available for women during pregnancy and for two months after birth if they fall under certain monthly income thresholds based on family size ($2,126 or less for a single woman or $3,624 for a family of three).

But to qualify after two months, the income threshold is significantly lower: $196 a month for a mother with one child or $230 for a mother with two children ($285 a month for a two-parent household with two children).

HB 133 would cost the state an estimated $84 million over the next two years, should lawmakers decide to appropriate the funds, according to a fiscal analysis produced by the Legislative Budget Board.

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Maternal mortality

Extending this Medicaid coverage has been the top recommendation from the Texas Maternal Mortality and Morbidity Review Committee to lawmakers for the past three legislative sessions.

The committee was established in 2013 under the Texas Department of State Health Services and issued its first recommendations to lawmakers in 2016, urging them to “increase access to health services during the year after delivery and throughout the interconception period to improve continuity of care, enable effective care transitions, promote safe birth spacing, reduce maternal morbidity, and reduce the cost of care in the Medicaid program.”

As part of that recommendation, the experts on the state panel said Texas should expand Medicaid coverage for women one year postpartum.

The group issued nearly identical recommendations in 2018 and 2020.

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The maternal mortality rate in Texas is above the national average, according to data from the U.S. Centers for Disease Control and Prevention.

In 2018, the estimated maternal mortality rate (women who died while pregnant or within 42 days of delivery) was 17.4 deaths per 100,000 live births and in Texas it was 18.5 deaths — that’s nearly 700 deaths nationally and about 70 in Texas that year.

But looking more broadly at women who died while pregnant or within one year of delivery, those numbers increase. During that time in 2018, an estimated 935 women died in the United States and an estimated 92 died in Texas.