HHSC implementing additional services for pregnant Texans


Maddie McCarthy


The Texas Health and Human Services Commission (HHSC) is moving forward in its process to implement additional services for pregnant Texans. 

House Bill 1575, which passed in the legislature in 2023, directed HHSC to create a set of screening questions for non-medical drivers of health, and to add community health workers (CHWs) and doulas as new Medicaid provider types. The bill is meant to improve health outcomes for pregnant Texans and their children.

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Joelle Jung, project manager of delivery system quality and innovation for Medicaid and Children’s Health Insurance Program Services at HHSC, discussed implementation work at a HHSC Value-Based Payment and Quality Improvement Advisory Committee meeting in May.

“HHSC was directed by this bill to determine a standardized set of screening questions for non-medical needs so all managed care organizations (MCOs)—as well as any Thriving Texas Families [formerly the Alternatives to Abortion Program] provider organizations—would need to screen pregnant women for certain non-medical needs, and then use those screening results to coordinate any services,” Jung said. “[MCOs will] also share all of that data with HHSC.”

In order to create the screening questions, HHSC researched questions other agencies in the industry use in their screening processes, and received input from stakeholders. Jung said the final set of screening questions is now complete and MCOs have had the opportunity to comment on them.

“The non-medical needs that will be identified through the standardized screening will be food needs, transportation needs, housing needs—and the housing questions are inclusive of both a question on the living situation, as well as a question on certain quality needs. So that’s inclusive of problems paying for utilities, problems with utilities, mold, lead, [and] missing smoke detectors. [There is] also a question on childcare needs.”

— Jung

If the screening produces a positive result, the patient will be asked if they would like help with that need, Jung said. Members are also able to select “decline to answer” in response to any question they are asked, and all patients must provide informed consent before they are screened.

Now that the screening questions are set, Jung said HHSC is implementing them into MCO contract amendments. The questions will appear in the MCOs’ Uniform Managed Care Manual, and other bill requirements—such as reporting requirements—will be outlined in the Uniform Managed Care Contract. MCOs will officially begin the screenings on Sept. 1.

Another major provision of HB 1575 adds CHWs and doulas as new Medicaid provider types, which is specific to case management services under the Children and Pregnant Women program, Jung said. HHSC has been working with the Department of State Health Services and stakeholders to implement doula credentialing criteria, she added.

“They are working on HHSC provider training to be conducted this summer, as well as working on all of the system changes needed to the provider enrollment management system so enrollment of these new CHWs and doulas as Medicaid providers could begin in fall 2024,” Jung said. 

The bill also requires HHSC to submit a legislative report every even-numbered year. The first report is due on Dec. 1. These reports will include analyses on quality outcomes.

Texas’ MCOs were asked if they would like to pilot the screening questions before the official implementation date in order to collect data for the first required report, Jung said.

“There are 10 MCOs that were interested in participating in our pilot,” she said.

The kickoff meeting for the pilot was on May 29.

Jung said MCOs will collect data on service coordination as a result of the screening questions identifying patient needs. For example, they will report when a person is referred to a food bank if that was identified as a need. MCOs will not collect data on the outcomes of service coordination.

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