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Texas post-partum Medicaid extension remains uncertain

On Behalf of | Sep 5, 2023 | Medicare Reimbursements

Texas has one of the highest mortality rates in the nation for new mothers. House Bill 12, a bipartisan effort passed by Republicans and Democrats expanding Medicaid coverage for new mothers to 12 months postpartum, was supposed to take effect September 1, but it appears its benefits won’t be available for access for at least seven months and may never be put into effect.

What is the reason for the delay?

The answer is simple yet complex: bureaucracy. Texas is one of 10 states that has opted out of Medicaid expansion. Under Medicare and Medicaid law, this means that Texas must obtain federal funding through the 1115 Medicaid waiver to cover limited populations that are especially vulnerable. Under the previous Texas legislature, lawmakers passed a similar law that extended benefits to new moms for six months that was never implemented. Securing the funding is complicated, as the six-month extension is still possible, yet the federal agency responsible for it has never signed off on the funding.

However, Texas is taking a different approach this time by submitting a state plan amendment that CMS, the agency overseeing Medicare and Medicaid, will need to approve or deny in 90 days. CMS can also reject the plan, but if approved, the project implementation won’t occur until March 2024.

Doctors once again in the middle

The uncertainty over when and if extended postpartum care will begin for Medicaid mothers again puts Texas doctors in the middle. Practices that continue to provide postpartum care beyond two months risk not receiving CMS payments for services rendered.

However, more complications can arise if healthcare providers do not extend care to new mothers with serious health problems. High mortality rates have the potential to continue if these women do not receive necessary treatment.