Is Medicaid for Postpartum Moms Still Happening? Most Likely.

Federal agency has a track record of long delays answering Texas’ requests


The state is aiming for implementation March 1 (image via Getty Images)

In a state with one of the highest numbers of pregnancy-related deaths in the nation and extremely restricted access to legal abortions, free health care for postpartum moms is finally coming down the pike.

Texas is one of only eight states that have not yet adopted Medicaid coverage for moms 12 months postpartum, a Centers for Medicare & Medicaid Services spokesperson told the Chronicle. State legislators sought to remedy that when they passed House Bill 12 with broad bipartisan support in 2023.

The law took effect Sept. 1, but four months later, coverage still isn't available. Why? Mostly red tape. Between the necessary paperwork, federal approval process, and an implementation to-do list, Texas Health and Human Services is working to implement the new coverage by March 1. It seems we're on track for that timeline to play out, but we're waiting on approval from a federal agency that has a track record of long delays answering Texas' requests. There is also a remote possibility that moms will never receive that coverage, if the federal government nixes the state's plan.

We’re waiting on approval from a federal agency that has a track record of long delays answering Texas’ requests.

To expand Medicaid access, Texas needs approval from the federal agency in charge of Medicaid, CMS. "Addressing the United States' maternity care crisis is a key priority for the Biden-Harris Administration," a CMS spokesperson told the Chronicle. They've approved postpartum extensions in most states.

But when Texas tried to implement six months of postpartum Medicaid coverage three years ago, the state moved slowly and the federal government went silent. Most states that have implemented this Medicaid extension have done so in two ways; the state of Texas has now tried one and moved on to Plan B. The first way to extend Medicaid to moms is through an alteration to the state's 1115 waiver, which gives federal authority for special state Medicaid care programs. In 2021, the Legislature passed a bill meant to do that. Eight months later, the state submitted a request to CMS to amend our waiver, and it's been under review for nearly two years. When asked why CMS neither denied nor approved that request, a CMS spokesperson told the Chronicle that CMS "does not comment on current reviews, nor can it speculate on potential dispositions."

So, the state's trying a different approach, having submitted a kind of request (called a state plan amendment or SPA) that CMS will be required to approve or deny in 90 days. HHSC submitted two SPAs to CMS on Oct. 20: a Medicaid SPA and Children's Health Insurance Program SPA. That means CMS will need to approve or deny the state's application this month. An HHSC spokesperson told us the state agency "is in regular communication with CMS regarding the SPAs."

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