Children’s Defense Fund-Texas Testimony in Support of HB133 THTQIP Waiver

Adrienne Lloyd, Senior Health Policy Associate
June 9, 2022

Good morning my name is Adrienne Lloyd and I am a Senior Health Policy Associate at the Children’s Defense Fund-Texas. I appreciate the opportunity to comment on the Texas Health and Human Services Commission’s (HHSC) planned amendment to the Texas Healthcare Transformation and Quality Improvement Program (THTQIP) waiver to extend Medicaid eligibility for eligible pregnant people for a total of six months postpartum.

We strongly support the THTQIP waiver amendment because we know that unsafe gaps in health insurance coverage, especially for new moms receiving Medicaid, contribute to poor health outcomes for moms and babies. These poor outcomes during the perinatal period also disproportionately harm families of color.

Because Texas has income eligibility cut-offs for Medicaid recipients that are more strict than any other state in the country, only a fraction of Texas moms—those who are not earning enough money to get by—will be eligible for Texas Medicaid as its implementation currently stands. This means that, once the PHE ends, the vast majority of Texas Medicaid moms will become uninsured just two short months after pregnancy unless the THTQIP waiver, or related postpartum coverage option, is implemented.

More tangibly, this means that in Texas, a single mom with two children would have to earn less than $326 per month to be eligible for the state’s regular Medicaid program. In context, the cost of diapers for a newborn cost $81 per month alone, not to mention food, rent, and childcare costs. We urge the Texas Legislature and HSSC to create pathways for postpartum coverage that do not leave most Texas moms–specifically those earning less than 100% of the FPL– uninsured during a critical time for their newborns’ growth and development and a time when moms are most vulnerable to postpartum morbidity and mortality.

Texas’ Maternal Mortality and Morbidity Review Committee found that nine out of ten pregnancy-related deaths were preventable, and one-third of these maternal deaths occurred 43 days to one year after pregnancy. Not only do these largely avoidable events inflict tragedy among families and long-term health issues for both mothers and their children, but it also places high financial strain on our state’s Medicaid program and roader health system. A recent Mathematica study found that failing to treat maternal mental health conditions costs Texas $2.2 billion for one year of births due to productivity losses, child and behavioral and developmental disorders, and maternal health expenditures.

Access to health insurance for moms is key for addressing these challenges. We also know that when parents are insured and access coverage, their children are more likely to be insured in programs they are eligible for and receive critical health services.

We commend HHSC for developing this amendment to the THTQIP 1115 waiver and we agree that extending postpartum coverage will have long-term benefits of improving continuity of care across the life cycle.

We urge the Texas Legislature and HHSC to continue exploring options for extending postpartum Medicaid coverage to a full year after pregnancy. Regardless of the outcome of the THTQIP waiver amendment, it is our hope that the Texas Legislature and HHSC will continue exploring options to extend Medicaid coverage for new mothers to one year postpartum, as recommended by Texas’ Maternal Mortality & Morbidity Review Committee and as proposed by most states.