Texas DSHS prioritizes healthcare access in rural border communities in policy recommendations to 2023 legislature


Boram Kim


The Texas Department of State Health Services (DSHS) released its 5-year plan on healthcare services for executive and legislative consideration last month, which focused one of its many recommendations on improving healthcare access in rural border counties. 


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The Statewide Health Coordinating Council (SHCC) focused on factors that affect health equity in Texas and recommended reforms to address rural access, Medicaid enrollment, youth mental health support, and telehealth services. 

“Access to quality health services was identified as the top priority in rural health over the last decade,” read the State Health Plan (SHP). “Types of access that were identified as the most concerning include emergency services, primary care, and insurance. Since 2010, 26 rural hospitals have closed in Texas. Hospital closures in rural areas negatively impact access to care and potentially health outcomes as well. Hospital closures lead to loss of access to emergency care, making emergency medical transport even more important.

For patients that rely on hospitals for specialty care or referrals, they lose that access as well. In particular, communities often lose access to obstetric care, mental health care, and diagnostic testing when hospitals close. Communities that lose hospitals have a difficult time recruiting employers and industries to the area.”

Border regions are predominantly Hispanic (88.4%) compared to the rest of the state and had higher COVID incidence and mortality rates than urban areas due to poor health literacy and healthcare infrastructure.

According to SHP, border areas had a higher uninsured rate than non-border areas, 37.9% to 24.5% respectively, with women in border areas having the highest rates of being uninsured at 42%. The percentage of uninsured individuals was inversely proportional to socioeconomic status, meaning the uninsured rate got higher as income levels dropped. 

The majority of Texans (52%) at or below the federal poverty line (FPL) remain uninsured, with 854,340 of those being children. The Hispanic population had the highest uninsured rate among racial groups at 27.3% compared to white (10%) and Black (15%) populations. 

The plan outlined three broad strategies for improving access to health: improving insurance coverage rates across the state; increasing the number of healthcare professionals, facilities, and services; and a reduction in social barriers to care. 

It recommended policies that promote increased and improved engagement with Medicaid by members and eligible non-members, physicians, and providers, saying the shortage of providers in rural areas creates a need for policies that redefine and redistribute healthcare provisional roles to better meet demands.  

Rene Hurtado, Chief of Staff for Emergence Health Network [EHN], the Mental Health Authority for the border county of El Paso, said the past year continued to pose challenges in caring for the community. 

“Coming back to transitioning as we continue to do in this whole process, back when we first started [during the pandemic], we switched from seeing 10% of our patient population remotely to seeing 90% of patients remotely in just a week or two, to now reverting back,” Hurtado said. “We have certain folks who enjoy telemedicine and we’re going to continue on that route and the folks who are anxious to come back and see their provider in person.

Moving across that COVID-19 continuum from a service delivery angle has been a challenge. I think Emergence, like almost every other organization in the country, has human resource challenges in regards to recruiting personnel, specifically licensed clinical personnel. Personnel has always been an underserved area in that respect, the pandemic and then the changes in the labor market really did not change that [for our region].”

EHN has been working with school districts to train staff and students on mental health first aid (MHFA). Hurtado says that while the organization has made significant inroads on mental health education, it remains far from blanket coverage for the thousands of schools across the county’s nine school districts. 

The state’s current student-to-school counselor and psychologist ratios of 387.4 to 1 and 2,570.4 to 1, respectively, do not meet national optimum standards of 250 to 1 and 700 to 1. Senate Bill 245 will propose establishing mental health telehealth services in public schools in the next session. 

Expanding teleservices is another legislative priority for HHSC. The SHP advocates for additional support to organizations in promoting their telehealth services, efforts in training and infrastructure, and teleservices utilization through frameworks like the Statewide Health Information Exchange.

Of the 316,000 households without broadband internet in Texas, 89% were rural. Medicaid teleservices cost clients $502 less per month than in-person services, with overall spending increased due to greater utilization of services. 

EHN worked with the state delegation led by Sen. César Blanco (D – El Paso) and Representatives Eddie Morales (D – Eagle Pass) and Joe Moody (D – El Paso) on developing legislative priorities in the session that include support for the mental health workforce, broadband access, and services for people with intellectual and developmental disabilities (IDD). 

Hurtado is also looking to the next session for additional support for pre-arrest programs that divert individuals away from incarceration and provide behavioral health support to justice-involved patients both during and after their incarceration. He remains optimistic for funding to grow existing programs like the state’s Crisis Intervention Team, where licensed crisis responders work with law enforcement in the field, and Certified Community Behavioral Health Clinics

“We’re always optimistic that the legislature will be really mindful of the needs of individuals with behavioral health issues and are able to give us the resources to grow programming the way they need to be designed to help individuals,” Hurtado said. “We would love to be in more schools and we would love to extend more programming to teachers and families and all personnel on campuses. So looking forward to hopefully growth in children’s mental health and school-based services.”