Abbott Signed Medicaid for New Moms Into Law, but It Might Not Happen Anyway

Gears of bureaucracy turn slowly (and sometimes not at all)


Photo via Getty Images

Texas has a problem with dying mothers. Our maternal mortality rate is one of the highest in the nation. So in the first legislative session after the overturning of Roe v. Wade, Democrats and Republicans alike said it was time to show support for Texas moms.

Democrats wanted to increase abortion access in cases of rape and dangerous pregnancy complications. They also presented modest efforts to help Texans get contraceptives. Moderate Republicans expressed support for certain abortion ban exceptions, while far-right lawmakers schemed to block interstate travel for abortion care and to grant fetuses "personhood" – which would turn abortion into homicide and miscarriage into manslaughter. All those efforts were fruitless.

What did pass with broad bipartisan support was House Bill 12, an extension to Medicaid coverage for moms 12 months postpartum. The House voted for it 134-9, with a round of applause led by bill sponsor Rep. Toni Rose, D-Dallas.

Even though the law takes effect Sept. 1, coverage won’t be accessible for new moms for about seven months, thanks to gunk in the bureaucratic gears.

Even though the law takes effect Sept. 1, coverage won't be accessible for new moms for about seven months, thanks to gunk in the bureaucratic gears. And there's a remote possibility that moms will never receive that coverage. In fact, last session the Legislature passed a similar law to expand Medicaid to moms six months postpartum and it was never implemented.

Why? Because Texas is one of 10 states that opted out of Medicaid expansion, we rely on federal funding through the 1115 Medicaid waiver to cover limited, especially-vulnerable populations. But securing that funding is a complicated mess. The state tried to fund the previously passed six months' coverage by altering its 1115 waiver agreement, but the federal agency that needed to sign off never did. The request for six months for new moms is still out there, neither approved nor denied by the Centers for Medicare & Medicaid Services.

So this time, the state is taking a different approach, submitting a kind of request (called a state plan amendment) that CMS will be required to approve or deny in 90 days. The problem is, Texas Health and Human Services hasn't submitted that amendment yet. Once they do and it's approved, it'll take another few months to iron out tech wrinkles presented by insuring thousands more Texans. The projected implementation date is March 1, 2024.

It's also possible CMS won't approve the amendment at all. But this time, at least, they'll be required to make a decision in a timely manner, and if they reject it they'll have to explain why.

So, that's anticlimactic. While we wait for those gears to turn, will new moms in Texas get to enjoy other benefits thanks to the bipartisan desire to support them post-Roe? Maybe financial support for child care, parental leave, or better access to contraception? Minimally, sort of. Gov. Greg Abbott did sign Senate Bill 379, which eliminates sales tax on diapers, wipes, baby bottles, maternity clothing, breast pumps, and feminine hygiene products. That bill was authored by Austin Rep. Donna Howard – chairwoman of the Texas Women's Health Caucus – though most of her bills aimed at protecting mothers' health died in committee.

"We left this session thinking, 'Okay, yay, clap our hands, we've got postpartum care,'" Howard said. "But in reality, some of these moms are going to be kicked off Medicaid in two months. It's awful. … We thought we passed something in 2021 that was going to help moms but it didn't. If not for the public health emergency that kept these women on Medicaid through the emergency, who knows how many more of them would be dead."

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