The 88th Texas Legislature adjourned its regular session on May 29th with the passage of several key healthcare reforms that address access to maternal, reproductive, and behavioral healthcare.
The FY 2024-2025 state budget increased funding for health and human services from the previous biennium by 17.3% to $102 billion in total funds, much of which will go to expanding access to these services.
In an interview with State of Reform, Sen. Charles Perry (R – Lubbock), vice chair of the Senate Health and Human Services Committee, spoke to the progress made in healthcare policy making.
“A lot of money went into healthcare this session,” Perry said. “We spent $81 billion in our Texas Medicaid program—$75 billion to support the Medicaid caseloads, [and] $2 billion of it was to increase our attendant care wages from $8.60 to $11, roughly.
We need to [add] another $2 billion on that probably next session to get them up to that $15 range so that we can have competitive attendant care wages that honestly keep about 300,000 people out of our nursing homes. From an investment [standpoint] … that makes more sense—is keeping those [individuals] in the least restrictive environment possible.”
Behavioral health
There was a renewed focus on mental health and school safety this session in the aftermath of the tragedy in Uvalde last year. Gov. Greg Abbott prioritized behavioral health access as one of the state’s “emergency” items at the start of this year’s session.
The state will spend some $12 billion in total funds over the next budget cycle on mental and behavioral healthcare, including $5.8 billion for ongoing treatment programs, $2.7 billion to build or renovate state mental health hospitals and community facilities, and $1.4 billion to support community mental health services.
An additional $221 million will be devoted to community mental health services for children across the state.
House Bill 3 will require an armed safety guard to be stationed at all public schools. The Texas Education Agency will administer $1.1 billion in grants to school districts—$15,000 per campus and $10 per student—to meet this mandate and support mental health first aid training for school district employees.
Rep. Donna Howard (D – Austin) was critical of this bill, saying the funding was insufficient and misdirected.
“[Funding] was nowhere near covering the expenses that the schools need,” Howard told State of Reform. “For one thing, [HB 3] also mandates that all campuses have an armed security officer. Here in Austin, we have 116 campuses—82 do not have that. So with the small amount of money [each school and student are] going to get, they’re not going to be able to meet the mandate. [Schools are] going to have to use other funds, much less address the mental health needs of students.”
Howard introduced HB 882, which proposed increasing the amount of money schools receive per student from $6,160 to $7,075 to account for inflation and support teacher salaries, but the proposal died in committee.
The state’s opioid crisis also prompted legislative action as lawmakers approved $18 million for opioid overdose reversal medication, as well as substance use disorder treatment and education. The state will have more funds to make overdose-reversing drugs like naloxone more widely available for first responders and educators.
A bill sponsored by Perry, Senate Bill 1677, which builds upon previous legislative efforts to expand behavioral health centers as a means to divert individuals from the criminal justice system to inpatient mental healthcare, awaits approval from the governor.
“Basically, if [individuals] are in the criminal justice system, we get them competent to stand trial,” Perry explained. “If they’re never going to make competency, then they have the next level of care—[placement] into an institutional-type setting typically.
So that’s an important piece just from what’s right and helping those people that need it to get to that point, if they’re never going to be competent to stand trial.”
The state will also administer $83 million in community mental health grants and invest $2.3 billion in rural behavioral health initiatives that build mental health hospital bed capacity in critical areas.
SB 26 will establish a local mental health authority to conduct audits and report on state-funded programs and services related to behavioral health with the intention of improving their transparency and quality.
The approval of the measure would pave the way for innovation grants that support residency training, retention, and recruitment programs in behavioral health fields and reduce juvenile justice involvement and preventable emergency room visits.
Maternal and reproductive health
In 2021, the Texas Legislature passed a measure to extend Medicaid postpartum coverage to mothers from two to six months, but the Health and Humans Services Commission’s (HHSC) 1115 waiver request for that extension remains under review by CMS.
Reporting has indicated that the application’s language around coverage for miscarriages may be the reason for the approval delay.
After the Texas Maternal Mortality and Morbidity Review Committee’s (TMMMRC) report on maternal morbidity showed rates in Texas had increased, the legislature followed its outlined recommendations by advancing a state plan amendment that extends Medicaid postpartum coverage for new moms from two to 12 months.
The report revealed the severe maternal morbidity rate was disproportionately higher for Black women than other racial groups at 117.3 deaths per 10,000 hospital deliveries—more than double the rate for white women (56.3 deaths per 10,000 deliveries).
The Texas health system initiated AIM patient safety bundles in 2018 to address obstetric hemorrhage. Data showed that the protocols decreased rates of hemorrhage-related deaths among all racial demographic groups with the exception of Black women, who experienced an increase.
TMMMRC and the Department of State Health Services made a joint recommendation, calling on lawmakers to address maternal health equity in response to the data.
While the legislation still needs approval from the governor and federal government to take effect, sponsors of HB 12 described the bill’s passage as a big win for maternal health.
Rep. Shawn Thierry (D – Houston) told State of Reform she expects the governor to sign the bill this Friday.
“If you just think about it from a historical context, just a few sessions ago mothers on Medicaid were literally kicked off their coverage within 60 days of giving birth,” Thierry said. “We know that most women haven’t even had the chance to really get settled in and to know whether they need additional healthcare services.
We also know that the majority of the complications can extend from 60 days to one year, which is the true definition of a maternal mortality. So to now have that coverage go for a full year is huge because that will give women on Medicaid—Black moms who are already having a huge disparity in maternal health outcomes—that will just give them and us the longevity [and] continuity of care.”
Another of Thierry’s bills concerning maternal health, HB 465, proposed the establishment of a medical assistance pilot program to cover doula services under Medicaid by the fall of 2024. Thierry expressed disappointment in the measure’s failure to advance out of a Senate committee but affirmed she will continue to fight for Medicaid doula coverage.
“[HB 465] does have the big ‘M-word’, which is Medicaid, but it wasn’t Medicaid expansion because it simply was covering women that were already enrolled in the program and just providing that point of access to assisted care,” Thierry said. “It’s a lot harder though when you work in the opposite chamber, to get folks to truly understand the breadth and the scope of a bill and you sometimes run out of time, the way bills move from the House to the Senate.
But I do intend to work in the interim with leadership on both sides … to further explain the bill and the positive impact that it would have on improving maternal care outcomes. I always tell people that you can’t have healthy babies without healthy moms. And so I’ll continue to have those conversations.”
Meanwhile, efforts to establish an Office of Health Equity and a Women’s Health Advisory Committee (WHAC) failed this session. Howard, who helped lead those efforts, said work on women’s health will remain her focus in the interim.
“[WHAC] was extremely valuable when it did exist because you had people who were actually on the ground delivering services able to meet regularly with the agency to talk about what was working and what wasn’t working—to be more nimble [about] how we addressed the needs,” Howard said. “What we did last interim is we brought together stakeholders and met with them as a group and then invited the agency staff to come in and meet with them.
It was a very fruitful meeting in terms of clarification of some things that were going on. So even if we don’t have an official continuation of that advisory committee, we can still call together the stakeholders, which I assume we will try to do more often this time over the interim to ensure that some of these things that we put in place are going forward as they need to be.”
As a member of the House Appropriations Committee, Howard helped secure $447 million in funding for women’s health programs, an increase of $160.1 million over current spending for the continuation of programs like Healthy Texas Women Plus and family planning.
Another piece of legislation to emerge from the session is HB 3058, which creates legal protections for medical providers caring for pregnant patients, under the specific circumstances of “ectopic pregnancy” and “previable premature rupture of membranes.”
Texas’s Alternatives to Abortion (A2A) program will receive $140 million over the 2024-2025 biennium, a 40% percent increase from the current cycle.
Joe Pojman, PhD, executive director for the Texas Alliance for Life, told State of Reform the organization was pleased with the expanded support for the program, saying the passage of SB 24 will ensure its continuation now as the Thriving Texas Families (TTF) program.
“Now the [A2A] program is going to be [on a] statutory basis,” Pojman said. “The executive commissioner of HHSC will promulgate rules for a variety of things like outcome measures for how well the contractors are performing—according to what the department sees. It also more closely links [TTF] with other programs that the state has so it’s easier for those clients to access them. It’s more natural for the providers to link and refer the clients to [the Medicaid program].”
A2A served over 113,000 women in FY 2022 with a range of services, including maternity care, housing, education, and material goods. SB 24 will improve the transparency and metrics around the program and give faith-based groups the opportunity to play a larger role in supporting women, according to Perry.
“Our focus this time was to expand those wraparound support networks for those moms,” Perry said. “Especially [the] first year through [age] three. We’ve got [early childhood intervention services] for those Pre-K kids … We have young moms that honestly came out of an environment that didn’t know what moms were supposed to be like. So all of that is going to make us a better society down the road [and] gives those kids a fighting chance.”
Lawmakers approved $80.8 billion for Medicaid across related state agencies, including more than $2 billion to raise wages and promote community health workers, private duty nursing, and pediatric and ambulatory services.
One reform that will be critical to supporting both maternal and behavioral health services is SB 74. Speaking to State of Reform about his bill, Sen. Nathan Johnson (D – Dallas) said the measure will promote the utilization of community health workers under Medicaid managed care organizations (MCOs).
“SB 74 has to do with the way that MCOs are able to classify the expenses of having community health outreach,” Johnson said. “We have an underutilization of the Medicaid system because people don’t understand it. And that actually can apply to the healthcare system in general. [SB 74 is] going to provide greater financial incentives for the MCOs to employ more community health workers.”