Texas Senate committee approves 12-month postpartum Medicaid coverage bill

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A Senate committee approved a bill Thursday that would allow pregnant Texans to remain on Medicaid for 12 months after they give birth. The bill has already cleared the House, so the next step, if the chamber chooses, is to send it to the Senate floor for a vote.

Texas currently offers low-income mothers Medicaid coverage for two months after pregnancy. Last session, the House voted to extend that to 12 months, but the Senate reduced it to six months.

The bill is expected to gain more traction in the Senate this year after the U.S. Supreme Court overturned Roe v. Wade and state lawmakers approved a near-total ban on abortion in Texas. A bipartisan coalition of lawmakers and advocacy groups across the ideological spectrum have supported the bill, although at least one key anti-abortion group has pulled its support in recent weeks.

Brenham Republican Sen. Lois Kolkhorst, chair of the Senate Committee on Health and Human Services, sponsored the bill in the Senate.

“You cannot raise a child without being healthy,” she said in a Senate committee hearing Tuesday. The bill ensures “women who give birth to children in this pro-life environment are cared for and make sure their children are cared for as well.”

The bill comes at a key moment, as the federal COVID-19 public health emergency comes to an end. The Texas Health and Human Services Commission is beginning the process of recertifying Medicaid eligibility and moving Texans off the program for the first time in three years.

“In talking to women that have had this extended coverage … it’s the first time in their life they’ve had any meaningful health coverage for any period of time,” Diana Forester, director of health policy for Texans Care for Children, said at the hearing. “That’s what this legislation is all about. It’s about saving moms and empowering families.”

The bill represented a rare show of political unity around an often fraught issue in Texas, which is one of just 12 states that has not expanded Medicaid under the Affordable Care Act, leaving about 1 in 5 adults without health insurance. But many conservative groups backed this bill, noting repeatedly that it is an extension of coverage — not Medicaid expansion.

“Expansion, by definition, is the inclusion of groups that aren’t currently eligible,” said David Balat, the health policy director at the right-leaning Texas Public Policy Foundation. “And that’s just not the case here. … We need to focus on fixing the program for those for whom it was intended, so that’s really why this has been a priority.”

The bill even united anti-abortion and abortion access groups — briefly. But now, Texas Right to Life has revoked its support of the bill, due to generic language echoing federal Medicaid regulations that could potentially allow someone to access health insurance after an abortion.

The bill says the 12-month coverage period begins on the last day of pregnancy; it does not specify how that pregnancy has to end.

“The way that House Bill 12 passed the Texas House, it would allow for a woman to have an elective abortion in another state or to have an illegal abortion in Texas and then to qualify for that year of medical coverage,” Texas Right to Life President John Seago told The Texas Tribune. “That is unacceptable. I think that is an absolutely dangerous policy.”

Seago presented the House committee with an amendment that would exempt people who have had abortions from receiving Medicaid coverage, but the chamber did not adopt it.

Such an amendment would likely doom Texas’ effort to fast-track the approval of its extension through the federal system. Last session’s proposal to extend Medicaid coverage for six months was deemed “not approvable” by the Centers for Medicare and Medicaid because it included only women who deliver a baby or have an “involuntary miscarriage.”

Texas Right to Life raised a similar argument in the Senate committee hearing, but the committee did not amend the bill. Seago called it a “political tragedy” to allow the bill to pass in its current form.

But many who testified urged the committee to pass a “clean bill” — sans amendments — to ensure Texas can quickly get the extension approved and ensure new parents can remain insured for up to a year.

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