5 Things Texas: Food insecurity, Vaccine mandates, Youth behavioral health


Eli Kirshbaum


This edition of “5 Things We’re Watching” includes the Feeding Texas CEO’s thoughts on food insecurity in the state, Texas hospitals’ response to Gov. Abbott’s ongoing push to prohibit vaccine mandates, and a story on how the recently approved Proposition 6 could blur the rules concerning visitation in assisted living facilities.

Please don’t hesitate to reach out to me with feedback or story ideas. Thank you very much for reading


Eli Kirshbaum
Health Policy Reporter

1. Q&A: Feeding Texas CEO on food insecurity

Gov. Abbott’s continued extension of emergency SNAP benefits has been critical in supporting food-insecure Texans, says Feeding Texas CEO Cynthia Cole. In this Q&A, Cole talks about how SNAP benefits are addressing a crucial social determinant of health for many Texans, which demographics rely on them most, and the policies she wants to see to increase food security in the state.

Cole says state and federal support, like the $95 million the legislature recently allocated for food banks, has been key in supporting the food-insecure. She also highlighted “food Rx partnerships,” which she describes as partnerships between food banks and providers where providers screen new patients for food insecurity and direct them to a local food bank if needed.


2.THA responds to Abbott’s vaccine mandate ban

Texas hospitals are voicing strong opposition to Gov. Abbott’s recent ban on vaccine mandates for any entity. Carrie Kroll, VP of advocacy, quality, and health policy at THA, said Abbott’s “one-size-fits-all” approach to restricting these mandates shouldn’t apply to hospitals because they are different from ordinary businesses and need to prioritize the health of their patients.

“COVID-19 is not unlike the flu, which [some of] our hospitals have long chosen to have mandates in place [for]. It’s just that additional layer that hospitals can take in creating more safety for the patients,” Kroll said. She added that THA will continue its legislative advocacy to safeguard hospitals’ ability to make their own decisions about vaccination requirements.


3. Rural provider shortage, lack of insurance are key drivers of youth mental health crisis

A scarcity of behavioral health services in Texas’s rural counties is fueling the state’s worsening youth behavioral health crisis, according to Taylor Counseling Group Founder Dr. Christopher Taylor. He said the expansion of telehealth services throughout the state has helped alleviate the issue but most therapists and psychiatrists still choose to practice in large urban areas like Dallas and Houston.

Taylor said one of the main challenges to bolstering this workforce is the multi-year certification process for providing behavioral health services, saying “it takes a long time to bulk up that population.” He also highlighted how some providers’ refusal to take insurance exacerbates the issue: “… many therapists choose not to [take insurance] … So they have private practice rates … and for many people that’s not affordable.”


4. Proposition 6 and SB 25: Who makes assisted living visitation rules?

Texans’ approval of Proposition 6 during last week’s elections means the state now has a constitutional amendment guaranteeing the right to an essential caregiver in assisted living facilities. Carmen Tilton, VP of public policy at the Texas Assisted Living Association, said this amendment could create confusion around visitation rules because it’s inconsistent with previously passed legislation.

Tilton worked with lawmakers during this year’s regular session to pass SB 25, which puts this right to visitation into statute. While SB 25 gives HHSC the authority to change visitation rules in the event of future COVID surges, the new amendment delegates that authority to the legislature. “The concern is that it could create a situation where the ballot proposition overrides the nuance that was crafted in [SB 25],” said Tilton.


5. The health-related provisions of the revised BBB plan

With the release of President Biden’s scaled back “Build Back Better” plan last week, State of Reform columnist James Capretta broke down some of the health policy items that made their way into the president’s updated domestic agenda. He emphasized that more health-related items could be added to the plan in the near future as negotiations continue at the capitol.

The revised BBB plan includes Medicare coverage for hearing services and a permanent 6% FMAP increase for states offering HCBS. It also provides fully subsidized ACA marketplace coverage for individuals in the coverage gap from 2022-2025, dropping its previous provision of offering fully federalized Medicaid coverage to these individuals starting in 2025 over concerns that it was unfair to states that have expanded Medicaid and thus bear 10% of expansion costs. Read Capretta’s full analysis here.