Texas’s application for extending postpartum Medicaid coverage to 6 months remains under CMS review


Boram Kim


Last week CMS indicated that Texas Health and Human Services Commission’s (HHSC) application to extend Medicaid coverage for new mothers from 2 to 6 months would not be approved in its current form. 


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HHSC said on Thursday that CMS informed them that the application would not be approved but did not offer specifics as to the reasons why. Governor Greg Abbott soon afterwards released the following statement. 

“The Biden Administration is risking robbing mothers of services that Texas specifically extended for them post-partum,” Abbott said. “It risks the lives and health of Texas women and their babies all for the sake of a political agenda. Last session, I worked with the legislature to pass into law bipartisan legislation to extend Medicaid health care coverage to six months post-partum and also provide $345 million for women’s health programs. President Biden must immediately direct his administration to reverse this unconscionable move, or get ready for a fight with Texas.”

The Texas House of Representatives passed a bill last session extending postpartum health care via Medicaid from 2 to 12 months. The legislation was modified in the Senate and amended to 6 months of coverage before it was passed. The legislation required Texas to seek approval for the extension from CMS. House Speaker Dade Phelan (R – Beaumont) reiterated the governor’s sentiment on Twitter, indicating he plans once again to push for extending postpartum Medicaid coverage to 12 months in the next legislative session. 

However, CMS said on Friday that the application remains under review and that no decision has been made. 

The state’s 6 month coverage extension falls short of the federal government’s 12 month recommendation for postpartum care for women and children. Texas is 1 of 12 states that has not expanded Medicaid coverage under the Affordable Care Act to additional people with low incomes. 

Medicaid in Texas serves mostly low-income children and has some of the strictest eligibility requirements in the country. For example, single parents with one child must earn $196 or less per month to qualify.

Pregnant Texans are more likely to be uninsured and less likely to seek early prenatal care than the rest of the country, and the state has staggering rates of maternal mortality and morbidity, especially among Black women. Nearly half of all births in the state are covered by Medicaid. Expanding postpartum Medicaid to 1 year was one of the top recommendations of the state’s Maternal Mortality and Morbidity Review Committee. 

Currently, the ongoing federal Public Health Emergency is keeping an estimated 1 million Texans enrolled in Medicaid. Texas health policy advocates say without Medicaid expansion, widespread coverage loss would have devastating effects on the state’s health system when PHE imminently ends.

“When individuals lose Medicaid coverage, have a gap in coverage and then re-enroll, their health care costs are often higher than if they received continuous coverage,” wrote Melissa McChesney, Health Policy Advisor to HHSCA for UnidosUS, back in January. “A gap in coverage may lead to interruptions in access to medications, therapies, and other medical treatments. Delayed or skipped treatment often leads to worsening conditions and greater use of high-cost care. Safety net providers, already reeling from pandemic-related disruptions and demands, would face increased uncompensated care.”