Texas health agency says its plan to extend maternal Medicaid coverage is 'not approvable' by feds

HHSC said it was initially told the plan was “not approvable.” Federal Centers for Medicare and Medicaid Services issued a statement Friday saying Texas’ plan to extend coverage to six months was not rejected but still under review.

click to enlarge A midwife cares for a newborn baby in 2018. - Texas Tribune / Natalia Ojewska
Texas Tribune / Natalia Ojewska
A midwife cares for a newborn baby in 2018.
Texas’ application to extend Medicaid coverage for new mothers from two months to six months is not going to be approved by the federal government in its current form, according to the Texas Health and Human Services Commission. The federal Centers for Medicare and Medicaid Services said in a statement Friday that the application is still under review.

Legislators who pushed for the extension say they believe the application was not approved because of language that could be construed to exclude pregnant women who have abortions, including medically necessary abortions. The language in the bill that passed during the 2021 legislative session extended coverage to pregnant women who deliver a baby or have an “involuntary miscarriage.”

“That’s not a medical term, involuntary miscarriage,” said Rep. Donna Howard, D-Austin, a nurse and former health educator. “What I’m concerned about, and I think what maybe was the concern here, is those people who wanted their pregnancies to come to full term but have complications and a termination later in pregnancy and should be allowed to remain on Medicaid.”

Kelli Weldon, a spokesperson for the Texas Health and Human Services Commission, said CMS has verbally confirmed that Texas’ application is not approvable; HHSC officials have requested written confirmation. A spokesperson for CMS said the agency does not discuss ongoing conversations between the agency and states.

The stalled-out application process is a “self-inflicted wound,” Howard said. As part of the 2021 American Rescue Plan Act, the federal government eased the application requirements for states that expanded Medicaid for a full year postpartum.

The Texas House of Representatives overwhelmingly approved a bill that offered 12 months of coverage, but the Senate amended the legislation to six months instead. Because of that change, the state was required to go through the more onerous application process.

In a statement, Gov. Greg Abbott said the decision “risks the lives and health of Texas women and their babies all for the sake of a political agenda.” Abbott said President Joe Biden should “get ready for a fight with Texas” if his administration does not accept the state’s waiver.

House Speaker Dade Phelan, R-Beaumont, echoed this criticism.

“This is the latest hypocritical, disappointing move by the Biden administration that puts the care and needs of Texas mothers and babies at jeopardy — all in the name of partisan politics,” he said in a statement on Twitter.

Phelan indicated that he plans to once again push for a full year of postpartum Medicaid. State Rep. Toni Rose, D-Dallas, who filed the original bill last session, said she is optimistic about it passing both chambers next year.

“It was already my plan to work on adding the additional six months that we did not receive during the last legislative session,” Rose said. “But especially in light of today’s news and the Supreme Court decision to overturn Roe v. Wade, it’s never been more critical that our moms have access to comprehensive health care.”

Rose said she will also push to remove any language that may have resulted in issues with the application.

Texas is one of just 12 states that has not expanded Medicaid; as a result, Medicaid in Texas mostly serves low-income children. 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.

Expanding postpartum Medicaid to one year was one of the top recommendations of the state’s Maternal Mortality and Morbidity Review Committee. Howard said this is going to become only more pressing now that Texas has banned all abortions, except to save the life of a pregnant patient.

“Over half of births in Texas are Medicaid births already,” she said. “Women who have means will be able to access abortion by traveling, and those with more limited means will have more barriers, so logically, that means an increase in Medicaid births.”

Right now, due to the ongoing federally declared Public Health Emergency, no one is being moved off of the Medicaid rolls, even after their eligibility expires. That state of emergency is set to expire this fall, though the federal government has extended it many times already.

“We are hopeful CMS will work with us toward approval before the end of the Public Health Emergency to ensure women in Texas Medicaid continue to receive postpartum care,” Weldon said in an emailed statement.

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